Browsing by Subject "Change"

This dissertation explores the complex process of organizational change, applying a behavioral lens to understand change in processes, products, and search behaviors. Chapter 1 examines new practice adoption, exploring factors that predict the extent to which routines are adopted “as designed” within the organization. Using medical record data obtained from the hospital’s Electronic Health Record (EHR) system I develop a novel measure of the “gap” between routine “as designed” and routine “as realized.” I link this to a survey administered to the hospital’s professional staff following the adoption of a new EHR system and find that beliefs about the expected impact of the change shape fidelity of the adopted practice to its design. This relationship is more pronounced in care units with experienced professionals and less pronounced when the care unit includes departmental leadership. This research offers new insights into the determinants of routine change in organizations, in particular suggesting the beliefs held by rank-and-file members of an organization are critical in new routine adoption. Chapter 2 explores changes to products, specifically examining culling behaviors in the mobile device industry. Using a panel of quarterly mobile device sales in Germany from 2004-2009, this chapter suggests that the organization’s response to performance feedback is conditional upon the degree to which decisions are centralized. While much of the research on product exit has pointed to economic drivers or prior experience, these central finding of this chapter—that performance below aspirations decreases the rate of phase-out—suggests that firms seek local solutions when doing poorly, which is consistent with behavioral explanations of organizational action. Chapter 3 uses a novel text analysis approach to examine how the allocation of attention within organizational subunits shapes adaptation in the form of search behaviors in Motorola from 1974-1997. It develops a theory that links organizational attention to search, and the results suggest a trade-off between both attentional specialization and coupling on search scope and depth. Specifically, specialized unit attention to a more narrow set of problems increases search scope but reduces search depth; increased attentional coupling also increases search scope at the cost of depth. This novel approach and these findings help clarify extant research on the behavioral outcomes of attention allocation, which have offered mixed results.

Ligand binding can modulate function of proteins and nucleic acids by changing both the populations of functionally distinct conformational states and the timescales on which they interconvert. For this reason, both thermodynamic and kinetic details of coupling can be important to proper function. How tightly does ligand bind to the different conformational states? What effect does ligand binding have on the conformational equilibrium and conformational kinetics? On what timescales and in what order do binding and conformational change occur? Using a combination of stopped-flow kinetics, isothermal titration calorimetry, and x-ray crystallography, we determine the mechanisms of coupled binding and conformational change in protein (Bacillus subtilis RNase P protein) and RNA (DP17 biosensor) systems.

The results demonstrate that rigorous kinetic analysis can be used to estimate the equilibrium and rate constants for conformational changes, as well as the affinities of ligands for different conformational states. A single ligand can bind to different conformational states of the same protein or nucleic acid with affinities that differ by orders of magnitude. This binding shifts the conformational equilibrium towards the higher affinity state through a combination of increasing rate constants for the forward conformational change and decreasing rate constants for the reverse conformational change. Using a flux-based analysis of the mechanisms we show that molecular recognition is kinetically partitioned between a number of pathways that differ by the order in which binding and conformational change occur. The absolute and relative flux through these pathways varies with ligand concentration, the affinities of the ligand for the various conformational states, and the ability of ligand to accelerate the conformational change. Together, the results give insights into how biological function depends on the kinetic and thermodynamic details of coupled binding and conformational change.

Background: Hospital adoption of health information technology (HIT) systems is promoted as essential to decreasing medical error and their associated 44,000 annual deaths and $17 billion in healthcare costs (Institute of Medicine, 2001; Kohn, Corrigan, & Donaldson, 1999). Leading national healthcare groups, such as the Institute of Medicine, Agency for Healthcare Research and Quality, Institute for Healthcare Improvement, and the Leap Frog Group continue to advocate for increased use of HIT (AHRQ, 2010; Beidler, 2010; Institute of Medicine, 2001; Page, 2003; The Leapfrog Group, 2009), such as provider order entry and electronic health record systems, as a way to improve healthcare quality in hospitals. Even under intense pressure to adopt HIT, however, a mere 2% of US hospitals report having a comprehensive electronic health record system. Further, more than 50% of US hospitals have only rudimentary HIT systems (Jha et al., 2009). With the ARRA HITECH Act of 2009, the pressure on hospitals to quickly adopt HIT and achieve meaningful use is mounting.

While a large body of literature exists about HIT implementation, the majority is anecdotal case reports. The remaining studies investigated attitudes about HIT or the impact of HIT on patient care processes and outcomes. Thus, best strategies for implementing HIT in hospitals remain unknown. Study design choices, such as the use of self report data, retrospective data collection methods, subjects from single care units or single healthcare professions further limit our understanding HIT implementation in complex hospital care settings.

Methods: This prospective, longitutdinal case study used a novel approach, sensemaking, to understanding how project teams may work to implement HIT in an academic medical center. Sensemaking, defined as the social process of establishing the meaning of events and experiences (Weick, 1995), is associated with learning and problemsolving in research studies of healthcare and nonhealthcare settings. Through direct observation and document review I observed project team social interaction and activities over the course of the 18 month preimplementation phase of an HIT implementation project in a single tertiary care hopsital.

Conclusions: In this study, I described team actions and activities that enhanced clinician team member sensemaking including: frequent, collective interaction with HIT and focusing team members' attention on specific aspects of HIT function. Further, study findings demonstrated that team members' perceptions of HIT and care processes varied across healthcare professions, management levels, and departments. Supportive social interaction from team leaders and members encouraged team member participation and resulted in members' voicing observations, perceptions and attitudes about the HIT and hospital care processes. Sensemaking of HIT teams not only resulted in identification of needed HIT design changes, but also revealed assumptions and information which may prove critical to successful HIT implementation in hospital care environments. Based on study findings, I suggested strategies for selecting and preparing HIT team members as well as for HIT team activities. This study advanced our understanding of how project teams function and bring about change in complex hospital care environments by not only identifying HIT implementation issues within but also describing the link between team member social interaction and implementation actions.

Three distinct chapters explore the individual-level dynamics of legitimacy judgments and support for leaders and their initiatives. Chapter 1 develops a theoretical framework for understanding the content of legitimacy judgments and the process by which those judgments develop and change over time. Chapter 2 explores the role of group orientation in moderating the impact of instrumental, relational, and moral concerns in determining support for leaders. Chapter 3 explores the role of power in moderating leaders' assumptions about the types of behaviors that will elicit support for followers.

In Chapter 1, I build on institutional, social psychological, and sociological theory to develop a theoretical framework that specifies both the content underlying judgments of the legitimacy of social entities and a model of the process by which these judgments develop and change over time. With respect to the content of legitimacy judgments, I argue that individual-level judgments of the legitimacy of social entities are based on perceptions and beliefs about the entity that fall along three key dimensions: instrumental, relational, and moral. With respect to the process by which legitimacy judgments develop and change over time, I specify three modes of the legitimacy judgment process (evaluative, passive, and socialization), and I explain which of these modes is likely to predominate as individuals move through the stages of the legitimacy judgment process. The model specifies the circumstances under which the legitimacy of existing institutions is likely to be either challenged or bolstered. I conclude by discussing the implications of this framework for advancing a more detailed understanding of the micro-level dynamics of critical areas of inquiry in organizational studies.

In Chapter 2, I present a series of three studies demonstrating that individuals' intrinsic or extrinsic orientation toward their group moderates their responsiveness to different types of behaviors and appeals, such that individuals who have an intrinsic orientation (such as high identifiers and individuals who feel a high level of group belongingness) are more responsive to moral behaviors and appeals, while individuals with an extrinsic orientation (such as low identifiers and individuals who feel a low level of group belongingness) are more responsive to instrumental behaviors and appeals.

In Chapter 3, four studies demonstrate that subjective feelings of social power impact leaders' assumptions about the bases of their legitimacy with followers, which in turn impacts leaders' decisions about what types of leadership behaviors and tactics to engage. Study 1 demonstrates that leaders who feel a high level of power within their group or organization perceive support from followers as stemming primarily from their instrumental rather than relational behaviors, while leaders who feel a low level of power perceive that the support they receive from followers stems primarily from their relational rather than instrumental behaviors. Study 2 is a vignette study in which individuals primed with high power report greater expectations of support in response to decisions made on instrumental rather than relational bases, while individuals primed with low power report greater expectations of support in response to decisions made on relational rather than on instrumental bases. Study 3 replicates this interaction and shows that the effect is mediated by leaders' assumptions about the types of behaviors that followers prefer. Study 4 demonstrates that leaders primed with power are more likely to engage in instrumental behaviors in their attempts to persuade followers, while individuals primed with low power are more likely to engage in relational behaviors in their attempts to persuade followers. Theoretical and practical implications are discussed.

Chapter 4 describes a final study that integrates the findings from Chapters 2 and 3. Specifically, Chapter 4 demonstrates that there is a positive effect of leader power on support for the leader among low, but not high, identifying groups. The findings further indicate that this effect is mediated by followers' perceptions of the leader's instrumental behaviors. Implications, limitations, and future directions of the research are discussed.

How do churches change? In the life of congregations, collective identity informs congregational practice which, in turn, informs collective identity, forming a reinforcing loop that artificially prevents congregations from making significant changes to their congregational practice. To change the practices would be to change the identity, and to change the identity would be to change the practices.This thesis explores the interaction of collective identity, congregational practice, and change. After a review of pertinent scholarship concerning organizational and congregational change, this study provides an in-depth analysis of three churches that have made significant changes to their congregational practice in the last decade. Employing a multiple case study methodology, the actions of these congregations are compared to one another and to existing change literature. In the end, these three congregations demonstrate how the effective use of engaging with their histories to re-story their present collective identities allowed them to meet these new changes in a way that fits with their identities. Rather than preventing them from making significant changes, the reinforcing loop of collective identity and congregational practice propelled them.