Re-Contracting for the Implementation of Algorithmic Technology in Professional Work in a U.S. Academic Medical Center
Abstract: The use of decision-support algorithms to transform organizational work has increased dramatically with the increasing quantity of information and the development of more sophisticated technologies, but prior research on professions, work, and healthcare has shown that professionals may resist the implementation of such flexible technologies that threaten their expertise. This paper reports preliminary findings from a two-year ethnographic study of the introduction, in a U.S. hospital’s primary care department, of clinical decision-support algorithms built into the electronic medical record (EMR) system. I find that implementation of decision-support algorithms may fail not only because professionals resist the replacement of their hard-won expertise by the expertise encoded in evidence-based algorithms, but also because implementing such new technologies may require breaking the existing relational contract that exists between the organization and subordinate semiprofessionals. Many managerial practices require informal relational contracts rather than formal contracts enforced by courts because task assignment, promotion, and termination decisions often involve actions that cannot be fully specified in advance. My preliminary findings suggest that, when implementing flexible technologies results in the violation of existing relational contracts between the organization and subordinate semiprofessionals, in order for implementation to be successful, managers may need to meet with subordinate semiprofessionals offline in recontracting spaces to rebuild the clarity, credibility, and adaptability of the unwritten set of expectations of the employment relationship. These findings have implications for our understanding of how flexible technologies such as decision-support algorithms can be successfully implemented in professional organizations.
Biography: Katherine C. Kellogg is a Professor of Work and Organization Studies at MIT. She is the author of Challenging Operations: Medical Reform and Resistance in Surgery (University of Chicago Press, 2011, Winner of the Max Weber Award from the Organizations, Occupations, and Work section and the Sociology of Law Biannual Distinguished Book Award from the Law section of the American Sociological Association). Her papers have been published in the Administrative Science Quarterly, the American Journal of Sociology, the American Sociological Review, and Organization Science. Kellogg using comparative ethnographic methods to study change in professional work inside of organizations in response to emerging technologies, new regulations, and social movements.