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Challenging Operations: Medical Reform and Resistance in Surgery, by Katherine C. Kellogg. Chicago, IL: University of Chicago Press, 2011. 230pp. $25.00 paper. ISBN: 9780226430034.
Some of the most important sociological analyses of authority relations in organizations have been done in medical settings (e.g., Coser 1958). The medical professions, perhaps more than any other professions, and hospitals, as much as any other type of organization, rely on the exercise of authority to get things done. Patient outcomes depend on doctors and nurses smoothly dividing complex and precise tasks among a team of professionals and then ensuring that those tasks are properly carried out. The decisionmaking authority and task structure of medical organizations have become firmly entrenched in a status hierarchy of doctors, residents, and nurses, which is itself buttressed by a complex system of formal and informal rules and legitimating accounts.
Katherine Kellogg's book, Challenging Operations: Medical Reform and Resistance in Surgery, looks at what happens when outside reform changes one those integral rules. The reform was a rule change that required hospitals to reduce the number of hours that surgical residents could work in a week. Before the reform, intern residents regularly worked 120 hours a week. Faced with increasing pressure from external groups that were distressed by the high rates of error associated with sleep-deprived residents, in 2003 the American Council for Graduate Medical Education instituted a new rule that residents could not work more than 80 hours per week. Although the rule change covered all hospitals...