Inhabited Decision-Making: Institutional Norms and Practical Concerns in High-Stakes Settings

• In Event: Organizations, Occupations, and Work Section Roundtables
  In Refereed Roundtable (90 minute): Table 15: Healthcare Organizations

Abstract

High-stakes situations in organizations such as hospitals often require critical decision-making in highly pressurized contexts that have immediate life and death consequences. Drawing on a 19-month ethnographic study and 32 qualitative interviews in a labor and delivery unit in a Midwestern U.S. hospital, I examine how healthcare providers navigate high-stakes situations where institutional norms, organizational rules, and immediate practical concerns collide. Using an inhabited institutionalist lens, I find that through two relational processes – connecting care and disconnecting care – providers are able to creatively link and separate patient care to navigate three recurrent sources of tension: conflicting patient and provider priorities, the intersection of temporal and spatial constraints, and threats to hospital legitimacy. Connecting and disconnecting care are boundedly creative practices that enable providers to balance normative expectations with situational demands, illustrating how social relationships shape organizational decision-making in high-stakes and highly pressurized contexts. This study advances theory on inhabited institutionalism and high reliability organizations by revealing how interactional processes sustain organizational functioning when moral and practical pressures collide.

Author

• Amelia Hawbaker, Saïd Business School