Team Configurations and Subordinate-Driven Managerial Control

(In preparation for submission to Organization Science)

I examine how configurations and cultures of clinical teams within a teaching hospital explain variation in the receptivity and performance of physicians who are asked to correct documentation errors. Utilizing a longitudinal inductive research design, I follow a team of clinical documentation nurses who monitor case notes written by physicians and make (in-person and electronic) documentation change requests to correct errors and optimize hospital billing outcomes. I use data from a two-year field study centered on the documentation team to unpack the relationship between sub-ordinate regulatory agents (nurses) and high-status experts (clinicians). I designed and deployed a novel electronic data collection platform at my field site, which nurses use to document, rate and explain their interactions with clinical teams and individual physicians every week. In addition, to further unpack these quantitative patterns, I analyzed archival program data and conducted interviews with team members. My preliminary findings indicate that individuals belonging to larger teams, engaged in tasks of high task complexity, and teams with rigid hierarchies are more likely to be recalcitrant in their responses to documentation change requests. In contrast, smaller teams, teams with norms of sub-ordinate participation and low-to-medium complexity tasks are more likely to be amenable to regulatory requests. Methodologically, I quantitatively identify determinants and boundary conditions of physician-nurse interaction and performance, and qualitatively unpack points of collaboration breakdown and the strategic interpersonal tactics used by nurses who seek to turn around uncooperative targets. Overall, this paper extends recent research on compliance structures based on “subordinate activation tactics” (Kellogg 2018)- wherein lower status subordinate workers help effectuate behavioral changes in targeted experts on behalf of management.