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Between the years 1993 and 2000, the W. K. Kellogg Foundation sponsored the Comprehensive Community Health Models (CCHMs) Initiative in three Michigan counties. CCHMs was comprised of three closely related community initiatives carried out in the midst of a failed national health care reform effort and the continued penetration of managed care arra...
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... level outcomes impact specific persons, and include disease reduction, increased childhood immunizations, or changes in particular lifestyle behaviors. The distinctions between (1) the source of conceptualization and control of a collaborative health change initiative (internally initiated and externally initiated) and (2) the level of change targeted by initiative designers (individual change and systems change) can aid in our understanding of such initiatives (See Table 1). ...Citations
... , participation/collaboration (Medved et al., 2001;Stohl & Cheney, 2001;Wendt, 1998), team dynamics (Gibbs, 2009), technology (Leonardi et al., 2009, volunteering (McNamee & Peterson, 2014), and workplace flexibility (Putnam et al., 2014). ...
... Prior research in the healthcare domain has explored collaborative interactions (DiMatteo et al., 1994;Ellingson and Buzzanell, 1999;Medved et al., 2001;Young and Flower, 2002) and noted that these interactions tend to increase when there is a sense of equality among care givers (Barron, 2000). Since the sum of an OR team's collaborative interactions produces the procedural outcomes, surgeons and other team members need to communicate with each other effectively during an episode of care so that everyone is aware of what other team members are doing and observing (Lewis, 2006). ...
This ethnographic study of more than 90 surgeries (referred to as episodes of care) identifies the antecedents to operating room (OR) supply waste. The study specifically considers the role of planning instances and communication patterns among members of the surgery team on supply waste within the OR. We operationalize planning instances in terms of the number of changes to the physician preference card (PPC), the key document that is used to plan items needed for surgery. Communication patterns among members of the surgery team are captured by measuring the density of communication among the OR team members during an episode of care. The unplanned costs during an episode of care are used as a measure of OR supply waste. Hundreds of hours were spent observing episodes of care and tracking supplies. A combination of participant-observation, survey, and secondary data were analyzed to extract theoretical and practical insights. The results show that planning instances have a curvilinear relationship with unplanned costs. In particular, as the number of changes to the PPC increases, unplanned costs first increase and then decrease. Higher density of the OR team’s communication network is associated with lower unplanned costs. This study has significant theoretical and managerial implications that we discuss and offer directions for future research.
... Terms such as "local communities," for example, are often valorized as a force for good. Medved et al. (2001), for instance, studied how systemic exclusionary practices in healthcare could be overcome and ameliorated when providers engaged in comprehensive stakeholder dialogues with local communities. Scholars have on other occasions been aware of the need to critique and assess how local communities are valorized both in research and in practice. ...
... It is not surprising, then, that collaboration among multiple organizations with different practices and values involve tensions that are complex and consequential (Gray & Purdy, 2014). Past research has identified tensions as a key issue in various IOC contexts, including community health (Medved et al., 2001) and refugee networks (Tomlinson, 2005); however, most tensions discussed in the IOC literature are those that collaborators face as they engage in joint activities, such as making decisions together while having to compete for limited resources (Doerfel & Taylor, 2004). Although those tensions reveal the complexities of communication and relationships among collaborators, the role of conveners in managing tensions has been largely overlooked. ...
... Either-or approaches treat oppositional tension poles as independent and deny their co-existence; thus, people with either-or orientation tend to separate tensions and favor one over the other (i.e., selection). This can be an appealing option to conveners because it offers the potential to prevent challenges that tensions can cause and allows them to organize the step-by-step process of IOCs neatly (Medved et al., 2001). For example, to manage formalization-flexibility tension, conveners may choose formalization to develop a clear structure, set a boundary, and increase efficiency; later, they may realize that the IOC process takes many directions and that their abilities to adapt to unexpected situations are limited. ...
Conveners, as the main organizers of complex inter-organizational collaborations (IOCs), experience tensions as they make decisions based on collaborators’ competing interests and ideas. This paper theorizes conveners’ tension management as their proactive efforts to shape the IOC processes – as opposed to reactive responses to emergent tensions – and examines how they are related to IOCs’ collaborative capacity. A comparative case analysis of two IOCs in regional planning reveals that conveners’ organizing practices that actively promoted tensions contributed to creating a more dynamic and tension-resistant collaborative environment, compared to those of conveners who tried to prevent tensions. Using tensile structure as a metaphor, the author theorizes about when and how proactively promoting tensions can enhance collaborative capacity.
... transcendence and reframing). In a different study of managed care, Medved et al. (2001) identify five types of tensions that cross organizational levels, for example, sharing versus guarding information between leaders and external stakeholders, short-term local projects struggling with long-term global issues, and linear or stage models of global planning in tension with experiences at the local level. Responses to tensions reveal that linear, incremental models fail to capture ongoing changes that move forward, backward, dissolve, and then reorganize. ...
Working within a Bakhtinian perspective of relational dialectical tensions, this study seeks to elaborate on current organizational change theories through a rich set of qualitative data collected on an Internet start-up that revolutionized the music industry. Following the company for 12 years, we focused on the tensions arising during the company’s development and on the responses to these tensions. Our results indicate that with a process model, tensions and decisions develop in a reflexive relationship, which shows that change happens, not in spite of unintended consequences, but because of the unintended consequences of the decisions enacted. We show that change is not always the result of deliberate intentions, conscious choices, and purposeful actions of individuals, but rather as an ongoing process that evolves through countervailing dynamics at multiple organizational levels. Tensions and responses to them are pivotal to this process of changing and should be analyzed as directional markers for future oppositional struggles. Consistent with the Bakhtinian position, we find that change occurs within the interplay of tensions as actors live out struggles and decisions in the midst of organizing.
... Collaborations in the organizational context are often strategic (i.e., their outcomes are for the benefit of some and not others). Medved et al. (2001) identify an information-use tension, in which leaders disseminate some information within the collaboration at the same time as they protect other information for only their use in the marketplace. This is not uncommon (see Browning, Beyer, & Shetler, 1995;Keyton, Ford, & Smith, 2008). ...
Collaboration is a type of interaction that is frequently used in for-profit, nonprofit, and governmental organizations to reach a common shared goal, activity, or production. Generally, collaborations are temporary and negotiated sites of interaction. Identity, power, and strategy are common themes that arise through the evaluation of interaction among collaboration members. Two models for organizational and interorganizational collaboration exist; however, many other theories and models from specific contexts influence the study of collaboration in organizations. Collaboration can be represented as a structure, a process, or both. Future research in this area should address the scalability of findings from across research that addresses collaboration as a method of resolving conflict, or as a problem solving process, to collaborations that exist in organizational and interorganizational settings.
... These conflicting demands have been discussed and studied as tensions (e.g., Cooren, Matte, Benoit-Barné, & Brummans, 2013;Jian, 2007;Medved et al., 2001;Trethewey & Ashcraft, 2004), contradictions (Johansson & Stohl, 2012;Putnam, 2007;Tracy, 2004), dialectics (e.g., Butler & Modaff, 2008;Putnam, 2004;Seo & Creed, 2002;Tracy, 2004), and paradoxes (e.g., Harter & Krone, 2001;Poole & Van de Ven, 1989;Putnam, 1986;Smith & Lewis, 2011;Stohl & Cheney, 2001). These perspectives have in common that they focus on conflicting demands faced by organizations and their members who must communicatively construct understandings and responses. ...
Organizational scholars have traditionally used conceptual definitions to classify situational tensions such as dialectics, dilemmas, contradictions, and paradoxes. We propose instead to use organizational members’ reactions to define and distinguish among different forms of tensions. In the present study, we propose a model in which dilemmas vary in terms of press (the sense of urgency that they invoke) and balance (the degree to which both sides of the dilemma are regarded as equally important and urgent). Depending on the degree of press and balance, organizations are predicted to undertake various response strategies. To evaluate this model, we studied a large sample of members’ descriptions of organizational responses to dilemmas in the Dutch crisis response system (N = 149). Results indicated variation in press and balance, and while some participants enacted dilemmas as choices, others enacted dilemmas in ways that acknowledged and tried to address both alternatives.
... A second process outcome focused on the way that tensions enabled or constrained actions. For example, studies of such dialectics as stability-change (Medved et al., 2001); autonomy-connectedness ); empowerment-disempowerment ); standardized-idiosyncratic practice; vague-detailed language use; withholding-disclosing alternatives (Olufowote, 2011); and risk-control demonstrated how agency constrained or enabled action. ...
... Importantly, discourse as constellations of language, logics, and texts become rooted in routine social interactions and processes of organizing. As the work on process studies and relational dialectics illustrate (Carlo et al., 2012;Medved et al., 2001), organizational contradictions infuse everyday discourses in ways that are often overlooked in the research on large-scale systems (Van de Ven & Poole, 1995). Postmodern and relational dialectics' researchers, in turn, highlight clashing discourses that both enact and respond to paradoxes (e.g., through habitual forms of argument, terminology, story themes, metaphors, humor, and patterned interactions). ...
This article presents a constitutive approach to the study of organizational contradictions, dialectics, paradoxes, and tensions. In particular, it highlights five constitutive dimensions (i.e., discourse, developmental actions, socio-historical conditions, presence in multiples, and praxis) that appear across the literature in five metatheoretical traditions—process-based systems, structuration, critical, postmodern, and relational dialectics. In exploring these dimensions, it defines and distinguishes among key constructs, links research to process outcomes, and sets forth a typology of alternative ways of responding to organizational tensions. It concludes by challenging researchers to sharpen their focus on time in process studies, privilege emotion in relation to rationality, and explore the dialectic between order and disorder.
... A second process outcome focused on the way that tensions enabled or constrained actions. For example, studies of such dialectics as stability-change (Medved et al., 2001); autonomy-connectedness ); empowerment-disempowerment ); standardized-idiosyncratic practice; vague-detailed language use; withholding-disclosing alternatives (Olufowote, 2011); and risk-control demonstrated how agency constrained or enabled action. ...
... Importantly, discourse as constellations of language, logics, and texts become rooted in routine social interactions and processes of organizing. As the work on process studies and relational dialectics illustrate (Carlo et al., 2012;Medved et al., 2001), organizational contradictions infuse everyday discourses in ways that are often overlooked in the research on large-scale systems (Van de Ven & Poole, 1995). Postmodern and relational dialectics' researchers, in turn, highlight clashing discourses that both enact and respond to paradoxes (e.g., through habitual forms of argument, terminology, story themes, metaphors, humor, and patterned interactions). ...
... The three cases reflect much of what organizational communication as well as management and organization scholars have written about tensions, contradictions, 258 F. Cooren et al. paradoxes, and dilemmas with regard to negotiations (Putnam, 2004), employee participation (Stohl & Cheney, 2001), interorganizational partnerships (Tomlinson, 2005), virtual team collaboration (Gibbs, 2009), routines (Rice & Cooper, 2010), telecommuting (Hylmöo & Buzzannell, 2010, feminist organizations/organizing (Ashcraft, 2006;D'Enbeau & Buzzannell, 2011), the adoption of information and communication technologies (Jian, 2007), collaborative interorganizational relationships (Lewis, Isbell, & Koschmann, 2010), community health initiatives (Medved et al., 2001), emotional labor (Tracy, 2005), downsizing (Fairhurst, et al., 2002), and occupational goals (Tracy, 2004). All these studies point to the intractable character of organizational tensions (Ashcraft, 2006). ...
