How to Orchestrate Change from the Bottom Up

Organizational change is difficult. It’s challenging to get people who are set in their ways to go about their jobs differently. So what types of interventions might actually change people’s behaviors in ways that make change more palatable? To answer that question, a researcher conducted a two-year ethnographic study of the primary-care departments in two U.S. hospitals. Both had received grants to implement the same change throughout their hospitals, but one was dramatically more successful than the other. What made the difference? At the hospital that was the most successful, managers had enlisted the aid of medical assistants to help change the doctors’ behaviors. They had a had a high capacity for influence because they had a lot of structural power; in other words, they were best poised to intervene in a doctor’s workflow and critical tasks. The act of leveraging the structural power of low level workers to push change from the bottom up may have implications for other fields, too, including law, accounting, or consulting.