Dr. Kellog Chapter 2 Summary

Chapter two focuses on the three different hospitals and their different programs. Dr. Kellogg explains why she choose these three hospitals. Each hospital has many factors in common like they all had a high reputation, they possessed similar demographic, they had similar size, and how each had little external pressures to reform. They also similar programs for intern residents and top manager interests. She believes micro-level approach is more important than the macro-level explanation because the macro-level explanation fails to support why Advent adapt the reform. Dr. Kellogg also give defenses against the possible criticisms that her research ad gives the merits of her qualitative ethnographic. Next, we look into the defenders.
In Chapter

three, the book talks about one of the main sources of resistance against the reform of ACGME are general surgeons, who are also known as the “Iron Men”. These Iron Men are the main defender against the work hour reform and desire to maintain their current condition. These general surgeons hold a high position in the hospital hierarchy as they are value for their abilities. The Iron Men are general surgeons who went through the whole ordeal of working for 120 hours per weeks and starting that the bottom of the hierarchy but crawled up the hierarchy with time. The Iron Men are general surgeons that hold a strong belief in three core ideals: continuity of care, learning by doing, and living the life of a surgeon. They also believe in the “heroic surgeon” idea. The heroic surgeon idea requires the surgeons to be action-oriented, to be tough, reliable, to be confident, not to rely on others, hardworking, and certain in their actions and decisions. Iron Men represent a strong macho persona and as result of this persona most Iron Men are male. Most of the high ranks in the hierarchy are Iron Men so attempting reform the hospitals without them is difficult.
Chapter four is about the potential reformers in the hospitals.

Dr. Kellogg identifies four individual groups of outsiders to the “Iron Men” persona. These outsiders are females, specialists, incoming interns, and other male who are “Family Men, “Egalitarian”, and “Patient-Centered Men”. These outsiders failed to meet the standards of the Iron Men or are rejected the Iron Men and they are mostly to be in support of the work hours reforms. Many females residents try to adapt the Iron Men persona but are usually are exclude of the Iron Men persona because of their sex. Specialist residents are little unique as they are disinterested in the iron ma practices because they are only work with them for about year and Iron Men exclude them to focus more on incoming general surgeon interns. Incoming interns are against the Iron Men persona because they are new to the culture and do not want to work the long 120 hours. The incoming interns are usually convert to Iron Men persona during their residency period. The other male who are “Family Men, “Egalitarian”, and “Patient-Centered Men” do not meet the standard of the Iron Men persona because they have different goals and values. The “Family Men” want to spend more time with their families. “Egalitarian” are not comfortable the Iron Men persona. “Patient- Centered Men” wants to spend more quality time with their patients rather simple drop in and out like the other surgeons. We have finish with part one of the book and will begin explaining part two of the

book.
In chapter five talks how, the defenders resisted the reforms. This chapter shows the audience the tactics of top managers, chiefs, ad senior Iron Men and their power. An example of resistance from the defender was the night float team. The night float team program let interns hand off their patients and the work associated with them to another during their shift to get some rest. The defenders discourage the usage of night float team program by not accepting hand offs, spread bad gossip about the intern, and punishing the interns. The defender did this because the handing off patients to another go against one of the core ideals of the Iron Men, continuity of care.
In chapter six details how, the reformers began to develop ways to counter the defenders. Dr. Kellogg argues the main reasons the reformers were able to become so organize against the defender, was presence of relational spaces. Advent and Calhoun hospitals allowed “free spaces”, which the reformers used to group together away the defenders to developed and organize ways to challenge the defenders’ opposition against the reform. Dr. Kellogg credits relational spaces as major reason why the reform was success at Advent and Calhoun Hospitals, but not at Bayshore as Bayshore do not have relational spaces so it failed to carry out the reform.
Chapter seven focuses on the countermobilizing for resistance. The defenders use their power and influence to break down the reformers by negatively labeling their practices and by recruiting some reformer to their side. This was initial success as things like the hand off stop at Calhoun, but they continued at Advent. At Calhoun, D. Kellogg argues that the men at the top of the social hierarchy felt that their social position was threatened by the reform and the females at the top of the hierarchy.
Chapter eight is about the change at Advent and tactics that resulted in the reform occurring at the hospital. Dr. Kellogg talks how collective disruption was important aspect in enforcing the reform. The non-surgical interns were willing to challenge the defenders by using hand offs because they were outsiders to the defenders, they suffer far less than the surgical interns. Reformer chief were important as they were able to facilitate hand offs as they have a power in the hierarchy unlike the intern residents.
In the book conclusion section, Dr. Kellogg details her research method, talks, key characters, and important of her micro-level approach. Dr. Kellogg suggests several recommendations and tactics to reformers, medical administrators, and medical providers for improving upon the success of the work hour reform.