Jillian’s research is on how professionals learn from each other, and on how the specific organizational structures through which professionals interact shapes who learns what and for how long.    I keep thinking of surgery rooms in which one surgeon’s expertise gets conveyed both to other physicians and to nurses, assistants, and students who may be watching.   And she is interested in how organizations can configure themselves to enhance the learning of highly effective tools without also enhancing the problematic stuff that might be going on.  Jillian, can you tell us about some of your main findings?

Jillian explained that her most recent paper with Carlos Inoue showed how professional physicians in Brazil are influenced in decisions on how to deliver babies by their most recent conversations with peers.    Peer influence matters a great deal to whether babies are delivered by C-Section rather than vaginally.    Physicians in this study are advice-seeking as professionals. 

She also described the results of another study that she has done with Carlos on whether specialists or generalists are more susceptible to the influence of peer advice.  The answer:  Generalists.

Anita and Jillian turned to the question of whether this is good or bad news.   It’s a bit scary that physicians would order surgeries more frequently based on recent conversations, especially because the evidence does not support the idea that this is a learning effect.   But, as Jillian explains, it happens.  It’s true.

Anita then asked Jillian how this peer effect sizes up against a finding in another of Jillian’s papers on the stickiness within organizations of physician practices.

In an earlier paper, Jillian showed that superstar physicians cast a long shadow on the performance of the clinics in which they worked even decades after their departure.  Perhaps through peer effects, these superstar physicians changed the ways that their clinics operated.  And the routines that emerged from this imprinting continued even decades after the departure of the superstar.

Which effect is greater?  Jillian conjectured that the organizational effect was likely greater, especially for the poorer performing clinics.  This is because bureaucratic influence is often much harder to overcome than we may initially think.   So the outstanding performance of great clinics may persist relative to bureaucratic clinics, even when those bureaucratic clinics employ physicians that are open to peer advice.

Let’s take this to basics!

Jillian talked about how professionals tend to maximize for the patient, while their employing organizations often take a broader view.  In some instances, the two can be in conflict.  Local units may take a mandate to emphasize cost-saving or policy changes in ways that physicians would not prioritize.  And yet, when an organization can adapt a policy – such as to hold daily meetings – to its own protocols, situation and cadence, then the results may be positive.

Jillian gets the last word.

There’s a lot of opportunity in studying physicians for improving knowledge about how professionals work within organizations to accomplish important goals.  Health care organizations are fundamentally different and have an outsized impact on society.