We studied an interprofessional collaboration to understand how professionals engaged with paradox in collective decision-making. At the beginning of our study, we observed vicious cycles in which conflict led to negative tension. Professionals were holding tightly to a particular pole of the paradox, and the higher-status pole was consistently overrepresented in collective decision-making. By the end of our study we observed the presence of virtuous cycles, where conflict led to more positive tension, and where professionals engaged in collective decision-making with more equal representation of conflicting approaches. We call this change process protecting the paradox and we identify three strategies that support this process: (1) promoting equality of both poles, (2) strengthening the weaker pole, and (3) looking beyond the paradox by focusing on desired outcomes. We contribute to the paradox literature by showing how vicious cycles can be shifted to virtuous cycles, how professionals and managers can work together to protect a paradox, and how status differences between poles can be redistributed.
AbbottA. (1988). The system of professions: An essay on the division of expert labor. Chicago, IL: University of Chicago Press.
2.
AbeleJ. (2011). Bringing minds together. Harvard Business Review, July–August2011, 86–93.
3.
AdlerP. S.KwonS. W.HeckscherC. (2008). Perspective—Professional work: The emergence of collaborative community. Organization Science, 19, 359–376.
4.
AndriopoulosC.LewisM. W. (2009). Exploitation-exploration tensions and organizational ambidexterity: Managing paradoxes of innovation. Organization Science, 20, 696–717.
5.
AtwalA.CaldwellK. (2005). Do all health and social care professionals interact equally? A study of interactions in multidisciplinary teams in the United Kingdom. Scandinavian Journal of Caring Sciences, 19, 268–273.
6.
BeechN.BurnsH.de CaesteckerL.MacIntoshR.MacLeanD. (2004). Paradox as invitation to act in problematic change situations. Human Relations, 57, 1313–1332.
7.
BrownJ.LewisL.EllisK.StewartM.FreemanT.R.KasperskiM. J. (2011). Conflict on interprofessional primary health care teams – can it be resolved?Journal of Interprofessional Care, 25, 4–10.
8.
CaldwellK.AtwalA. (2003). The problems of interprofessional health care practice in the hospital setting. British Journal of Nursing, 12, 1212–1218.
9.
ChreimS.LangleyA.Comeau-ValléeM.HuqJ. L.ReayT. (2013). Leadership as boundary work in healthcare teams. Leadership, 9, 201–228.
CreswellJ. W. (2013). Research design: Qualitative, quantitative, and mixed methods approaches. Los Angeles, CA: SAGE Publications.
12.
CuffD. (1992). Architecture: The story of practice. Boston, MA: MIT Press.
13.
CurrieG.LockettA.FinnR.MartinG.WaringJ. (2012). Institutional work to maintain professional power: Recreating the model of medical professionalism. Organization Studies, 33, 937–962.
14.
D’AmourD.Ferrada-VidelaM.San Martin RodriguezL.BeaulieuM. (2005). The conceptual basis for interprofessional collaboration: Core concepts and theoretical frameworks. Journal of Interprofessional Care, Supplement 1, 116–131.
15.
DenisJ. L.LangleyA.RouleauL. (2007). Strategizing in pluralistic contexts: Rethinking theoretical frames. Human Relations, 60, 179–215.
16.
DenzinN. (2006). Sociological methods: A sourcebook (5th edition). New Brunswick, NJ: Aldine Transaction.
17.
FiolC. M. (2002). Capitalizing on paradox: The role of language in transforming organizational identities. Organization Science, 13, 653–666.
18.
FiolC. M.PrattM. G.O’ConnorE. J. (2009). Managing intractable identity conflicts. Academy of Management Review, 34, 32–55.
19.
FreidsonE. (1989). Medical work in America: Essays on healthcare. Binghamton, NY: Vail-Ballou Press.
20.
FreidsonE. (2001). Professionalism, the third logic: On the practice of knowledge. Chicago, IL: University of Chicago Press.
HallP. (2005). Interprofessional teamwork: Professional cultures as barriers. Journal of Interprofessional Care, Supplement 1, 188–196.
23.
HoffmanA. J.HennR. (2008). Overcoming the social and psychological barriers to green building. Organization & Environment, 21, 390–419.
24.
JarzabkowskiP.LêJ.Van de VenA. H. (2013). Responding to competing strategic demands: How organizing, belonging, and performing paradoxes coevolve. Strategic Organization, 11, 245–280.
25.
JayJ. (2013). Navigating paradox as a mechanism of change and innovation in hybrid organizations. Academy of Management Journal, 56, 137–159.
26.
KrugmanM.SmithV. (2003). Charge nurse leadership development and evaluation. Journal of Nursing Administration, 33, 284–292.
27.
LégaréF.StaceyD.PouliotS.GauvinF.P.DesrochesS.KryworuchkoJ.DunnS.ElwynG.FroschD.GagnonM.P.HarrisonM.PluyeP.GrahamI. (2011). Interprofessionalism and shared decision-making in primary care: A stepwise approach towards a new model. Journal of Interprofessional Care, 25, 18–25.
28.
LeichtK. T.FennellM. L. (2008). Institutionalism and the professions. In GreenwoodR.OliverC.SahlinK.SuddabyR. (Eds.), The Sage handbook of organizational institutionalism (pp. 431–448). London: SAGE Publications.
29.
Leonard-BartonD. (1992). Core capabilities and core rigidities: A paradox in managing new product development. Strategic Management Journal, 13, 111–125.
30.
LevinthalD. A.MarchJ. G. (1993). The myopia of learning. Strategic Management Journal, 14, 95–112.
31.
LewisM. W. (2000). Exploring paradox: Toward a more comprehensive guide. Academy of Management Review, 25, 760–776.
32.
LockeK. (2001). Grounded theory in management research. Thousand Oaks, CA: SAGE Publications.
33.
LüscherL. S.LewisM. W. (2008). Organizational change and managerial sensemaking: working through paradox. Academy of Management Journal, 51, 221–240.
34.
MarchJ. G. (1991). Exploration and exploitation in organizational learning. Organization Science, 2, 71–87.
35.
MarshallC.RossmanG. B. (2010). Designing qualitative research (5th edition). Thousand Oaks, CA: SAGE Publications.
36.
McGaffinB. J.DeaneF. P.KellyP. J.CiarrochiJ. (2015). Flourishing, languishing and moderate mental health: Prevalence and change in mental health during recovery from drug and alcohol problems. Addiction Research & Theory, (ahead-of-print), 1–10.
37.
MilesM. B.HubermanA. M.SaldañaJ. (2014). Qualitative data analysis: A methods sourcebook. SAGE Publications.
38.
NembhardI. M.EdmondsonA. C. (2006). Making it safe: The effects of leader inclusiveness and professional status on psychological safety and improvement efforts in health care teams. Journal of Organizational Behavior, 27, 941–966.
39.
NoordegraafM. (2011). Risky business: How professionals and professional fields (must) deal with organizational issues. Organization Studies, 32, 1349–1371.
PutnamL. L. (2015). Unpacking the dialectic: Alternative views on the discourse–materiality relationship. Journal of Management Studies, 52, 706–716.
42.
PutnamL. L.FairhurstG. T.BanghartS. (forthcoming). Contradictions, dialectics, and paradoxes in organizations: A constitutive approach. Academy of Management Annals.
43.
RaischS.BirkinshawJ. (2008). Organizational ambidexterity: Antecedents, outcomes, and moderators. Journal of Management, 34, 375–409.
44.
ReayT.HiningsC. B. (2005). The recomposition of an organizational field: Health care in Alberta. Organization Studies, 26, 351–384.
45.
RobertsC., (1989). Conflicting professional values in social work and medicine. Health and Social Work, 14, 211–218.
46.
SchadJ.LewisM.RaischS.SmithW. (forthcoming). Paradox research in management science: Looking back to move forward. Academy of Management Annals.
47.
SeoM. G.PutnamL.BartunekJ. M. (2004). Dualities and tensions of planned organizational change. In PooleS.Van de VenA. (Eds.), Handbook of organizational change (pp. 73–107). Oxford: Oxford University Press.
48.
SmithW. (2014). Dynamic decision making: A model of senior leaders managing strategic paradoxes. Academy of Management Journal, 57, 1592–1623.
49.
SmithW. K.LewisM. W. (2011). Toward a theory of paradox: A dynamic equilibrium model of organizing. Academy of Management Review, 36, 381–403.
50.
SmithW. K.TushmanM. L. (2005). Managing strategic contradictions: A top management model for managing innovation streams. Organization Science, 16, 522–536.
51.
StakeR. (1995). The art of case research. Thousand Oaks, CA. SAGE Publications.
