"Two-Step Leverage and the Reform of Professional Work Related to the Affordable Care Act in Two US Hospitals"

Prior research on healthcare, social movements, and organizations has shown that professionals frequently resist organization managers’ attempts to adapt their expert work in response to reform.  My 2-year comparative ethnographic study of healthcare reform implementation in two US hospitals demonstrates that one way that organization managers can implement reform is by engaging in two-step leverage, whereby they influence professionals by changing the daily work of low-status actors on whom these professionals depend.