The institutional work of hospital risk managers: democratizing and professionalizing risk management

The growing importance of risk management programs and policies in health care organizations has given rise to a new organizational figure, the risk managers. This paper seeks to better understand their role by looking at their risk work as a form of institutional work. From an inductive study of hospital risk managers in the Quebec health care sector, we provide a situated account of the risk work or ‘the effortful pattern of practices’ accomplished by hospital risk managers at the intra- and extra-organizational levels. The results show that they engage in two broader recursive forms of institutional work. At the intra-organizational level, it is by building bridges, autonomizing teams, legitimizing risk work, and pragmatizing interventions that hospital risk managers contribute to democratizing the risk management practices in their organization. At the extra-organizational level, it is by networking with colleagues, hybridizing knowledge, shaping identity, and debating solutions that they contribute to articulating a professionalization project. We argue that the recursive relationship between these two forms of institutional work, namely democratizing and professionalizing risk management, demonstrates how the risk work done at one level facilitates the risk work accomplished at the other. The paper provides three contributions. First, it opens the black box of the hospital risk managers’ roles by showing the complexity of their risk work, instead of formalizing expectations about their role in a normative way, as is generally the case. Second, this research provides evidence about how actors with limited collective power and resources such as hospital risk managers participate in disseminating risk management programs and policies. Third, the paper offers a multi-level understanding of the ways by which hospital risk managers work to institutionalize risk management program and policies. The paper ends by discussing the importance of gaining a better understanding of the risk managers’ role and their institutional work.