‘When all think alike, then no one is thinking’: Understanding the Praxis of Creative Insubordination as a Decision-Making Strategy in Philippine Medical Schools

Background Exercising discretion is vital when making decisions. While decision-making implies having to choose between predefined alternatives, discretion requires sifting through several solutions and critically choosing the desired one that implies a choice between many alternatives without rigid guidelines pointing to one direction or the other. While previous studies have constantly investigated the nature and dynamics of creative insubordination or discretionary insubordination in primary and secondary education little is known as to how such a construct operates in higher education. Purpose This study was undertaken to address the central question: “What attributes define creative insubordination as a decision-making strategy among Philippine medical school deans?” Design Anchored on descriptive phenomenology, 21 medical deans who have been in the position for at least 4.5 years (range 4.5-26 years) were purposively selected for in-depth semi-structured interviews. Guided by the rules of cool and warm analyses, transcribed texts were phenomenologically reduced and interpreted, and validated via member checking procedure. Findings Five interesting elements that typify the modes of behavior in the practice of creative insubordination surfaced, namely: cognitional elasticity, emotional sensitivity, conational sincerity, relational mobility and axiological reflectivity. Conclusion This study provides eidetic images of the multidimensional facets of individual attributes necessary for the praxis of discretionary decisionmaking by a select group of Philippine medical deans in varied instances.


INTRODUCTION
Discretion is vital to administrative decision-making. It requires sifting through several solutions and critically choosing the desired one when alternatives have no rigid guidelines pointing to one direction or the other. Discretion is a concept that cannot be predicted and controlled; otherwise it would not be discretionary. [2] School administrators exercise discretion to make decisions which have positive consequences and avoid decisions that result in negative outcomes.
"Creative insubordination" [3] or "discretionary insubordination" [2] has been described as a component of decision-making. Oftentimes, decision-making within the school is impersonal and conflicting [4][5][6] because school policies and procedures are imperfectly implemented [7]. Principals who practice creative insubordination adopt behaviors that challenge bureaucratic directives from a higher office. [8] These behaviors contain a moral element [9,10], meant to counter the adverse and dehumanizing effects on the school and its stakeholders [11], although Spring [2] hinted that sometimes, self-interest goals may be involved.
Creative insubordination has been described as a component of discretionary decision-making which usually involves challenging or not complying with directives from a higher office for the decision to fit the local situation. Often implemented with a sense of humor and a touch of mischief, the aim however, is to counter the dehumanizing effects of bureaucratic authority [11].
Among the evasive strategies employed by principals were deliberately missing deadlines, following orders literally, ignoring channels to procure human and material resources and using parents and other members of the community to communicate school concerns with superiors [12]. McPherson and Crowson [13] studied the administrative behavior of principals during school reform in Chicago and found that principals moved outside of the bureaucracy to get assistance and resources.
Crowson [4] investigated the reasons behind why principals engage in acts of creative insubordination and concluded that this type of counter bureaucratic behavior was a survival mechanism for principals and a balance for the anti-educational forces within the school organization. In a related functional analysis of school administration as brinkmanship, Haynes [14] concluded that a positive correlation existed between exercise of behavior and years of experience in principalship.
In his study in 1992, Machiavelli [15] advised administrators how to practice creative insubordination by informally lobbying board members, winking at obstructive rules and pursuing devious ends in the interest of their school. The best administrators were portrayed as risk takers who hid their activities for the public to see only good results. Machiavelli was credited for his unusual insights into the modern concept of the executive, who needs to act decisively but must take initiatives to exceed his base of authority and be willing to undergo undue exposure to criticism if he is to manifest a strong leadership stance [16].
Santin [17] for her part examined how the independent variables of leadership style and selected demographic characteristics of principals may relate to the dependent variable of the principal's predisposition to use creative insubordination in decision-making.
Through the years, the concept has evolved into one of the catchphrases concerning breakthroughs in education, i.e., the concept of design thinking typified in literature as applying out-of-the-box tendencies towards a task [36,37]. Its constructs also involved the fascination for ambiguity and risk-taking [38], problem-solving [39], critical questioning [40] and creative confidence [41,42].
Ultimately, school administrators who engage in creative insubordination circumvent negative sanctions [38,[43][44] through risk-taking activities for the public to see only good results [15], acting decisively and be willingly exposed to criticism to manifest a strong leadership posture. [16] The primary and secondary education literature is replete with studies that explored this phenomenon of creative insubordination [3][4][5][6][11][12][13]44,45] but none have dwelt on its dynamics in higher education, nor specifically in medical education.
Like other professionals at the helm of higher education, physicians possess the special expertise to connect solutions to problems through algorithmic approaches honed through academic preparation and training that stress autonomous decisionmaking [46]. As academic deans, however, they need to make heterogeneous decisions that are less clearly bounded.
In medical colleges and universities, the dean is positioned in the middle of administrative hierarchies at the helm of knowledge workers [47]. He mediates between the administration and faculty, addressing issues of accountability, autonomy and efficiency [48]. Oftentimes he is hampered by the lack of training in academic leadership [49] and his role is embedded in fluid contexts that require a high level of creativity in decision-making [50].
In this study, we adopt the perspective of strategy as something that people do, strategy as an activity involving people doing things differently and in ways difficult to imitate. [34] Through the lived experiences of a select group of medical deans, this study looks at creative insubordination as a human action. Our focus is on what medical deans engaged in creative insubordination as a decision-making strategy do differently in their strategies. From this point of departure, this qualitative study addresses the central question: What attributes define creative insubordination as a decision-making strategy among Philippine medical deans?

METHOD Design
This qualitative study utilized the descriptive phenomenological design to describe and understand creative insubordination as experienced by deans in the context of Philippine medical education. It employed several frames of reference, namely: transcendental subjectivity (neutrality and openness to the reality of others), eidetic essences (universal truths), and the lived-world plane of interaction (researcher and participant must interact) [51] to achieve a universal description of the phenomenon.

Selection
Participants included Philippine medical deans purposively sampled because they had experiences in the phenomenon being researched. [52] To ensure data validity and credibility [53], participants should have served a minimum of 3 years, deemed a reasonable extent of time for them to experience dynamics of the phenomenon in their positions. They were also known for their national and/or regional visibility and their contributions to their respective professional specialty organizations. The profile of the respondents is as shown in Table 1.

Research Instrumentation
Data were gathered over a six-month period through in-depth interviews. Their baseline characteristics were initially gathered using a robotfoto [54].
Written informed consent was sought [55], making them aware that participation in the study was completely voluntary; that they were free to withdraw at any point and that their responses will be strictly confidential as data will be coded and reported only in the aggregate.
A semi-structured questionnaire prompted them to think aloud of ways they framed, thought about and resolved institutional challenges they faced, as well as functional strategies they employed in their area [56]. The face-to-face protocol permitted them to speak as individuals at length and in detail, allowing researchers to get to know and develop a sense of trust and rapport with each participant. Clarifying probes and follow-up questions anchored on their actual responses were asked. Questions were based on facts and events rather than on the participants' interpretations, and the researchers were careful not to impose their definition of creative insubordination on the participants. Interviews took an average of two hours. All interviews were tape-recorded and transcribed.

Mode of Analysis
Data gathered from the robotfoto were tallied and analyzed. The transcribed responses were independently coded and an emergent theme analysis was conducted. Phenomenological reduction was done through a repertory grid where concepts drawn were listed, categorized (cool analysis) and thematized (warm analysis) revealing the dimensions of decision-making strategies among respondents. Member checks were used as a form of data review. The audit trail was kept through field notes, audiotapes and complete transcriptions of each interview, coding of the transcripts, and construction of the repertory grid to organize the field text. [57] Findings This descriptive phenomenological study of creative insubordination as a decision-making strategy among 21 medical deans revealed the following conceptual clusters portrayed in Table 2.
As academic administrators, the deans' perspectives regarding their ability to make decisions for their school were thematized into five dimensions. They come to the job with their thoughts (the thinking facet) and emotions (the feeling facet) about the work, and by what means to carry it out (the intending facet). Their efforts can be directed either inside the school they manage or outside it, to the rest of the organization or to its external environment (the doing and dealing facet). Their decisions were further shaped by their value inclinations (the deepening facet). Conceptually, these five dimensions are interrelated to one another such that each dimension is tempered bi-directionally by four other dimensions as shown in Figure 1.

Cognitional Elasticity
Through cognitional elasticity (the thinking facet) in creative insubordination, deans recognized that the academic administrator's real-life is punctuated by diverse and disconcertingly complex issues where rigid beliefs and paradigms have no place. Whether thinking individually or as part of a group, the deans manifested their attentiveness to the inconsistencies and perplexities in their context. Faced with issues of excessive traditionalism, dwindling resources and too much work with too few who are willing to share the work, the administrators admit the following: Flexibility in thinking is manifested by reinterpreting policies that would otherwise inhibit them from being creative as verbalized in these portrayals:  They breached order and control so that improvised products may come out of the new order as disclosed in these experiences: "I started reclassifying the faculty into a core and base faculty…the core faculty stayed longer hours and we started to give them more incentives. There was no precedence, but I think that the timing is right." (CH) "I was able to marry the concerns of the faculty and the directives of the administration." (RL)

Emotional Sensitivity
Emotional sensitivity (the feeling facet) enabled the deans to respond passionately in authentic ways when dealing with problematic situations. They wrestled with inner conflict borne out of uncertainties about doing what they think they ought to do and the possibility that they might lose their job. This emotional tug-of-war is expressed through the following excerpts: "They (the administration) never manifested either for or against. Except that when my term ended, they reappointed me. I was overaged and they reappointed me. To that extent, that might have been a sign of support. When that extension ended, they again reappointed me. (I knew) they were really giving me a chance to prove, to make it work." (AA) "I know that my position is at risk and my position was hinged on whether I would cooperate with them (the administration) or not because they came to me several times." (TS) Unforeseen circumstances are pervasive, and two deans explicitly expressed their concern on this matter: "I am a scene-to-scene, day-to-day kind of leader. I always adjust to situations." (RH) "A few months after my appointment as dean we were told that we could no longer be supported financially by the government. After the government cut our subsidy for the college, I said that we must collect minimal tuition fees that are still very affordable." (EM)

Conational Sincerity
Through conational sincerity (the intending facet) in creative insubordination the deans showed perseverance and ability to effectively process tasks in the face of surmountable difficulty. They genuinely pondered on all the issues involved and believed that their insights were well-motivated and likely to be effective. Invigorated by purpose, they championed advocacy until their initiatives were carried out as this excerpt depicts: "I think it depends upon your perspective. Some will just talk about it, while others will do something about it. I will rather be doing something about an issue rather than talking about it." (PA) Timing is crucial and these administrators seized opportunities when present: "I wanted our school to be the benchmark. If I can only get 40 of the faculty members to really commit to the task of curriculum reform…I had that opportunity and I seized it." (AA) "I started thinking and made the academic ranking as honorific scholarships and the money we saved, we used as grant-in-aid. We are the first medical school to have a grant-inaid." (FS) However, there are situations when the temptation to 'just do it' was tempered by caution and the administrators felt that a 'no action' approach was better.
"I like problem-based situations, I think it is the best way to learn Medicine, but we did not pursue it, our faculty members are not ready for it and our students are not ready too." (RH) A dean disclosed her sentiments regarding how she needed to be resolute, especially when decisions conflicted with policies set by higher-ups: "As much as possible we do not want to participate in other programs of the University because we lack support from the administration.

So, I must make them understand and I have to do what I have to do." (EM)
Two deans validated how synergy moved people to action and facilitated collaboration: "Just come up with modifications to satisfy all other stakeholders… some people refuse to understand but you just need to talk to them again." (JP) "We don't want our people to be tentative, so empowerment is the best leadership thing that I can think of. You can empower your people to be managers themselves, not to depend upon you." (PA)

Relational Mobility
To be creatively insubordinate, the deans engaged in relational mobility (the doing and dealing with facet), an interpersonal influence process aimed at eliciting voluntary change in preferences from others. Clients are the medical schools' raison d'être and they expressed how looking after their welfare was paramount: "We were the first to offer full scholarships for Cum Laude graduates of undergraduate programs, without quota. The entire class can be 50 or 1000 and all of them can be scholars if they fulfill the criteria, it is a form of academic marketing." (RE) "Some of our students drop-out because of funds so when we see that they are good students and have difficulty in paying, we offer them a service contract agreement and now we are implementing the "Study now, Pay later" scheme." (PA) They also shared the value of energizing peers and constituencies, setting aside time to communicate with them in no-holds barred sessions: "The most pressing leadership challenge is dealing with the resistance to change. What I do is personally sit down with everybody and explain to them the problems. "What matters is that they were involved in the decision-making before the change happened"(ED) "Also, I instituted a 'no agenda' monthly meeting with the faculty. We just have a lunch meeting, come up with your own ideas we will look whether it is good or bad, and come up with their complaints ... so from that we grow. So it's a different style of doing things in a way. So, everybody can come up with anything. Creative ideas, bad ideas and then we discuss." (JP) One dean shared how bureaucracy was overcome by influence brokering: "I still have the tendency to go up directly, however you must know the exact time when to request, when to present something or whatever. If I want something done, and I do it my way, it will happen. If I follow the bureaucracy, even if there is no legal or political impediment, it gets forgotten and it gets lost in the red tape."(RE) Another dean shared how being a friend of the family in a family-owned school became an enabler of change:

"Of course, it helps that I am a friend of the family so I can always explain my side." (LQ)
Stakeholder mobilizing that capitalizes on one's social networks also proved very effective: Through axiological reflectivity (the being and deepening facet), the deans engaged in navelgazing in the midst of difficult challenges and examined their identity in relation to the values which underpinned their work. Through these 'ways of deepening', the deans manifested creative insubordination whenever they controlled access to information. A dean expressed how she exercised information gatekeeping choosing not to reveal more than she needed to: "I tend to follow…well to some extent we did all our changes without getting terminated. I never had to explain the changes…I was surprised. I did my thing all the time when there might be some written rule, I did not check for written policies or rules which might restrain us in our changes."(AA) They utilized personal appeals, casual discussions in the halls and behind-the-scenes negotiations, in issue selling, to focus their University Presidents' and Chancellors' attention on the 'wicked problems' that beset their institutions: "I had to sell the concept to everyone, both the administration and the faculty." (LQ)

"More often than not, if I have innovations and I let them flow through the course of bureaucracy, it stops at the first level. If I wanted it done and implemented easily, I go straight to the Chancellor and within a month it is already implemented… somehow that is how things happen in our school." (RE)
They maximized latitude in interpreting rules and policies.
"One of the things we changed was our daily time record. From an 8am-12nn; 1-5pm system to only a statement that says "I have rendered full service for the month of… Because if we insist on the 8-12nn; 1-5pm system, nobody would teach." (MA) "When we cannot raise the tuition fees because of PD 451, I went to MECS and I told them, 'Can you make our school deregulated so I can raise tuition fees?' We became deregulated and I was able to increase tuition fees by 30%." (FS) But they made sure that they mitigated blame and that their discretionary actions will be defensible: "When I feel strongly about something and I feel it is right, then I impose it and take full responsibility for the consequences. But then of course, I will make sure that there will be no one to blame." (RE) "When you do change even if you have the perfect formula, there are sequelae which may come out later that you need to troubleshoot for the things that you were not able to foresee. Those are things that take up so much time." (TS)

DISCUSSION
This phenomenological study clarified and enlightened the essence of creative insubordination as constituted in awareness of a select group of Philippine medical deans. The apodictic nature of their decision-making practices highlights creative insubordination as a multi-faceted administrative decision-making strategy and the extent to which it is practiced by these physician academic leaders encompassed their entire thought processes lending credence to what Leithwood and Hallinger [58] proposed, that 'what administrators do depend on what they think-their overt behaviors are the result of covert thought processes.' The administrators' practice of creative insubordination is aptly surfaced through their effective use of cognitional elasticity, emotional sensitivity, conational sincerity, relational mobility and axiological reflectivity.
Cognitional elasticity is expressed through informed minds that think and operate effectively on a contingent basis. "Wicked" problems with rigid rules pushed our participants to exercise rising extents of accountability when faced with the need to exercise discretion and procedural transparency, similar to the findings of Choi and Chun. [59] Interestingly, the deans in this study encountered concrete episodes that fostered the need for emotional sensitivity supporting the crucial role of emotional intelligence so that creativity can thrive through 'the deployment of discretion' on a shared basis throughout an institution. [60,61] Consonant with Lipsky's [62] conceptualization of the inevitability of discretion, our participants shed their cloak of tentativeness and wore the robe of confidence convinced that they cannot go wrong because their creatively insubordinate decisions grew out of their own life experiences and circumstances and were thus more appropriate than decisions conceived by others in earlier times and in other places. This ability enabled them to put a positive spin to even apparently unproductive experiences, thus sending a very important and reassuring message to their clients, peers and subordinates.
Exhibiting conational sincerity, the deans did not hesitate to act and commit personal, as well as organizational resources to set precedents for their institutions. They learned to be 'street-wise', focused and keenly aware that they are always under scrutiny by stakeholders who might interpret any delay in decision-making as ineptitude and incompetence. Failure to exercise discretion as to meet community needs invites political scrutiny that seriously challenges legitimacy of the discretionary choices. [63] Engaged in a largely social enterprise, the administrators in this study displayed relational mobility by working out personal relations with individuals in their own orbit: family, friends, neighbors, the alumni, allowing their circle of influence to increase rapidly as the need arose. They made people voluntarily adopt changes in practice and to self-monitor compliance knowing that peers and subordinates resent being issued direct orders or be subjected to close supervision and frequent inspection. They crossed divisional boundaries of their own structures, reached and got involved in increasing number of interagency experiences always expecting that they would be listened to attentively. They maintained a posture of conviction when confronted by individuals in authority. [64] The deans' collective voice also resonated with axiological reflectivity. As local actors, they mediated policy and influenced outcomes guided by what they perceived as just and fair. [62] They actively reconceptualized accountability [65] and made it an integral aspect of organizational relationships characterized by collegiality [66] rather than impose toxic policies in their schools. They operated in an ethical manner and when their most genuine convictions were tested, they reflected on their fundamental values and ideals as the ultimate source of deep-seated purpose, [67] thus increasing the value of the chosen alternative and decreasing that of rejected ones. Consequently, whether good or bad, popular or unpopular, a decision once made was implemented with no second guessing and no doubts. Not all discretionary choices, however, are necessarily nor inevitably right [65] hence, wrong decisions were accepted with full responsibility for adverse outcomes, although all agreed that they would rather 'cover their butt' pre-emptively rather than face the consequences of an erroneous decision which paralleled with Manley-Casimir's [68] concept of defensibility. Through the practice of creative insubordination, Filipino medical deans, as chief strategists, were able enact their varied roles to implement strategically effective change in their medical schools. [69] CONCLUSION The pivotal role of creative insubordination in decision-making of medical school deans cannot be underestimated. This study provides eidetic images of multidimensional facets of individual attributes necessary for the praxis of discretionary decisionmaking by a select group of Philippine medical deans in varied instances.
Administrators reinterpreted the accepted, valued and regulated norms of their institutions because contingencies such as new opportunities, new technology, new situations, new demands, new conditions and new faces and personalities, continue to challenge them. They realized that unmindfully honoring long-standing rules, norms and policies of their institutions may work against the fundamental and essential processes that kept their institutions alive. Re-interpreting these institutional rules, norms and policies while adapting to the local context may have been a daunting and often intimidating undertaking, but it was the very path by which new understandings emerged and growth took place.
Intuitively, administrators knew that as portrayed in the pentagonal framework, creative insubordination as a decision-making strategy consisted of all facets taken as one. That a decision is only good thought, good feeling and good intention until it has been carried out in work and action and have become accomplishments through an organizational structure morally committed to strengthen the decision-making process.
This study interestingly provided insights into the dimensions of discretionary decision-making involved in creative insubordination. An in-depth look at the context that fosters creative insubordination is likewise worth looking into.
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