Standardizing work in healthcare through architecture, routines and technologies

Abstract

This chapter presents an in-depth longitudinal study of hospital work. It discusses standardization after the introduction of a computer-mediated nurse– nurse/interdisciplinary handover in a cardiology ward and its effect on collaborative work activities. The standardization also plays out in the physical architecture adopted by the hospital, which impact on “who” and “how” collaboration progress – the impact of standardized spaces. The chapter focuses on the constant strive in health care to make work practice more effective by employing an increasingly broader approach towards standardization. The number of involved standards is central. Typically for this have been the introduction of the electronic patient record (EPR) system and a following chain of standards made feasible through possibilities from using an EPR system. Sociomateriality is used to illuminate the fact that standardization efforts cannot be investigated as isolated efforts, rather as one of several social and material interconnected ones. Particular to the case was how the physician–nurse handover was made computer mediated, which involves or alter interdisciplinary collaboration in the handover process. Although increased efficiency has been successfully achieved, the chapter discusses how altering some work impacts other processes, especially interdisciplinary collaboration, social relations, and informal learning. Further, architecture has gained sparse attention in the standardization of work processes in health care. Architecture contributes to standardized work practice when striving for efficiency and also become a conflicting standard in interdisciplinary collaboration.