Appropriation process of dirty work: focus on health executives in a medical services restructuring

Abstract

Purpose The literature related to the dirty work had been mobilised to explain how the changes in hospitals (technification and increasing complexification work in particular) affected the allocation of the function between the various corporation (physicians, nursing staff, administration), and contributed to make them evolve. The purpose of this paper is to better understand in a context of organisational change what is the process that allows individuals to appropriate the dirty work that one tries to delegate to them. Design/methodology/approach To deal with this issue, for a year and a half, the authors conducted a longitudinal case study based on the evolution of the organisational merger between to medical units in a French hospital. Findings The results showed that the appropriation of dirty work first needs the acceptance of task shifting, then a phase to normalise dirty work through various tactics (reframing, refocusing, and team recognition). The authors also emphasised the essential role played by these activities to enhance collaboration between doctors and caregivers in their quest for restructuring and institutionalising change. Originality/value While the literature on dirty work focuses on the “how and why” the allocation of the function between the various corporation can evolve, this research investigates more in depth the working of the appropriation process itself. The issue of appropriation introduces a new element in the framework of dirty work and can constitute an interesting focus for managers looking to enhance organisational change.