The Role of the Quality Coordinator: Articulation Work in Quality Development

Madsen, Marie Henriette

doi:10.1057/9781137518163_8

Cited by 2 publications

(5 citation statements)

References 17 publications

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“…Our analysis illustrates that nurses contribute to the vital coordination and adjustment of the new service [ 18 , 22 , 61 ]. According to Allen and May [ 28 ], “high-quality healthcare depends not on individual brilliance but on ensuring that all the necessary elements (material, knowledge, people) to meet patient needs are aligned in social time and space ”.…”

Section: Discussionmentioning

confidence: 99%

“…Many studies have pointed to the unpredictability of local translation, response, accommodation, and implementation [ 1 , 14 , 16 , 17 ]. Health care professionals’ willingness to commit to local implementation processes is key to success [ 13 , 15 , 16 , 18 – 20 ], as new and additional work is required [ 14 , 21 , 22 ]. To make a new service work professionals need to engage in work practices development, not just be willing to change [ 1 , 8 , 14 – 16 , 18 , 20 ].…”

Section: Introductionmentioning

confidence: 99%

“…Studies underpinned by the theory of the social organization of healthcare work describe how nurses perform organizing work and direct patient work simultaneously and continuously and highlight this combination as a crucial element of nursing work [ 22 – 26 ]. Direct patient work is the nurses’ clinical work, while organizing work involves care trajectories and organizing patient work.…”

Section: Introductionmentioning

confidence: 99%

“…Articulation wor k captures professionals’ practices in coordinating and aligning the varied elements related to individual patients’ care trajectory: “the work that makes the work, work” [ 25 , 29 , 30 ]. It connects the discontinuous and changing elements of professional practices and technologies, and requires the ability to respond to and handle emergent and unanticipated situations [ 22 , 25 ].…”

Section: Introductionmentioning

confidence: 99%

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Organizing work in local service implementation: an ethnographic study of nurses’ contributions and competencies in implementing a municipal acute ward

Krone-Hjertstrøm

Norbye

Abelsen

et al. 2021

BMC Health Serv Res

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Background The increased prevalence of chronic diseases and an ageing population challenge healthcare delivery, particularly hospital-based care. To address this issue, health policy aims to decentralize healthcare by transferring responsibility and introducing new services in primary healthcare. In-depth knowledge of associated implementation processes is crucial for health care managers, policymakers, and the health care personnel involved. In this article, we apply an ethnographic approach in a study of nurses’ contributions to the implementation of a new inpatient service in an outpatient primary care emergency clinic and explore the competencies involved. The approach allowed us to explore the unexpressed yet significant effort, knowledge and competence of nurses that shaped the new service. Methods The study combines observations (250 h) and several in situ interviews with healthcare personnel and individual in-depth interviews with nurses (n = 8) at the emergency clinic. In our analysis, we draw on a sociological perspective on healthcare work and organization that considers nursing a practice within the boundaries of clinical patient work, organizational structures, and managerial and professional requirements. Results We describe the following three aspects of nurses’ contributions to the implementation of the new service: (1) anticipating worst-case scenarios and taking responsibility for preventing them, (2) contributing coherence in patient care by ensuring that new and established procedures are interconnected, and (3) engaging in “invisible work”. The nurses draw on their own experiences from their work as emergency nurses and knowledge of the local and regional contexts. They utilize their knowledge, competence, and organizing skills to influence the implementation process and ensure high-quality healthcare delivery in the extended service. Conclusions Our study illustrates that nurses’ contributions are vital to coordinating and adjusting extended services. Organizing work, in addition to clinical work, is a crucial aspect of nursing work. It ‘glues’ the complex and varied components of the individual patient’s services into coherent and holistic care trajectories. It is this organizing competence that nurses utilize when coordinating and adjusting extended services. We believe that nurses’ organizing work is generally invaluable in implementing new services, although it has not been well emphasized in practice and research.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Organizing work in local service implementation: an ethnographic study of nurses’ contributions and competencies in implementing a municipal acute ward

Krone-Hjertstrøm

Norbye

Abelsen

et al. 2021

BMC Health Serv Res

View full text Add to dashboard Cite

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“…In our data analysis, we drew on the theory of the social organization of healthcare work, particularly the concepts “organizing work” and “articulation work” [12,13,14]. This theoretical perspective allowed us to view healthcare as a complex social organization in which professional knowledge and values, regulative and managerial structures and incentives were integrated into the organizational structures [15,16]. These structures continuously shape and are shaped by the daily work of professionals.…”

Section: Introductionmentioning

confidence: 99%

Making New Health Services Work: Nurse Leaders as Facilitators of Service Development in Rural Emergency Services

2018

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Nurse leaders in middle management positions in Norway and other Western countries perform additional new tasks due to high demands for quality and efficacy in healthcare services. These nurses are increasingly becoming responsible for service development and innovation in addition to their traditional leadership and management roles. This article analyses two Norwegian nurse leaders efforts in developing an emergency service in rural municipal healthcare. The analysis applies an ethnographic approach to the data collection by combining interviews with the nurse leaders with observations and interviews with six nurses in the emergency service. The primary theoretical concepts used to support the analysis include “organizing work” and “articulation work”. The results show that in the development of an existing emergency room service, the nurse leaders drew upon their experience as clinical nurses and leaders in various middle management positions in rural community healthcare. Due to their local knowledge and experience, the nurses were able to mobilize and facilitate cooperation among relevant actors in the community and negotiate for resources required for emergency medical equipment, professional development, and staffing to perform emergency care within the rural healthcare context. Due to their distinctive professional and organizational competency and experience, the nurse leaders were well equipped to play a key role in developing services. While mobilizing actors and negotiating for resources, the nurses creatively balanced these two aspects of nursing work to develop the service in accordance to their expectation of providing the highest quality of nursing care to their patients. The nurse leaders balanced their professional ambitions for the service with legal directives, economic incentives, and budgets. Throughout the development process, the nurses carefully combined value-based and goal-based management concerns. In contrast, other studies investigating nursing management and leadership have described that these orientations are in opposition to each other. This study shows that nurses leading the processes of change in rural communities manage the change process by combining the professional and organizational domains of the services.

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The Role of the Quality Coordinator: Articulation Work in Quality Development

Cited by 2 publications

References 17 publications

Organizing work in local service implementation: an ethnographic study of nurses’ contributions and competencies in implementing a municipal acute ward

Organizing work in local service implementation: an ethnographic study of nurses’ contributions and competencies in implementing a municipal acute ward

Making New Health Services Work: Nurse Leaders as Facilitators of Service Development in Rural Emergency Services

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