Embedding hospital-based medication review: The conflictual and developmental potential of a practice
Journal of Health Organization and Management
ISSN: 1477-7266
Article publication date: 18 April 2019
Issue publication date: 24 May 2019
Abstract
Purpose
The purpose of this paper is to explore the embedding of hospital-based medication review attending to the conflictual and developmental nature of practice. Specifically, this paper examines manifestations of contradictions and how they play out in professional practices and local embedding processes.
Design/methodology/approach
Using ethnographic methods, this paper employs the activity-theoretic notion of contradictions for analyzing the embedding of medication review. Data from participant observation (in total 290 h over 48 different workdays) and 31 semi-structured interviews with different healthcare professionals in two Swedish hospital-based settings (emergency department, department of surgery) are utilized.
Findings
The conflictual and developmental potential related to three interrelated characteristics (contested, fragmented and distributed) of the activity object is shown. The contested nature is illustrated showing different conceptualizations, interests and positions both within and across different professional groups. The fragmented character of medication review is shown by tensions related to the appraisal of the utility of the newly introduced practice. Finally, the distributed character is exemplified through tensions between individual and collective responsibility when engaging in multi-site work. Overall, the need for ongoing “repair” work is demonstrated.
Originality/value
By using a practice-theoretical approach and ethnographic methods, this paper presents a novel perspective for studying local embedding processes. Following the day-to-day work of frontline clinicians captures the ongoing processes of embedding medication review and highlights the opportunities to learn from contradictions inherent in routine work practices.
Keywords
Acknowledgements
Conflict of interest: the authors declare no conflict of interest.
This work was supported by the Swedish Research Council for Health, Working Life and Welfare (Forte) under Grant No. 2014-4657; the Medical Research Council of Southeast Sweden (FORSS) under Grant Nos FORSS-476971, FORSS-568651; and County Council of Östergötland patient safety research fund (Region Östergötlands Medel för Patientsäkerhetsforskning) under Grant Nos LIO-533151, LIO-626451.
Citation
Reichenpfader, U., Wickström, A., Abrandt Dahlgren, M. and Carlfjord, S. (2019), "Embedding hospital-based medication review: The conflictual and developmental potential of a practice", Journal of Health Organization and Management, Vol. 33 No. 3, pp. 339-352. https://doi.org/10.1108/JHOM-09-2018-0268
Publisher
:Emerald Publishing Limited
Copyright © 2019, Emerald Publishing Limited