Negotiated Order and the Clinical Pharmacist: The Ongoing Process of Structure

Abstract

Negotiated order theory was initiated about twenty‐five years ago within the interactionist perspective as an alternative to the dominant perspective of organizational behavior as structurally determined. Since that time, the theoretical framework has proven itself to be a viable means of understanding individual relationships within their larger contexts, for understanding the relationship between process and structure. This theoretical perspective is particularly appropriate for analyzing the attempts of hospital pharmacists to negotiate an expanded, more “clinical” role for themselves on the medical team. This article presents data gathered through extensive participant observation of pharmacists in two hospital settings as it applies to negotiated order theory.

Becoming hybrid: The negotiated order on the front line of public–private partnerships

“…Although the negotiated order concept can lack specificity (Allen, 1997), past research typically highlights three elements of the negotiation process. First, there are (more or less explicit) disagreements about given activities or situations; second, interactions around these disagreements are characterized by processes of negotiation or exchange, rather than direct authority or force; and third, settlements are reached that maintain or transform social order (Day and Day, 1977; Maines, 1982; Maines and Charlton, 1985; Mesler, 1989; O’Toole and O’Toole, 1981; Strauss, 1978; Thomas, 1984). Extant literature has identified forms of negotiation including trade-offs, deals and pacts, compromises, exchanges and silent bargains (Day and Day, 1977; Maines, 1982; Mesler, 1989; O’Toole and O’Toole, 1981; Thomas, 1984).…”

Mechanisms and Meaning Structures

“…Micro-sociologists from Blumer on, however, usually understand the problem of situational meaning in terms of interaction and negotiated order, rather than as trans-situational systems of relational meaning (Fine 1996;Fine and Kleinman 1983;Hall 1997;Mesler 1989;J. Thomas 1984;Wolkomir 2001).…”

Boundary encroachment and task delegation: clinical pharmacists on the medical team

“…In an economic climate of cost constraints, hospital administrators ask all departments to document the cost effectiveness of their personnel. By not recording their therapeutic input in the patient's chart, clinically oriented pharmacists have struggled to find alternative means of documentation (see Facchinetti 1985, andMesler 1989 for a discussion of these problems for clinical pharmacy; and see Burkle et al 1982;Chrymko and Conrad 1982;Saklad et al 1984, andSmith 1982 for examples of pharmacy's attempts to resolve them).…”