Standardization of Work: Co-constructed Practice

Abstract

There is strong pressure to achieve greater uniformity, standardisation and application of best practices in the service professions, a sector which is growing in presence and importance. At the same time, there is a conflicting demand for the delivery of high-quality (or highly priced or 'knowledge intensive') specialised or localised services. Our paper analyses information systems' embedded efforts of standardising service work through an in-depth interpretative study of an ongoing standardisation initiative within the field of nursing. Nursing provides a graphic illustration of the dilemmas involved in the standardisation of service work. In nursing, standardisation is commonly a feature of projects to improve both efficiency and quality in health care. In contrast to the dominant conception of standardisation as a largely top-down, imposed process, we offer a view of standardisation as incomplete, co-constructed with users and with significant unintended consequences. The paper contributes by i) developing a theoretical perspective for the standardisation of information-system-embedded 2 service work and ii) operational and practical implications for system design and health care management.

The Right Kind of Feedback: Working through Standardized Tools

“…Opinions about the role technology plays in an organization are highly variable, ranging from those who see it as an unproblematic transfer of ready-made packages to those who have empirically demonstrated the contextual situatednesss of technology use (Ellingsen et al 2007;Hepsø 2009;Orlikowski 2010). Moreover, its role is often not explicitly addressed and consequently black boxed, as Orlikowski and Scott (2008) found when they reviewed four leading journals on management research, in which 95% of the articles published in the last decade had no such reflection.…”

The interplay between global standards and local practice in nursing

“…Several studies have pointed out how the development of standards is co-constructed with an emerging work practice [40]. Still, very few have taken a mixed method approach and illustrated the extent (frequency analysis) and content (the longitudinal case study) of the mutual shaping process empirically.…”

“…Still, due to its origin in science and technology studies [26,34,40], a perspective on coconstruction has seldom been underpinned by quantitative data. Quantitative data such as frequency analysis may provide insight about the scope of use of terminology in a specific context.…”

“…co-construction [26,30,34]. The development of a standard in a local practice is therefore one of co-construction in which standardisation and work practice mutually shape and constitute each other [40]. Carlile (2004) uses the framework of transferring, translating, and transforming to illustrate the complex processes necessary to share and access domain-specific knowledge [41].…”

Quality Development in Health Care: Participation vs. Accreditation

“…These investments influence the relations between work organization and technology, which in turn transform each other (e.g., Berg et al, 2003). The introduction of new technologies is accompanied by standardization efforts to improve efficiency and quality in health care (e.g., Ellingsen et al, 2007;Klein, 2002). For example, during 2016-2017, the Capital Region and Region Zealand in Denmark have implemented the single largest information technology (IT) investment in the Danish health care sector to date (€400 million), replacing more than 30 IT systems with the Epic healthcare platform (Sundhedsplatform.dk) -an electronic health record system from the largest vendor of such systems in the US (epic.com).…”