White Coats at the Coalface: The Standardizing Work of Professionals at the Frontline

Abstract

This study advances theory on professionals by introducing a novel ‘coalface perspective’ to study frontline professionals’ standardizing work. Our multimethod quantitative and qualitative approach explores when, why and how medical professionals in German university hospitals actively maintain care pathway enactment – a technique to standardize day-to-day medical work – in their everyday patient treatment. Professionals’ actively standardizing their work is an understudied yet highly relevant phenomenon that the established ‘autonomy perspective’ – which covers how professionals resist standardization – falls short of explaining. Introducing a coalface perspective overcomes this shortcoming by uncovering novel links between professionals’ day-to-day problem-driven motivations for standardizing work, the characteristics of everyday situations of frontline professional work and practices of standardizing work at the frontline. This study has implications for research on frontline professionals and coalface-perspective research in general.

The Institutional Logic of Digitalism: Exploring The Aftermath of Large-Scale Technology In Healthcare Organisations

“…First, they represent the organisational view of ICT experts, which is distinct from that of clinicians and managers. This stands in contrast with the standardisation of skills and autonomy as the basis for co-ordination in professionalism (57) and with the formal organisation structure as the basis for co-ordination in managerialism. Second, the models guide ICT experts in the implementation and maintenance of systems.…”

“…This paradoxical relationship between the need for standardisation and the quest for autonomy in professionalism has been addressed by several other scholars. (54)(55)(56)(57) The paradox is especially visible in day-to-day routines that promote standardisation and work practices that promote autonomy. (57) This was even more evident in our case, which introduced digitalism.…”

Health Care Research and Organization Theory

“…Adler and Kwon (2013) investigated how physicians' traditional autonomy was challenged by various economic and organizational forces by focusing on the diffusion of clinical guidelines that rationalized healthcare delivery in hospitals. Building on this, Wilhelm, Bullinger, and Chromik (2020) found that such standardization can be maintained as opposed to resisted by physicians when it provides a solution to a pressing problem such as the lack of organizational resources or inconsistent medical socialization of junior professionals.…”

Resourcing Under Tensions: How frontline employees create resources to balance paradoxical tensions

“…Studying resourcing needs to consider that 'everyday actions are consequential in producing the structural contours of social life' (Feldman & Orlikowski, 2011, p. 1241, since organizational and institutional embeddedness gives actors' practices meaning in concrete situations (Seidl & Whittington, 2014;Smets et al, 2017). Focusing on frontline work requires researchers to account for individuals' everyday problems and tensions and for their embeddedness in the situational, organizational and institutional contexts (Wilhelm, Bullinger, & Chromik, 2019) that provide them with potential resources for addressing these problems and tensions. Frontline work requires action yet constrains actors' room for manoeuvre, and is therefore the ideal setting to study such a pervasive and organizationally relevant phenomenon as resourcing under tensions.…”