Article

Introducing the electronic patient record (EPR) in a hospital setting: boundary work and shifting constructions of professional identities.

Department of Adult Learning and Counselling, Norwegian University of Science and Technology, Trondheim, Norway.
Sociology of Health & Illness (Impact Factor: 1.88). 10/2011; 34(5):761-75. DOI:10.1111/j.1467-9566.2011.01413.x
Source: PubMed

ABSTRACT Today's healthcare sector is being transformed by several ongoing processes, among them the introduction of new technologies, new financial models and new ways of organising work. The introduction of the electronic patient record (EPR) is representative and part of these extensive changes. Based on interviews with health personnel and office staff in a regional hospital in Norway, and with health administrators and information technology service-centre staff in the region, the article examines how the introduction of the EPR, as experienced by the participants, affects the work practices and boundaries between various professional groups in the healthcare system and discusses the implications this has for the understanding of medical practice. The article shows how the EPR has become part of the professionals' boundary work; expressing shifting constructions of professional identities.

0 0
 · 
0 Bookmarks
 · 
62 Views
  • [show abstract] [hide abstract]
    ABSTRACT: Freidson is a foremost analyst of the medical profession. Most recently Freidson attacks those who claim that medicine is declining in power. He insists that medicine has not lost the core elements that make it a powerful, indeed, the dominant, health profession. The author compares Freidson's early writings on medicine with his most recent ones, and shows that there are critical confusions in Freidson's central concepts of professional autonomy and dominance. This difficulty is illuminated by viewing dominance, autonomy, and subordination as on a continuum of control. Using this continuum, the author argues that Freidson implicitly admits what he set out to deny (that medicine has not declined in power) by shifting his focus from medical dominance to that of autonomy. Freidson also now rejects valid parts of his earlier work (that which emphasizes social structural determinants of behavior over socialization). In equating medicine in the United States with teaching in that country, Freidson's contention of "little change in medical power" meets its own refutation. Finally, despite his derogation of others, Freidson's lack of an adequate framework to explain the dynamics and not simply the structure of health care produces purely normative, utopian (and unhelpful) policy recommendations.
    International Journal of Health Services 02/1992; 22(3):497-512. · 1.24 Impact Factor
  • Source
    [show abstract] [hide abstract]
    ABSTRACT: Technological solutions to problems of knowledge and practice in health care are routinely advocated. This paper explores the ways that new systems of practice are being deployed as intermediaries in interactions between clinicians and their patients. Central to this analysis is the apparent conflict between two important ways of organizing ideas about practice in primary care. First, a shift away from the medical objectification of the patient, towards patient-centred clinical practice in which patients'heterogeneous experiences and narratives of ill-health are qualitatively engaged and enrolled in decisions about the management of illness trajectories. Second the mobilization of evidence about large populations of experimental subjects revealed through an impetus towards evidence-based medicine, in which quantitative knowledge is engaged and enrolled to guide the management of illness, and is mediated through clinical guidelines. The tension between these two ways of organizing ideas about clinical practice is a strong one, but both impulses are embodied in new 'technological' solutions to the management of heterogeneity in the clinical encounter. Technological solutions themselves, we argue, embody and enact these tensions, but may also be opening up a new array of practices--technogovernance--in which the heterogeneous narratives of the patient-centred encounter can be resituated and guided.
    Social Science [?] Medicine 03/2006; 62(4):1022-30. · 2.73 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: This paper makes the case for bringing empirical analysis to the heart of conceptual work about health care practice. Drawing on ethnographic observations in intensive care units in the UK, it identifies and analyses a mismatch between the practice of a particular health care specialty and its associated professional and academic discourse. As a result, two claims in academic nursing discourse are criticised: first, that nursing practice is (or should be) focused on individual patient care; and second, that nursing is (or should be) radically distinct from medicine. By raising the analytical profile of situated practice, health care workers (in particular, but not exclusively, nurses) are shown to undertake important caring work with patients' relatives. Their work includes caring not only for an individual patient's social self, but also for patients'social contexts. The paper also argues that theoretical emphases on nursing's unique perspective and on differences between medicine and nursing are exaggerated in clinical practice, for example there are many similarities between what nurses and doctors actually do. Reasons for the persistence of these claims in academic nursing discourse are put forward-nursing seems to be quite unusual in needing an explicit theory of practice, and the paper speculates on why this is the case. The general lesson of the paper is that analytical evidence about the context and content of practice needs to be afforded a more fundamental role in the development of theories about practice-based disciplines.
    Social Science [?] Medicine 05/2006; 62(8):2079-90. · 2.73 Impact Factor

Erna Håland