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Abstract

Introducing an effort to reform hospital care – ripples on water

This study deals with organizational change in the health care sector. Can a hospital change itself? Previous studies have pointed to difficulties. The initiative discussed, to restructure hospital care, includes ideas for change, management, and learning. A change initiative called “Leadership in Improvement and Application” (LIFT) was launched. It consisted of a mixture of management tools – such as cultural engineering initiatives, total quality management (TQM), and business process reengineering (BPR) – and taking the form of modern management. It was launched by a new hospital director, consultants and researchers from a university. The study uses organizing as a theoretical path and combines reform and practice perspectives to illustrate how ideas can be translated into management practice. The methodology of the study includes observations, interviews, and documents. The methodology is inspired by an ethnographic approach and in reporting the research some narrative devices are used. Here is also a method that Gherardi (2006) calls “talk in practice” and “talk about practice,” applied. It includes the assumption that talk is also action, when I shed light on the heterogeneous materials that may receive, and act on, the initiative. The study shows how a controversy is created, gains momentum, climaxes, and reproduces itself. The series of connected events or actions in hospital care shows how ideas can materialize, and be made reality, but that translating them from regular to automatic action can prove hard to achieve. Within the organizing process that leads to (re)organization(s), actors engage in role play, assigning groups to readymade behaviors. The study also shows that the various groups of actors – each motivated by different interests – operate within different time frames. The process takes time. The main conclusions of this thesis are related to time, space, and materiality. A series of events take place over time. They are connected by a strong coupling tool. They connect to unrelated areas (e.g., non-management practice) via communication (a verbal action). The study replaces the reasoning prevalent since the late 1970s concerning decoupling and recognize the potential of loose coupling. Relevant actors refer to health care processes as pathological and abnormal. This study shows a new perspective for conversation.