Repairing disrupted care processes as sources of stability, learning and change in a Finnish hospital: An activity-theoretical study.

INTRODUCTION: In high-income countries, it is estimated that one in every 10 patients is harmed while receiving hospital care; 50% of these are preventable. The aim of this study was to deepen our understanding of disruptions of care processes and how the repairing of disruptions can be sources of stability, learning and change in complex health care settings. METHODS: The organisational interactions associated with disruptions in the standard care processes of 15 surgical patients were followed in a public sector hospital in Finland. The patients and medical professionals were interviewed in situ during the observation of the care processes. An activity-theoretically informed methodological framework was used to identify and analyse disruptions and the associated repair efforts and repair solutions. RESULTS: Disruptions were frequent and found in all 15 care processes. These related to (1) the patient's worsening physiological state, (2) the equipment used in surgical care, (3) the information flow, (4) delays in the care process and (5) the unclear division of labour within the team. The actors carried out three types of repair efforts (technical, cognitive-emotional and extended collaborative) to overcome the disrupted processes, which usually led to repair solutions that restored stability. DISCUSSION: The different repair efforts required different kinds of collaboration and learning. Extended collaborative repair was most demanding, providing challenges and opportunities for practice change and expansive learning.

Organizational dynamics of interprofessional practice in the Norwegian prison system.

Reoffending rates may be reduced through efforts to rehabilitate prisoners. A more nuanced understanding is needed of how front-line prison and health care services collaborate during the rehabilitation process. We report an investigation of the organizational dynamics of interprofessional practice among prison, mental health, and welfare services in two Norwegian prison case studies. First, a high security (closed) prison where a coordination network was implemented among prison management, front-line staff, and external service personnel to enhance the prisoners' life management skills. Second, an (open) transitional residence, where interprofessional practice was facilitated by front-line prison staff to increase prisoners' ability to reintegrate into society through their socialization and access to external services. The study demonstrates the demands on prisoners as they move from passive service receivers to active service users/organizer, and how interprofessional practice and models of service integration support them in this process.