Center for Activity Theory and Developmental Work Research

Saaren-Seppälä T (2004): Yhteisen potilaan hoito -tutkimus organisaatiorajat ylittävästä yhteistoiminnasta sairaalan, terveyskeskuksen ja lapsipotilaiden vanhempien suhteista. Acta Universitatis Tamperensis 1052. Tampere University Press.
Sähköisenä: Acta Electronica Universitatis Tamperensis 401.

Abstract
Institutional practice connecting patients, primary and secondary medical care is culturally and historically developed and takes place as daily routines. Still the actors treating the same patient have an opportunity to improvise their actions in the care-network. Collaborative activity across the organizational boundaries is studied here as a relation between children's parents, primary care physicians and hospital specialists who are taking into use a new co-operative tool called the care-agreement.
The care-agreement was collectively developed in a project of the Children's Hospital. The research data of this study was collected during the project in 1997 – 1999. This is a longitudinal research with a naturally occurring ethnographic data that consists of a tape-recorded patients’ visits to hospital and primary care, interviews of the 16 child patients’ parents (24) and interviews of health care professionals (72) treating the children, plus each patient's medical files from every care provider including (561) doctor’s appointment. The analysis of the data is done by using mostly qualitative, but also quantitative methods. Sociology of medicine and Activity Theory and Developmental Work Research are the theoretical framework of the study.
Collaborative activity is investigated through referral practices, care responsibility, power, trust and object sharing within the personal and institutional relations of the partners involved in the child's care. Care responsibility was unclear and embraced contradictory accounts when the care was divided within a network. Multiple medical problems and fragmented health care systems are not producing continuity of management for an individual patient's care, if there is a lack of personal knowing, or of organizational tools for cooperation. The care-agreement prompted a wide range of new justifications of responsibility and made data transmission significantly better than before. It also brought a new kind of exchange between the partners like reciprocity of relationships and empowering. Historical analysis of the collaborative activity puts the critical pathways, continuity and care-processes into a new light - standardized and organizationally managed-care is not enough. There is a need for personal knowing and individual solutions as well when the patient's care is divided across levels of care.
This study points out that it is possible to change clinical decision-making practices towards a collaboratively shared object of work through socially constructed artefacts. In other words, health care professional might act perfectly in their own organizations but their actions or non-actions always have unintended or intended affects on their colleagues in other organizations and on the care available to a patient.