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Kerosuo, H. (2007). Renegotiating disjunctions in interorganizationally provided care. In R. Iedema (Ed.) The Discourse of Hospital Communication—Tracing Complexities in Contemporary Health Care Organization, 138-161. Basingstoke, Hampshire, UK and New York: Palgrave Macmillan.
The increasing complexity of work and organization raises new challenges for service production in traditional organizations. The conventional and familiar practices of working and organizing work are becoming re-designed. However, many institutions such as health care are still trapped inside old metaphors of organizing according to which work and organizations can be thoroughly planned, broken down into units, and optimized. Organizational interfaces explore the dynamics related to complexities in health care practice. Organizational interfaces uncover how discrepancies of organizational interests, values, power, and division of labor are mediated at critical points of linkage in patients’ care provision. Interfaces typically occur at points where different, and often conflicting, life worlds or organizational fields intersect revealing the ‘gaps’ in the care provision. In these situations, interactions between participants become oriented towards problems of bridging, accommodating, segregating, or contesting the everyday care practices.
In this paper, I will explore challenges related to organizational interfaces in the interaction between patients and providers when they are improving the patients’ care provision. The data of the study was gathered in an intervention project in which new tools and a new care practice were implemented and enhanced in the care of patients with multiple illnesses. Altogether, the care of the twenty-six patients was analysed with the patients actively participating the project. However, the organizational interfaces appeared most distinctively in intervention meetings called ‘change laboratories’. At a change laboratory, a patient and professionals engaged with problems in a patient’s care provision. While the encounters at the change laboratories promoted learning and development of the care practice under study, they also uncovered lacks and tensions in the care provision. In this study, these occurrences are analysed in the data that contains videotaped interviews with the patients and care providers, as well as the videotaped change laboratory meetings. The concepts of the gap, the collision, and the bridge guide the analysis of organizational interfaces. Gaps are types of ruptures emerging in inter-subjective interaction. Collisions involve asymmetry of power and dominance between professional and lay knowledge. Bridge building refers to negotiation, crossing over a rupture and working out the gaps in the care provision.
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