Translational mobilisation theory: a new paradigm for understanding the organisational elements of nursing work

Translational Mobilisation Theory (TMT) is a generic sociological theory that explains how emergent projects of collective action are progressed in complex organisational contexts. Grounded in a substantial programme of research on healthcare work, it has value for understanding the organisational component of the nursing role for educational, practice and research purposes. This paper introduces Translational Mobilisation Theory, outlines its core components, and considers its application to nursing using ethnographic research on the organising work of nurses as an empirical reference. Organising work is a neglected element of the nursing function and lacks theoretical foundations. As the complexity and intensity of healthcare continues to accelerate this is an important gap in existing frameworks of understanding

Analysing healthcare coordination using translational mobilization

Purpose The purpose of this paper is to introduce translational mobilization theory (TMT) and explore its application for healthcare quality improvement purposes. Design/methodology/approach TMT is a generic sociological theory that explains how projects of collective action are progressed in complex organizational contexts. This paper introduces TMT, outlines its ontological assumptions and core components, and explores its potential value for quality improvement using rescue trajectories as an illustrative case. Findings TMT has value for understanding coordination and collaboration in healthcare. Inviting a radical reconceptualization of healthcare organization, its potential applications include: mapping healthcare processes, understanding the role of artifacts in healthcare work, analyzing the relationship between content, context and implementation, program theory development and providing a comparative framework for supporting cross-sector learning. Originality/value Poor coordination and collaboration are well-recognized weaknesses in modern healthcare systems and represent important risks to quality and safety. While the organization and delivery of healthcare has been widely studied, and there is an extensive literature on team and inter-professional working, we lack readily accessible theoretical frameworks for analyzing collaborative work practices. TMT addresses this gap in understanding

Institutionalising emergent organisation in health and social care

Purpose The purpose of this paper is to argue for the institutionalisation of emergent forms of organisation in health and social care and offer a conceptual framework for this purpose. Design/methodology/approach Drawing on ethnographic research on the organising work of nurses and Translational Mobilisation Theory, this paper extends two classic Straussian sociological concepts – illness trajectory and articulation work – to conceptualise emergent organisation as Care Trajectory Management. Findings Failures of coordination are well-recognised threats to quality and safety and recent decades have witnessed an explosion of neoliberal technologies and governance arrangements designed to “measure and manage” these risks. Yet in a significant and growing proportion of health and social care provision successful service integration depends not on rational planning, but iterative negotiations and adjustments in response to contingencies. While ubiquitous in health and social care systems, these emergent forms of organisation lack legitimacy, the work involved is relatively invisible and practice is poorly served by prevailing management discourses. Originality/value The Care Trajectory Management Framework provides an alternative discourse and logic on which to develop strategies and technologies to support emergent organisational processes in acute and community care contexts

The importance, challenges and prospects of taking work practices into account for healthcare quality improvement

Purpose – The purpose of this paper is to underline the importance of taking work practices into account for quality improvement (QI) purposes, highlight some of the challenges of doing so, and suggest strategies for future research and practice. Patient status at a glance, a Lean-inspired QI intervention designed to alleviate nurses of their knowledge mobilisation function, is deployed as an illustrative case. Design/methodology/approach – Ethnographic data and practice-based theories are utilised to describe nurses’ knowledge mobilisation work. The assumptions about knowledge sharing embedded in patient status at a glance white boards (PSAGWBs) are analysed drawing on actor network theory. Findings – There is a disparity between nurses’ knowledge mobilisation practices and the scripts that inform the design of PSAGWBs. PSAGWBs are designed to be intermediaries and to transport meaning without transformation. When nurses circulate knowledge for patient management purposes, they operate as mediators, translating diverse information sources and modifying meaning for different audiences. PSAGWBs are unlikely to relieve nurses of their knowledge mobilisation function and may actually add to the burdens of this work. Despite this nurses have readily embraced this QI intervention. Research limitations/implications – The study is limited by its focus on a single case and by the inferential (rather than the empirical) nature of its conclusions. Originality/value – This paper illustrates the importance of taking practice into account in healthcare QI, points to some of the challenges of doing so and highlights the potential of practice-based approaches in supporting progress in this field

Care trajectory management: a conceptual framework for formalising emergent organisation in nursing practice

Aim: To offer a new conceptual framework for formalising nurses’ work in managing emergent organisation in health and social care. Background: Much health and social care requires continuous oversight and adjustments in response to contingencies. Nurses have an important role in managing these relationships. Evaluation: A longstanding programme of research on the social organisation of health and social care work provided the foundations for the article. Key issue: Nurses’ work in managing emergent organisation may be conceptualised as Care Trajectory Management and factors contributing to trajectory complexity are explored. Conclusions: Care trajectory management is essential for the quality and safety of health and social care but poorly served by existing management frameworks. Implications for nursing management: Care trajectory management offers a conceptual framework for the development of new management structures to support an important but poorly supported element of nursing practice

The shape of general hospital nursing: the division of labour at work

This thesis is about nursing work and the ways in which nurses in a general hospital accomplished occupational jurisdiction. It is based on ethnographic data generated on a surgical ward and a medical ward in a single NHS trust hospital. The study is set in the context of recent developments in nursing and medical education (DHSS, 1987; GMC, 1993; UKCC, 1987) and health policy (DH, 1989) which have created the impetus for shifts in the division of labour in health care, reviving deep-rooted historical tensions between professional and service versions of nursing. Drawing on the work of Hughes (1984), Abbott (1988) and Strauss and colleagues (Strauss et al, 1963; Strauss et al, 1964; Strauss, 1978) the aim of this project was to move on from the policy debates and develop a less essentialist account of the nursing role through an exploration of the ways in which nurses managed the parameters of their work in the course of their everyday activities. Hughes concept of 'dirty work' is employed as a sensitising device. The work of hospital-based general nurses is explored through the analysis of five key nursing boundaries: nurse-doctor, nurse-support worker, nurse-patient/relative, nurse-nurse, and nurse-management. The professional and sociological literature suggested that as a result of recent policy developments, there would be an increased need for negotiation of nurses' inter-occupational boundaries with medicine and support workers and that this was likely to be subject to some tension. But field observations revealed that nurses accomplished these inter-occupational boundaries with minimal negotiation and little explicit conflict. Conversely, there were policy-related tensions at the three other key nursing boundaries - at nurses' infra-occupational boundary, at the boundary between nurses and patients and their relatives, and at the boundary between ward-based nurses and nursing and general management - which were largely unanticipated

Prioritising the mobilisation of emergency medical services: patient making at the healthcare gateway

Purpose The purpose of this paper is to analyse the socio-material practices through which organisational understanding of patients is accomplished in order to prioritise calls and mobilise emergency medical services at the gateway of the healthcare system. Design/methodology/approach The methodology of this paper is an ethnographic study of the co-ordination of collective action in an emergency services control room in the Welsh NHS, with data generation and analysis informed by Translational Mobilisation Theory. Findings Mobilisation of emergency medical services entails the translation of callers' undifferentiated problems into response priority categories, which are used by dispatch operators to mobilise crews. A central actor in these processes is the computerised Medical Priority Dispatch System. While designed to enable non-clinically qualified call handlers to triage calls in a standardised way, the system constrains caller–call handler interaction, which negatively impacts the categorisation process. Analysis of these interactional difficulties and associated mitigation strategies highlights opportunities for intervening to support co-ordination at this healthcare boundary. Originality/value Orthodox approaches to improving interface management are founded on a conceptualisation of “patients” as immutable actors in care transfer processes. Translational Mobilisation Theory brings into view the multiple versions of the “patient” produced by healthcare systems and offers a framework for analysing the mechanisms of action necessary to create organisational understandings of patients at boundary crossings. While the ambulance control centre is a singular case, the paper illustrates the value of attending to these processes in interface organisation

"Just a typical teenager": The social ecology of "normal adolescence" - insights from diabetes care

In Western society “normal adolescence” is understood to be a biologically driven phase characterized by emotional turmoil and irrational behavior. Despite being discredited within academic literature this discourse persists both in formal theory and everyday use. Drawing on the case of diabetes care, I argue that the discourse of “normal adolescence” derives its power from its value as a vocabulary of motive through which to navigate the contradictions inherent in the social order at this stage of the life-course. While helping us to comprehend sociologically the ecological niche in which “normal adolescence” is sustained, this analysis raises questions about the persistence of this discourse for social action