Institutional Logics in Continuous Improvement : A study of nurses’ involvement in healthcare change
Abstract: Problem: Continuous improvement is important in modern healthcare to control increasing costs and fulfil the demand for higher quality. This requires interdisciplinary collaboration between healthcare professionals. However, these professions are seeking to maintain and improve their social status through a ‘professional project’. There are existing professional barriers based on historical privileges and boundaries, leading to nurses holding lower status. The extent to which this motivates medical professionals and nurses in particular to be involved in continuous improvement is unclear. Is it that nurses are driven to become involved in continuous improvement by their ‘professional project’, and is there any evidence that involvement in continuous improvement benefits their status? Purpose: This thesis explores (a) the effect that the ‘professional project’ of nursing, gaining relative equality with doctors, has on involvement in continuous improvement activities, and (b) how involvement in continuous improvement activities affects the status of nurses relative to doctors. Method: This qualitative study has been performed through an interview study based on themes, on the topic of improvement in healthcare. The empirical data is gathered through semi-structured interviews conducted with professionals from Sweden, New Zealand and The Netherlands. The participants were active within Hospitals and Primary Care, and had the position of nurse, manager or doctor. Data was analysed using the Thematic Analysis approach as proposed by Braun & Clarke (2006). Findings: The results of our research suggest that nurses’ status has certainly improved. However, rational status-seeking described by many other researchers, could be better described as ‘seeking a voice’. Nurses are driven by ambition and improving patient care, rather than seeking strict equality with doctors. Continuous improvement has given nurses the opportunity to take on more technical roles and have more input on the way medical tasks are conducted. Enhanced communication between all levels of healthcare organisations has given nurses the opportunity to show their knowledge. It has resulted in more understanding and respect by doctors of what nurses are capable of. Nurses are highly motivated to participate in continuous improvement, driven by the common logic of patient centricity. However, external factors such as limited time and financial support slow them down.
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