Standardization for patient safety in a hospital department: killing butterflies with a musket?

Abstract

Purpose The purpose of this paper is to look at the ways in which standardization for patient safety is approached from different positions in the field, namely nurses and managers in a hospital department, the hospital management and standard inventers. We understand safety standardization and the responses to it as a strategizing process, where standards are legitimized, taken up, handled or countered. Design/methodology/approach Ethnographic fieldwork was conducted in a Danish hospital department. The study included observations, interviews and documents studies. The authors apply a Bourdieusian perspective, where the authors focus on the narratives told by standard inventers, managers and nurses to examine and understand their strategizing activities in relation to safety standardization. We understand strategizing as interested action emerging in the dialectics between a habitus and a position in a field. Findings The authors show how the standardization of work rests on the master narrative of patient safety management and how this narrative clashes with the nurses’ practical perception of good care, which rests on the counter-narrative of the clinical judgment. Originality/value Safety standardization in healthcare is often studied within the broader framework of performance management using functionalist outside-in and prescriptive approaches. This study contributes to this literature by approaching standardization and the responses to it as taking place in a dialectic movement between subjective shop floor experiences and wider field-level forces. Furthermore, the study contributes to the organization and management literature concerned with change and strategic action by endorsing the Bourdieusian conception of strategizing.