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

Abstract

PurposeThe 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/approachThe 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.FindingsMobilisation 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/valueOrthodox 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.