Practitioners and practice: Healthcare providers' experience of organizational change.

摘要

The American healthcare system is constantly changing, yet we know little about how healthcare workers experience these transformations and how these changes affect providers' interactions and coordination of care. Therefore, this dissertation examines the move of a Neonatal Intensive Care Unit (NICU) from an open bay to single-patient rooms as experienced by the staff. By focusing on staff perspectives, this study extends traditional macro level approaches to studies of change in the healthcare system by evaluating the multivalent, contingent, and temporal process of organizational change as it occurs in a case study at the local level. To understand this relationship, I analyze longitudinal qualitative and quantitative data gathered at a NICU as it moved locations. The survey data for my dissertation comes from the Teamwork, Clinical Culture and Change in the NICU study.;I assess three important aspects of providers' experience of change. First, I analyze the relationship between place and practice. I find that healthcare practices are simultaneously created by the place in which it occurs and contingently adapted to place on the basis of the preexisting culture. Second I assess providers' interpretations of change prior to its implementation. I find significant differences in providers' attitudes towards change. Importantly, these attitudinal differences are not simply a matter of individual reactions towards change but are rooted in occupational roles and responsibilities in the organization. Finally, I examine the relationship between change and providers' perceived control over their work. I find higher status workers perceived less change in their individual routines of patient care, compared to lower status workers. However, all providers experienced important changes in the social aspects of their work, including the practices involved in the coordination and collaboration of patient care. Findings from this dissertation have practical implications for healthcare organizations undergoing change as well as theoretical implications for medical and organizational sociology.