A sociomaterial inquiry into the clinical teaching workplace

摘要

Purpose - This paper aims to trace the relational and material ways in which workplace teams come together (or fail to) in the provision of patient care. Design/methodology/approach - Six inter-professional scholars brought their unique theoretical and disciplinary lenses to understand the contextualized experiences of the patient and the team. Adopting a critical narrative inquiry (CNR) approach, the experiences of 19 participants were documented as they interacted in the care of an elderly patient over a three-week period. Actor network theory constructs enabled the analysis of multiple artefacts implicated in the interactions to learn of their contribution to the enactment of her care. Findings - The study gives empirical insights about ways in which knowledge circulates amongst the workplace and how systemic structures may impede effective and quality patient care. Various types of knowledge are held by different team members, and both individuals and materials (e.g. technologies) can influence the way those knowledges are shared (or not). Research limitations/implications - Focusing on a rich data set surrounding one patient documented as theatre serves pedagogical purposes and serves as a shared "boundary-breaking" object to interrogate from multiple stakeholder perspectives. CNR provides for recursive, dynamic learning as readers critically consider experiences within their own contexts. Practical implications - Despite research that documents competing political, systemic and economic goals, sedimented policies and practices persist in ways that undermine care goals. Social implications - Tackling the urgent issue of an aging population will require expanding collaboration (for planning, research and so on) to include a broader set of stakeholders, including operational, administrative and post-discharge organizations. Attention to social infrastructure as a means to assemble knowledges and improve relationships in the care process is critical. Originality/value - Building a boundary-breaking shared object to represent the data offers a unique opportunity for multiple stakeholder groups to enter into dialogue around barriers to workplace interaction and collaboration progress, linking problems to critical perspectives.