Analysis

Role of routines in collaborative work in healthcare organisations

BMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a2448 (Published 17 November 2008) Cite this as: BMJ 2008;337:a2448
  1. Trisha Greenhalgh, professor
  1. 1UCL Research Department of Primary Care and Population Health, University College London, London N19 5LW
  1. Correspondence to: p.greenhalgh{at}pcps.ucl.ac.uk
  • Accepted 6 September 2008

Work routines are often viewed negatively, but Trisha Greenhalgh reviews evidence showing that they can be the key to maintaining and improving quality of care

We all know that health care is becoming more complex. This complexity carries risks. The US Institute of Medicine report Crossing the Quality Chasm and an international overview by the Organisation for Economic Cooperation and Development identified poor coordination and collaboration as a major (and growing) weakness of healthcare systems.1 2 Although the organisation and delivery of health care have been widely studied, the question of how to improve collaborative health care—that is, people working together around a common task or goal—has rarely been addressed either theoretically or empirically. Existing work on coordination of care is typified by “black box” studies that measure inputs and outcomes without examining the process of coordination.3

When undertaking a systematic review on the spread and sustainability of innovation in health care,4 I discovered a novel theoretical perspective on organisational routines.5 6 7 A subsequent search uncovered some important empirical work in healthcare settings that had been published in organisational sociology journals.8 9 10 11 12 13 14 15 16 Here, I synthesise the findings to consider how key theories, methods, and findings might be adapted and applied in a wider healthcare context.

What is a routine?

An organisational routine is “a repetitive, recognizable pattern of interdependent actions, involving multiple actors.”17 Becker suggested that the routine may be the most fruitful unit of analysis when researching organisational change and set out its defining characteristics (box 1).5 One purpose of routines in organisations is to reduce uncertainty (and hence, cognitive dissonance and stress). On our first day in a new job, for example, we experience confusion because we do not “know the ropes.” Work gradually becomes less stressful …

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