Improvising Prescription: Evidence from the Emergency Room |
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Authors: | Maria da Graça Batista Stewart Clegg Miguel Pina e Cunha Luca Giustiniano Arménio Rego |
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Affiliation: | 1. Economics and Management Department and CEEAplA, Universidade dos A?ores, Campus de Ponta Delgada, Ponta Delgada, Portugal;2. University of Technology Sydney and Nova School of Business and Economics, UTS Business School, Ultimo NSW 2007, Australia;3. Nova School of Business and Economics, Universidade Nova de Lisboa, Campus de Campolide, Portugal;4. LUISS Guido Carli University, Rome, Italy, Department of Business and Management, Viale Romania, Italy;5. Universidade de Aveiro and Business Research Unit (BRU‐UNIDE), Instituto Universitário de Lisboa (ISCTE‐IUL), Campus Universitário de Santiago, Portugal |
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Abstract: | Global medical practice is increasingly standardizing through evidence‐based approaches and quality certification procedures. Despite this increasing standardization, medical work in emergency units necessarily involves sensitivity to the individual, the particular and the unexpected. While much medical practice is routine, important improvisational elements remain significant. Standardization and improvisation can be seen as two conflicting logics. However, they are not incompatible, although the occurrence of improvisation in highly structured and institutionally complex environments remains underexplored. The study presents the process of improvisation in the tightly controlled work environment of the emergency room. The authors conducted an in situ ethnographic observation of an emergency unit. An inductive approach shows professionals combining ostensive compliance with protocols with necessary and occasional ‘underlife’ improvisations. The duality of improvisation as simultaneously present and absent is related to pressures in the institutional domain as well as to practical needs emerging from the operational realm. The intense presence of procedures and work processes enables flexible improvised performances that paradoxically end up reinforcing institutional pressures for standardization. |
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