Beyond Occupational Differences: The Importance of Cross-Cutting Demographics and Dyadic Toolkits for Collaboration in a US Hospital
Administrative Science Quarterly, Vol. 59, 2014
34 Pages Posted: 25 Feb 2016
Date Written: 2014
Abstract
This paper uses data from a 12-month ethnographic study of two medical-surgical units in a U.S. hospital to examine how members from different occupations can collaborate with one another in their daily work despite differences in status, shared meanings, and expertise across occupational groups, which previous work has shown to create difficulties. Nurses and patient care technicians (PCTs) on both hospital units faced these same occupational differences, served the same patient population, worked under the same management and organizational structure, and had the same pressures, goals, and organizational collaboration tools available to them. But nurses and PCTs on one unit successfully collaborated while those on the other did not. The paper demonstrates that a social structure characterized by cross-cutting demographics between occupational groups — in which occupational membership is uncorrelated with demographic group membership — can loosen attachment to the occupational identity and status order. This allows members of cross-occupational dyads, in our case nurses and PCTs, to draw on other shared social identities, such as shared race, age, or immigration status, in their interactions. Drawing on a shared social identity at the dyad level provided members with a “dyadic toolkit” of alternative, non-occupational expertise, shared meanings, status rules, and emotional scripts that facilitated collaboration across occupational differences and improved patient care. The paper details how cross-occupational collaboration difficulties can stem not only from occupational differences but also from demographic differences and suggests that the current literature may be overstating the occupational character of cross-occupational collaboration difficulties and understating their demographic character.
Keywords: cultural toolkit, coordination, cross-occupational collaboration, professions, intergroup relations, group diversity, demography, status, hospitals, healthcare, sociology of work and occupations, medical sociology
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