Improvising Prescription: Evidence from the Emergency Room

20 Pages Posted: 5 Apr 2016

See all articles by Maria Graca Batista

Maria Graca Batista

Centre of Applied Economics Studies of the Atlantic (CEEAplA)

Stewart R. Clegg

University of Technology, Sydney - School of Management; New University of Lisbon - Nova School of Business and Economics

Miguel Pina e Cunha

New University of Lisbon - Nova School of Business and Economics

Luca Giustiniano

University of Glasgow - Department of Business and Management

Arménio Rego

Universidade de Aveiro (GOVCOPP) and Instituto Universitário de Lisboa - Portugal and Business Research Unit (UNIDE-ISCTE, IUL)

Date Written: February 2016

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.

Suggested Citation

Batista, Maria Graca and Clegg, Stewart R. and Cunha, Miguel Pina e and Giustiniano, Luca and Rego, Arménio, Improvising Prescription: Evidence from the Emergency Room (February 2016). British Journal of Management, Vol. 27, Issue 2, pp. 406-425, 2016. Available at SSRN: https://ssrn.com/abstract=2759063 or http://dx.doi.org/10.1111/1467-8551.12143

Maria Graca Batista (Contact Author)

Centre of Applied Economics Studies of the Atlantic (CEEAplA) ( email )

Portugal

Stewart R. Clegg

University of Technology, Sydney - School of Management ( email )

Room C401A
Corner Quay Street & Ultimo Road
Sydney 2007, New South Wales
Australia
9514 3934 (Phone)
9514 3602 (Fax)

New University of Lisbon - Nova School of Business and Economics ( email )

Campus de Campolide
Lisbon, 1099-032
Portugal

Miguel Pina e Cunha

New University of Lisbon - Nova School of Business and Economics ( email )

Campus de Campolide
Lisbon, 1099-032
Portugal

Luca Giustiniano

University of Glasgow - Department of Business and Management

Arménio Rego

Universidade de Aveiro (GOVCOPP) and Instituto Universitário de Lisboa - Portugal and Business Research Unit (UNIDE-ISCTE, IUL) ( email )

Campus de Santiago
Aveiro, 3810-193
Portugal

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