Samia Chreim

Transforming New Ideas into Practice: An Activity Based Perspective on the Institutionalization of Practices

We develop an activity‐focused process model of how new ideas can be transformed into front line practice by reviving attention to the importance of habitualization as a key component of institutionalization. In contrast to established models that explain how ideas diffuse or spread from one organization to another, we employ a micro‐level perspective to study the subsequent intra‐organizational processes through which these ideas are transformed into new workplace practices. We followed efforts to transform the organizationally accepted idea of ‘interdisciplinary teamwork’ into new everyday practices in four cases over a six year time period. We contribute to the literature by focusing on de‐habitualizing and re‐habitualizing behaviours that connect micro‐level actions with organizational level theorizing. Our model illuminates three phases that we propose are essential to creating and sustaining this connection: micro‐level theorizing, encouraging trying the new practices, and facilitating collective meaning‐making.

Role construction and boundaries in interprofessional primary health care teams: a qualitative study

BackgroundThe move towards enhancing teamwork and interprofessional collaboration in health care raises issues regarding the management of professional boundaries and the relationship among health care providers. This qualitative study explores how roles are constructed within interprofessional health care teams. It focuses on elucidating the different types of role boundaries, the influences on role construction and the implications for professionals and patients.MethodsA comparative case study was conducted to examine the dynamics of role construction on two interprofessional primary health care teams. The data collection included interviews and non-participant observation of team meetings. Thematic content analysis was used to code and analyze the data and a conceptual model was developed to represent the emergent findings.ResultsThe findings indicate that role boundaries can be organized around interprofessional interactions (giving rise to autonomous or collaborative roles) as well as the distribution of tasks (giving rise to interchangeable or differentiated roles). Different influences on role construction were identified. They are categorized as structural (characteristics of the workplace), interpersonal (dynamics between team members such as trust and leadership) and individual dynamics (personal attributes). The implications of role construction were found to include professional satisfaction and more favourable wait times for patients. A model that integrates these different elements was developed.ConclusionsBased on the results of this study, we argue that autonomy may be an important element of interprofessional team functioning. Counter-intuitive as this may sound, we found that empowering team members to develop autonomy can enhance collaborative interactions. We also argue that while more interchangeable roles could help to lessen the workloads of team members, they could also increase the potential for power struggles because the roles of various professions would become less differentiated. We consider the conceptual and practical implications of our findings and we address the transferability of our model to other interprofessional teams.

Leadership as boundary work in healthcare teams

This paper proposes that boundary work is inherent to leadership practices in healthcare settings, and explores this phenomenon in interprofessional healthcare teams. Specifically, the study focuses on leading through and across boundaries in four interprofessional healthcare teams operating in the area of mental health services. We give special consideration to the specific contexts of these teams, and address the boundaries that are constructed and managed in interactions. Our qualitative study revealed that leadership can be exercised by different members and at different levels within the teams, and that it involves managing the boundaries between (a) roles of different members of the leadership constellation, (b) leadership and clinical roles, (c) formal leaders and other members of the team, (d) different professions, (e) personal life experiences and professional work, and (f) the team and what members consider to be the environment. We identify different types of boundary work tactics that involve opening, closing, and contesting/negotiating boundaries. In addition, we address the potential consequences of each of these tactics. We consider the implications of our findings to leadership research and practice in healthcare contexts and beyond.

Sociocultural Factors Influencing Incident Reporting Among Physicians and Nurses: Understanding Frames Underlying Self- and Peer-reporting Practices.

Objectives Voluntary reporting of incidents is a common approach for improving patient safety. Reporting behaviors may vary because of different frames within and across professions, where frames are templates that individuals hold and that guide interpretation of events. Our objectives were to investigate frames of physicians and nurses who report into a voluntary incident reporting system as well as to understand enablers and inhibitors of self-reporting and peer reporting. Methods This is a qualitative case study—confidential in-depth interviews with physicians and nurses in General Internal Medicine in a Canadian tertiary care hospital. Results Frames that health care practitioners use in their reporting practices serve as enablers and inhibitors for self-reporting and peer reporting. Frames that inhibit reporting are shared by physicians and nurses, such as the fear of blame frame regarding self-reporting and the tattletale frame regarding peer reporting. These frames are underpinned by a focus on the individual, despite the organizational message of reporting for learning. A learning frame is an enabler to incident reporting. Viewing the objective of voluntary incident reporting as learning allows practitioners to depersonalize incident reporting. The focus becomes preventing recurrence and not the individual reporting or reported on. Conclusions Physicians and nurses use various frames that bound their views of self and peer incident reporting—further progress should incorporate an understanding of these deep-seated views and beliefs.

Fix and forget or fix and report: a qualitative study of tensions at the front line of incident reporting

Introduction Practitioners frequently encounter safety problems that they themselves can resolve on the spot. We ask: when faced with such a problem, do practitioners fix it in the moment and forget about it, or do they fix it in the moment and report it? We consider factors underlying these two approaches. Methods We used a qualitative case study design employing in-depth interviews with 40 healthcare practitioners in a tertiary care hospital in Ontario, Canada. We conducted a thematic analysis, and compared the findings with the literature. Results ‘Fixing and forgetting’ was the main choice that most practitioners made in situations where they faced problems that they themselves could resolve. These situations included (A) handling near misses, which were seen as unworthy of reporting since they did not result in actual harm to the patient, (B) prioritising solving individual patients’ safety problems, which were viewed as unique or one-time events and (C) encountering re-occurring safety problems, which were framed as inevitable, routine events. In only a few instances was ‘fixing and reporting’ mentioned as a way that the providers dealt with problems that they could resolve. Conclusions We found that generally healthcare providers do not prioritise reporting if a safety problem is fixed. We argue that fixing and forgetting patient safety problems encountered may not serve patient safety as well as fixing and reporting. The latter approach aligns with recent calls for patient safety to be more preventive. We consider implications for practice.

Contestation about Collaboration: Discursive Boundary Work among Professions

We examine how professions responded to a potential change in jurisdictional boundaries by analyzing the written submissions of five professional associations in reaction to a government proposal to strengthen interprofessional collaboration, relating these responses to the professions’ field positions. We identify four foci for framing used by the professions to discursively develop their boundary claims: (1) framing the issue of interprofessional collaboration (issue framing), (2) framing of justifications for favored solutions (justifying), (3) framing the profession’s own identity (self-casting), and (4) framing other professions’ identities (altercasting). We find that professions employed these foci differently depending on two dimensions of their field positions – status and centrality. Our study contributes to the literature by identifying distinctive ways through which the foci for framing may be mobilized in situations of boundary contestation, and by theorizing how field position in terms of status and centrality influences actors’ framing strategies.

Contradiction and Sensemaking in Acquisition Integration

The authors draw on research on acquisitions and on newcomer adjustment to analyze acquired managers’ sensemaking experiences. They pursue three interrelated objectives: how acquired managers, as newcomers, make sense of role changes; how these managers’ frames contrast with new frames encountered at the acquirer; how relationships with acquiring managers influence adjustment to new roles and frames. The authors report on a study of three acquisitions of small firms by a large, bureaucratic, serial acquirer. Findings showed contraction of the managerial role—and the resulting reconfigured role identity—created tensions emanating from managing familiar situations under new frames. Relationships with acquiring managers—a potential source of informational, material, political, and social resources—played a role in mitigating or amplifying the challenges experienced. Comparison of acquired and acquiring managers’ frames showed that absorption of small firms by large, serial acquirers creates in organizations heterogeneous sensemaking spaces characterized by contradiction.

Double checking: a second look

Abstract Rationale, aims and objectives Double checking is a standard practice in many areas of health care, notwithstanding the lack of evidence supporting its efficacy. We ask in this study: ‘How do front line practitioners conceptualize double checking? What are the weaknesses of double checking? What alternate views of double checking could render it a more robust process?’ Method This is part of a larger qualitative study based on 85 semi‐structured interviews of health care practitioners in general internal medicine and obstetrics and neonatology; thematic analysis of the transcribed interviews was undertaken. Inductive and deductive themes are reported. Results Weaknesses in the double checking process include inconsistent conceptualization of double checking, double (or more) checking as a costly and time‐consuming procedure, double checking trusted as an accepted and stand‐alone process, and double checking as preventing reporting of near misses. Alternate views of double checking that would render it a more robust process include recognizing that double checking requires training and a dedicated environment, Introducing automated double checking, and expanding double checking beyond error detection. These results are linked with the concepts of collective efficiency thoroughness trade off (ETTO), an in‐family approach, and resilience. Conclusion(s) Double checking deserves more questioning, as there are limitations to the process. Practitioners could view double checking through alternate lenses, and thus help strengthen this ubiquitous practice that is rarely challenged.

Peer Support Providers' Role Experiences on Interprofessional Mental Health Care Teams: A Qualitative Study.

This study explores how peer support providers’ roles are defined and integrated in inter-professional mental health care teams, and how these providers relate to other practitioners and clients. Interviews were conducted with peer support providers in two different formal models of peer support employment. Qualitative data analysis was undertaken. The findings indicate that: peer support providers experience ambiguity and that some ambiguity may offer benefits; peer support providers enhance team acceptance of their role through several means and strategies; setting boundaries with clients is a delicate issue that requires several considerations that we discuss.

Proximity, knowledge transfer, and innovation in technology-based mergers and acquisitions

This paper presents the findings from a qualitative study on the extent to which three dimensions of proximity – geographic, cognitive, and organisational – impact knowledge transfer and innovation post-merger and acquisition (M&A). Findings show that the elements of proximity substantially influence both knowledge transfer and innovation although the nature of the impact varies and is influenced by the type of management interventions or lack thereof post-M&A.