Bridging the Gap Between Organizational Institutionalism and Situated Action: A Video-Based Analysis of a Simulation-Based Device in Healthcare

Abstract

This chapter bridge two intellectual traditions that often fail to be brought together in the organization studies literature, namely organizational institutionalism and situated and distributed approaches. While providing a better account of material aspects of institutions, they enhance the role of artefacts and tools as currently accounted by the situated/distributed approach. They couple a reference to materiality of institutions with a reference to the manipulation of objects and equipment in a changing environment. The ambition to establish a dialogue between these two intellectual traditions is made possible by an observation of specific “naturally occurring data”. It gives an access to recorded sequences of actions that provide a fine-grained analysis of the relation between the setting as a local workspace and the arena as a broader institutional context. This method enables to capture a disadjustment between distinct levels of activities: institutional environment (public durable framework), an external plan (defined as both an organizational programme and a scenario for acting) and situated action (real-time local interactional routines). The fieldwork is conducted in an experimental hospital and focuses on the implementation of a digital artefact—a simulation-based training device personified in a lifelike virtual mannequin—initially designed to improve teamwork skills in a health professionals’ community (doctors, physicians and nurses). In line with the tradition initiated by workplace studies, Felix et al. argue that the workspace is made of materials (cognitive artefacts and physical tools) and body movements that act as an external support for action when the environment is prepared and familiar.

We owe a great debt of gratitude to the Maison des Sciences de l’Homme et de la Société (MSHS) Sud-Est, which supported this pluridisciplinary research, and to Alain Percivalle, who gave us access to occurring natural data and took part in the simulation-based device at the hospital. Finally, we would like to thank the organizers of the OAP Seminar in Lisbon (2016) who selected our paper for publication and provided remarkable comments to improve the initial version of our work.

Appendices

Appendices

Appendix 1

Video sequence transcription

D: doctor, N: nurse

00.04 :

1. D: allez vite le massage

D: come on let’s go for the massage quickly

Doctor holding oxygenation’s mask on the face of the patient----to 11

ip on the machine ------------------------------------------to 11

Drawers noise --------------------------------------------------to

00.07 :

2. D:: () vite

hurry up

00.14 :

3 D: y a un choc qui est délivré a priori il devrait être délivré ?

there is a shock which is delivered in theory it should be delivered ?

electronic voice AED -----------------------------------------------to 11

00.17:

4 D: allez le choc est. délivré (.) on recule

here it goes shock is delivered(.) you have to be at distance

doctor’s gesture to indicate shock imminence

00.20:

5 D: c’est. bon pour le choc.

it’s ok for the shock

00.23:

6 D: allez on reprend l’massage ()

let’s go and start the massage again

Doctor oriented towards computer----

00.30 :

7 D: c’est bon pour la perf ?=

ready to put the drip on?

Doctor looking at nurse

0031 :

8 N: = ouais je sais je sais (.) il manque du matériel

yeah I know I know (.) material is missing

nurse is still searching for tools ---------------->

00.34 :

9 D: allez la perf c’est posé ?

Come on, is the drip on?

10 N: = ah c’est bon.

I found it

00.40 :

The nurse finds the needle and intravenous drugs

The nurse’s assistant leaving the patient’s bed and going near the nurse

The nurse seems to talk to herself

11 N: (inaudible)

00.42:

The nurse’s assistant looks at the nurse

Appendix 2

Transcription of the nurse’s interview during the auto confrontation session.

R: :

researcher

N: :

nurse

Looking together at the video, the researcher asks nurse to describe the moment when she was searching tools in the trolley’s drawers.

R::

Is it the same material you use in real settings? Usually, have you got some cues concerning the material’s locations?

N::

the configuration is not the same at all that in the… that in our own ward

R::

not the same at all

N::

hmm

N::

completely different. material was not in the usual place, everything was messy in the trolley so … so in fact I started panicking, I started panicking rather quickly