Abstract
Participant observation in a nonprofit nursing home reveals that informal patterns of work routinization depart markedly from official procedures designed to protect the health and safety of workers and residents. Six aspects of the informal organization of work are found to correspond closely to patterns observed by Roy (1954): the mismatch between time and tasks, the development of new (informal) skills, the institutionalization of rule-breaking, negative effects on quality, the collaboration of shop-level supervision, and workers’ experience of managerial irrationality. However, whereas classic manufacturing studies emphasized upper management's periodic attempts to force compliance to official rules and routines, here upper management engages only in symbolic interventions, collaborating with workers and nursing home residents in the “mock routinization” of work. The article concludes by showing how, in the context of contradictory external workplace regulation, all three parties to the labor process of the contemporary nursing home experience mock routinization as compatible with their own interests.
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Notes
Routinization is often used as a synonym for Taylorism – the process of breaking jobs down into individual components and subjecting each part of the job to detailed rules. Routines are thus collections of rules. But sociologists have long recognized that informal and unofficial rules can be as important as formal and official ones. Leidner's account of routinization emphasizes official rules, but in this paper I consider routinization to encompass the relationship between official and unofficial rules.
It might be argued that nursing home residents’ relative inability to exercise agency on their own behalf makes nursing home work a special case, and that nursing homes may in fact be more like factories than other kinds of service workplaces precisely because nursing home residents are so powerless. Such an argument ignores the considerable variation in residents’ capabilities and the ways more cognitively-intact residents can assert themselves – including, as this paper demonstrates, deciding whether to collaborate in or to resist ‘deviant’ unofficial care routines.
Manufacturing organizations, to be sure, also deal with risks associated with customers. In manufacturing, however, management can minimize the risks posed by customers by ensuring that its products are well designed and manufactured to acceptable tolerances. As long as these limits are not exceeded, deviations from official routines in the manufacturing process do not appreciably increase the organizational risks associated with customers. Thus the shop-floor games studied by Roy, Burawoy, and others are tolerable as long as the resulting products are not too far “out of spec.”
Much of the ethnographic literature on nursing homes emphasizes how nursing home routines dehumanize residents by limiting their choices about how to organize their daily lives (cf. Foner, 1994, Diamond, 1992). This is a valid criticism but it does overlook the fact that nursing home residents often take comfort in the regularity of their routines as well.
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Acknowledgments
The author thanks Michael Burawoy, Dan Clawson, Rachel Cohen, Randy Hodson, Sean O’Riain, Vincent Roscigno, Jeff Sallaz, Rachel Sherman, Kim Voss, and anonymous reviewers for helpful critiques and suggestions.
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Steve Henry Lopez is an assistant professor of sociology at The Ohio State University. He is the author of Reorganizing the Rust Belt: An Inside Study of the American Labor Movement (California, 2004), winner of the 2005 ASA Sociology of Labor Book Award. He is currently writing a book about the work of nursing home aides.
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Lopez, S.H. Efficiency and the Fix Revisited: Informal Relations and Mock Routinization in a Nonprofit Nursing Home. Qual Sociol 30, 225–247 (2007). https://doi.org/10.1007/s11133-007-9062-0
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DOI: https://doi.org/10.1007/s11133-007-9062-0