PalgraveStudiesinProfessionalandOrganizationalDiscourse Titlesinclude: RickIedema(editor) THEDISCOURSEOFHOSPITALCOMMUNICATION TracingComplexitiesinContemporaryHealthCareOrganizations KeithRichards LANGUAGEANDPROFESSIONALIDENTITY H.E.Sales PROFESSIONALCOMMUNICATIONINENGINEERING Forthcomingtitlesinclude: EdwardJohnson&MarkGarner OPERATIONALCOMMUNICATION CeciliaE.Ford WOMEN’STALKINTHEPROFESSIONALWORKPLACE PalgraveStudiesinProfessionalandOrganizationalDiscourse SeriesStandingOrderISBN 978-0-230-50648-0 (outsideNorthAmericaonly) You can receive future titles in this series as they are published by placing a standingorder.Pleasecontactyourbookselleror,incaseofdifficulty,writetous attheaddressbelowwithyournameandaddress,thetitleoftheseriesandthe ISBNquotedabove. Customer Services Department, Macmillan Distribution Ltd, Houndmills, Basingstoke,HampshireRG216XS,England AlsobyRickIedema DISCOURSESOFPOST-BUREAUCRATICORGANIZATION The Discourse of Hospital Communication Tracing Complexities in Contemporary Health Care Organizations Editedby Rick Iedema Editorialmatterandselection©RoderickArenMichaelIedema2007 Individualchapters©chapterauthors2007 Softcover reprint of the hardcover 1st edition 2007 978-1-4039-9848-4 Allrightsreserved.Noreproduction,copyortransmissionofthis publicationmaybemadewithoutwrittenpermission. Noparagraphofthispublicationmaybereproduced,copiedortransmitted savewithwrittenpermissionorinaccordancewiththeprovisionsofthe Copyright,DesignsandPatentsAct1988,orunderthetermsofanylicence permittinglimitedcopyingissuedbytheCopyrightLicensingAgency, 90TottenhamCourtRoad,LondonW1T4LP. Anypersonwhodoesanyunauthorisedactinrelationtothispublication maybeliabletocriminalprosecutionandcivilclaimsfordamages. Theauthorshaveassertedtheirrightstobeidentified astheauthorsofthisworkinaccordancewiththeCopyright, DesignsandPatentsAct1988. Firstpublished2007by PALGRAVEMACMILLAN Houndmills,Basingstoke,HampshireRG216XSand 175FifthAvenue,NewYork,N.Y.10010 Companiesandrepresentativesthroughouttheworld PALGRAVEMACMILLANistheglobalacademicimprintofthePalgrave MacmillandivisionofSt.Martin’sPress,LLCandofPalgraveMacmillanLtd. Macmillan(cid:2)isaregisteredtrademarkintheUnitedStates,UnitedKingdom andothercountries.PalgraveisaregisteredtrademarkintheEuropean Unionandothercountries. ISBN 978-1-349-54695-4 ISBN 978-0-230-59547-7 (eBook) DOI 10.1057/9780230595477 Thisbookisprintedonpapersuitableforrecyclingandmadefromfully managedandsustainedforestsources. AcataloguerecordforthisbookisavailablefromtheBritishLibrary. LibraryofCongressCataloging-in-PublicationData Thediscourseofhospitalcommunication:tracingcomplexitiesin contemporaryhealthcareorganizations/editedbyRickIedema. p. cm.“(Palgravestudiesinprofessionalandorganizational discourse) Includesbibliographicalreferencesandindex. 1. Hospitals“Administration. 2. Healthservicesadministration. 3. Healthfacilities“Administration. I. Iedema,Rick. RA971.D572007 362.11068“dc22 2006049485 10 9 8 7 6 5 4 3 2 1 16 15 14 13 12 11 10 09 08 07 This book is dedicated to all the practitioners we have worked with over the years and who have taught us so much about the complex nature of hospital work. This page intentionally left blank Contents ListofFiguresandTables ix ForewordbyJeffreyBraithwaite x NotesontheContributors xii 1 CommunicatingHospitalWork 1 Rick Iedema 2 Institutional and Professional Orders of Ethics in theDiscoursePracticesofResearchRecruitmentin Oncology 18 Ellen Barton 3 TheCommunicativeFunctionsoftheHospitalMedicalChart 39 Pamela Hobbs 4 GoverningtheOperatingRoomList 67 Robin Riley and Elizabeth Manias 5 Dialogues for Negotiating Priorities in Unplanned EmergencySurgicalQueues 90 Martin Lum and Anneke Fitzgerald 6 PersonalityDisorderinUKMentalHealthCare:Language, Legitimation and the Psychodynamics of Organized Surveillance 109 B. J. Brown and Paul Crawford 7 Renegotiating Disjunctions in Interorganizationally ProvidedCare 138 Hannele Kerosuo 8 AnaestheticTalkinSurgicalEncounters 161 CatherinePope,MaggieMort,DawnGoodwinand Andrew Smith vii viii Contents 9 Corridor Conversations: Clinical Communication in CasualSpaces 182 Debbi Long, Rick Iedema and Bonsan Bonne Lee 10 TheRoleofSignsandRepresentationsintheOrganization ofMedicalWork:X-raysinMedicalProblemSolving 201 Per Måseide 11 WhyDoDoctorsNotEngagewiththeSystem? 222 Christine Jorm, Jo Travaglia and Rick Iedema 12 NursingthroughTimeandSpace:SomeChallengestothe ConstructofCommunityofPractice 244 Sally Candlin and Christopher N. Candlin Index 268 List of Figures and Tables Figures 9.1 Layoutofoutpatientsclinic 186 12.1 Intersectingclinical–professionalcommunitiesofpractice 254 12.2 Thedifferentrolesinnursing 261 Tables 7.1 Descriptionofthechangelaboratorydata 147 7.2 Description of the patients participating in the intervention 148 9.1 Abbreviationsandpseudonymsusedforclinicians 187 ix