Documenting dreams : patient-centered records versus practice-centered records

This thesis explores how doctors and nurses use documents to share their knowledge within and across healthcare settings. In addressing this question I draw on a 15-month, multi-sited ethnographic study in several pediatric health care settings, following patients from primary care clinics, to emergency rooms, and in-patient units. The analysis focuses on the practices that go into documenting patients' histories and care, which include recordings on various on-line systems, preprinted forms, and whiteboards. By combining the previously distinct lenses of 1) knowing in practice, 2) time-space analysis of social interaction, and 3) communicative genre and genre systems, I suggest that doctors and nurses employ various types of document genres to manage, not only their distributed knowing about patients' care, but also their own movements across time-space. I outline a perspective on documents and knowing which attempts to highlight the role of human practice in how people use documents to coordinate their activities, share their capabilities, and get things done in complex distributed organizational work. The data suggest that doctors and nurses use medical documents as maps and itineraries to organize their distributed work practices. Doctors and nurses record patients' histories many times in different documents, with each document serving as a map and itinerary for a different constituency of people. Each of these documents is rarely used in isolation from other documents. Doctors and nurses constantly recombine the documents they use, which allows them to both appropriate documents from other settings into their local organization of work and build unique local combinations of documents.

Department dc:contributor.department

Sloan School of Management.

Grantor dc:publisher

Massachusetts Institute of Technology

Year dc:date.issued

2003

Author dc:creator

• Østerlund, Carsten Svarrer, 1965-

Advisor dc:contributor.advisor

• Wanda Orlikowski.

• Sloan School of Management.

Statement dc:rights

• M.I.T. theses are protected by copyright. They may be viewed from this source for any purpose, but reproduction or distribution in any format is prohibited without written permission. See provided URL for inquiries about permission.

Licence dc:rights.uri

• http://dspace.mit.edu/handle/1721.1/7582

Language dc:language.iso

eng

Handle dc:identifier.uri

http://hdl.handle.net/1721.1/8005

OAI identifier oai:identifier

oai:dspace.mit.edu:1721.1/8005