Standardization of Work: Co-constructed Practice

Abstract

There is strong pressure to achieve greater uniformity, standardization and application of best practices in the service professions, a sector that is growing in presence and importance. At the same time, there is a conflicting demand for the delivery of high-quality (or high-priced or “knowledge-intensive”) specialized or localized services. Our article analyzes information systems-enabled standardizing of service work through an in-depth interpretative study of an ongoing standardization initiative within the field of nursing. Nursing provides a graphic illustration of the dilemmas involved in the standardization of service work. In nursing, standardization is commonly a feature of projects to improve both efficiency and quality in health care. In contrast to the dominant conception of standardization as a largely top-down, imposed process, we offer a view of standardization as incomplete, co-constructed with users, and with significant unintended consequences. The article contributes by (a) developing a theoretical perspective for the standardization of information-system-embedded service work and (2) providing operational and practical implications for system design and health care management.

Keywords:

• classification
• health care
• nursing
• service work
• standardization

Notes

1. http://www.who.int/classifications/icd/en (accessed March 20, 2006).

2. http://www.nanda.org (accessed March 20, 2006).

3. http://www.snomed.org/snomedct (accessed March 20, 2006).

4. We treat the terms “care plan” and “nursing plan” as equivalents throughout this article.

5. http://www.nursing.uiowa.edu/centers/cncce/nic (accessed March 20, 2006).

6. http://www.nursing.uiowa.edu/centers/cncce/noc (accessed March 20, 2006).

7. Without going into the matter in depth, we recognize that there are other classification systems for nursing diagnoses and practice as well. These include the CCC (Clinical Care Classification), previously known as the HHCC (Home Health Care Classification) System (http://www.sabacare.com accessed March 20. 2006), the Omaha system, and the Patient Care Data Set (Hyun & Park, 2002, p. 100). The ICNP covers the whole range of diagnoses, interventions and outcomes (Hellesø & Ruland, 2001). A project to establish ICNP was initiated in 1989 by the International Council of Nurses as an effort to unify the existing nursing languages (Hyun & Park, 2002). The ICNP is still a “young” system, as version 1 was launched in 2005 by the Taiwan International Council of Nurses (http://icn.ch/index.html) accessed March 20, 2006.

8. http://www.nanda.org (accessed March 20, 2006).

9. http://www.nursing.uiowa.edu/centers/cncce/nic (accessed March 20, 2006).

10. http://www.iso.org/iso/en/ISOOnline.frontpage (accessed March 20, 2006).

11. Health Level Seven at http://www.hl7.org (accessed March 20, 2006).

12. American National Standards Institute at http://www.ansi.org (accessed March 20, 2006).

13. Unskilled nurses and substitutes fill the same role as qualified nurses and are referred to as nurses in this article.

14. After a stroke, some people suffer from a syndrome called “neglect.” People with neglect may not appear to process sensory information from the left side of their body. http://ww2.heartandstroke.ca/Page.asp?PageID=33&ArticleID=2570&Src=stroke&From=SubCategory.