Mediating workplace situational pressures: The role of artefacts in promoting effective interprofessional work and learning

Abstract

Introduction: This theoretical paper is a scenario-based account of interprofessional healthcare work that highlights tensions between desired and actual practice behaviour in clinical settings.

Case Study: In this account, against his best clinical judgment and because of situational ward pressures, a junior doctor prescribes antipsychotic medication for a high-risk confused, frail, elderly patient. A healthcare assistant, who possesses key patient-specific information, holds back on sharing this information because of similar pressures.

Analysis: Sociocultural analysis of this account identifies three epistemological factors constraining an individuals’ discretion and behaviour. First, situated team collective practice overrides individual knowledge. Secondly, collective practice, though held strongly by core members of clinical teams, may in fact be erroneous, and fail to support new learning about and through practice, to the detriment of patient care. Thirdly, situated practices of the ward community may marginalise some team members and inhibit their contributions to patient safety.

Conclusions: To redress such constraints, we propose the development of, and engagement with, artefacts or tools that shape inclusive practice and assist improvements in practice. Such an approach can lead to productive learning through practice in interprofessional healthcare teams. To elaborate the case, the illustrative example of the Delirium Early Monitoring System (DEMS) is used. This artefact can be effective in socioculturally mediating unhelpful situational pressures that impact on clinical teams’ management of delirium, by including and legitimising a range of professional voices. This mediation can also include voices that are external to the immediate clinical situation, which can inform interprofessional care, promote interdependence and foster patient-centred working communities of healthcare practice.