Re-coordinating activities: An investigation of articulation work in patient transfers

The coordination of distributed activities is central to organizational work. The effective functioning of organizations hinges on their ability to manage interdependencies both within (intra-) and between (inter-) various departments. However, more than just the management of these individual interdependencies is required for smooth work system coordination. Organizations must also manage the interactions between intra- and inter-departmental activities. To investigate how these interactions manifest in organizational work, we conducted a field study examining patient transfer process. We highlight the cross-boundary breakdowns that occur when intra-departmental and inter-departmental activities related to patient transfers negatively affect each other. We then describe the re-coordinating activities performed to mitigate the effects of cross-boundary breakdowns. We discuss a framework of inter-departmental coordination work that describes the relationship between cross-boundary breakdowns and re-coordinating activities. Furthermore, we classify the re-coordinating activities as a type of articulation work performed by hospital staff. This research can help us develop empirically-driven and theoretically-based design guidelines for coordination tools to maintain overall organizational workflow by balancing the goals and requirements of the various departments.