Prioritising the mobilisation of emergency medical services: patient making at the healthcare gateway
Journal of Health Organization and Management
ISSN: 1477-7266
Article publication date: 27 January 2021
Issue publication date: 27 April 2021
Abstract
Purpose
The purpose of this paper is to analyse the socio-material practices through which organisational understanding of patients is accomplished in order to prioritise calls and mobilise emergency medical services at the gateway of the healthcare system.
Design/methodology/approach
The methodology of this paper is an ethnographic study of the co-ordination of collective action in an emergency services control room in the Welsh NHS, with data generation and analysis informed by Translational Mobilisation Theory.
Findings
Mobilisation of emergency medical services entails the translation of callers' undifferentiated problems into response priority categories, which are used by dispatch operators to mobilise crews. A central actor in these processes is the computerised Medical Priority Dispatch System. While designed to enable non-clinically qualified call handlers to triage calls in a standardised way, the system constrains caller–call handler interaction, which negatively impacts the categorisation process. Analysis of these interactional difficulties and associated mitigation strategies highlights opportunities for intervening to support co-ordination at this healthcare boundary.
Originality/value
Orthodox approaches to improving interface management are founded on a conceptualisation of “patients” as immutable actors in care transfer processes. Translational Mobilisation Theory brings into view the multiple versions of the “patient” produced by healthcare systems and offers a framework for analysing the mechanisms of action necessary to create organisational understandings of patients at boundary crossings. While the ambulance control centre is a singular case, the paper illustrates the value of attending to these processes in interface organisation.
Keywords
Acknowledgements
This study was supported through the award of a Health Foundation Improvement Science Fellowship [2011–2014], thanks to the staff members of the Welsh Ambulance Service who granted the author access to their working worlds and participated in the study.Funding: The research was undertaken through the support of an Improvement Science Fellowship award, funded by The Health Foundation.
Citation
Allen, D. (2021), "Prioritising the mobilisation of emergency medical services: patient making at the healthcare gateway", Journal of Health Organization and Management, Vol. 35 No. 2, pp. 160-176. https://doi.org/10.1108/JHOM-07-2020-0305
Publisher
:Emerald Publishing Limited
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