Organising work in neonatal transfer: Optimising place of care for babies born moderately preterm.

Abstract

The organisation of neonatal units into geographically-based networks that offer different levels of care is intended to ensure babies receive the care they need via transfers between different units. In this article, we explore the significant organisational work required in practice to accomplish such transfers. Conducted within a wider study of optimal place of care for babies born between 27 and 31weeks' gestation, we draw on ethnographic work exploring the accomplishment of transfers in this complex care context. We undertook fieldwork in six neonatal units across two networks in England, representing 280hours of observation and formal interviews with 15 health-care professionals. Drawing on Strauss etal.'s concept of the social organisation of medicine and Allen's concept of 'organising work', we identify three distinct forms of such work central to the successful accomplishment of a neonatal transfer: (1) 'matchmaking', to identify a suitable transfer location; (2) 'transfer articulation', to successfully effect the planned transfer; and (3) 'parent engagement', to support parents through the transfer process. Our findings build on and extend Strauss etal. and Allen's work by both highlighting the different forms of 'organising work' undertaken in this clinical context and the distribution of such work across different professional groups.