Shaping the Buildings that Shape Us: The Entanglement of Space and Care Coordination

Abstract

In the rare event that a hospital confronts radical change, care activities must remain performant despite disruptions and unanticipated influences, otherwise patients may lose their lives. The reliable coordination of care work is central to this challenge because critically ill patients must get the appropriate treatment at the right time by the right specialists in the most cost-effective manner possible. Recent organizational research has shown that care coordination practices are emergent and socially situated but has paid less attention to the spatial context in which care work unfolds. Yet, the latter has direct implications for what is possible in the delivery of patient care. In this paper, we examine what happens to the work of neonatal intensive care when a leading Canadian hospital relocates to a newly built and equipped CAN$ 3 billion super hospital with a vastly different spatial layout and equipment arrangements. Through a two-year ethnographic field study of neonatal intensive care work before, during and after ‘the move’, we examine how space and coordination practices are transformed so that care activities can “travel” reliably. We show how and why care activities initially broke down as they were transported to a new socio-spatial setting and elaborate the process by which they were reconstituted to re- establish performance. In so doing, we explore the material- spatial basis of coordinating and deliver a material rather than a cultural or institutional account of radical change.