Strauss and Corbin 1990. pp. 216-7.
AS/JC 7-22-88 (Telephone)
************IMPORTANT MEMO: ROUTINE/NOVEL
I posed the issue, long ago observed, that nurses encountered
typical problems --- often costly of time and effort and
sentiment --- but do not act to change institutional rules or
procedures to prevent. Rather they go on with their
institutionalized-routine ways of doing work. (Problematic dying
patients for instance, or as in pain book). Rather they typify
this patient as like one(s) they have had before. But afterward
there is no institutional change. These I have thought for a long
time are due to the way organizations get work done, their
priorities, and perhaps structural strains that precipitate
recurrent semicrises. But here is a much better and detailed set
- When work processes break down, then there is a
change of procedure.
- If they don't change procedures, it's because the
work associated with the problem is not of high priority.
The nurses are SO BUSY doing the high priority work, that
they don't have time and effort to do anything else. They
will, in fact, if the problem (like a problem patient)
gets bad enough call in specialists-social work- ers,
chaplains, psychiatrists-because their own work has to go
on. Or they will ignore the patient; perhaps making the
problem worse, but...
- If the work affected by the breakdown of work
process is of high priority (like affect its efficiency
or patient's safety), then they have to reflect on how to
prevent this from occurring again.
- If the change is easily done, then it is
done through interactional processes: negotiation,
persuasion, even some coercion.
- If the change will be difficult
organizationally, this essentially means a lot of
additional work must be done but it must be done --- that
is: figuring out what's to be done, planning decision
making, persuading, negotiating, finding new resources,
acting to raise motivation, additional supervising when
the new rou- tines are instituted, etc. And of course, an
additional drain on the total articulation process until
everything is acting smoothly again.
- So, what we are saying is that THESE ARE THE CONDITIONS
FOR AND MECHANISMS THROUGH WHICH ACTION IS INSTITUTED TO
REPLACE ROUTINES WITH NEW INSTITUTIONALIZED PROCEDURES.
Notice: we have to look more closely at the meaning of
routine procedures. At the lowest level, it means how
tasks are done. But this can be done by staff agreement
as well as by administrative rules.