Fortællingerne om Sundhedsplatformen

Rikke Lønborg

Studenteropgave: Masterafhandlinger


The Capital Region and The Sealand Region are these years implementing “Sundhedsplatformen” (SP), which is a comprehensive IT-programme which is to support the clinical and administrative workflows in the hospitals. “Rigshospitalet” started their implementation in November 2016, and this dissertation is going to examine how the implementation strategy of Rigshospitalet (RH) is represented in physicians’ and nurses’ way of voicing their concerns on the topic of SP, and what narrative construction these expressions form during the implementation of SP at RH. The implementation strategy is included in this dissertation as part of the empiricism together with the interviews of two physicians and two nurses respectively. This means that the empirical field consists of texts (implementation strategy) from which the leadership perspectives appear, and interviews showing staff’s perspectives. The four interviews and the implementation strategy in this dissertation are treated as narratives to be narratively analyzed. First the narratives are analyzed tacsonomically on the basis of Fog et al.’s theory “The four elements of storytelling” (Fog et al., 2010). Thus a frame is created which contributes to reducing complexity, and a structure which can form the basis of the comparison of the narratives. Subsequently, a narrative theory is used to analyze the narratives in their complexity in relation to their narrative construction. The interest of the dissertation is to enhance the understanding of the construction of narratives and their transformation across “management layers”, so therefore a socially constructive hermeneutics principle is used where the socially constructed narratives are interpreted in the context they are part of. The narrative analysis shows that RH’s implementation strategy for SP has different expressions in the voicing on SP by the physicians and nurses respectively. A representation of the implementation strategy (management narrative) is seen in the nurses’ narrative, showing that the two narratives have the same message, namely that “SP has come to stay, and that SP is (or is going to be) a help to clinical staff in their wish to render a good treatment and care”. However, in the physicians’ narratives there is a contradictive difference to the management narrative when compared. Moreover, there is incongruity between the positioning of the “characters” in the management narrative and the physicians’ narrative respectively, when being analyzed by the “Fairytale model” (Aktantmodel). The management narrative states SP as a means for the clinical staff to use in order to obtain a better patient treatment (core service) whereas the physicians’ narrative gives the message that “SP does not Masterprojekt MPG 22.05.2017 Rikke Lønborg 4 work for doctors”. Seen from the Fairytale Model this means, that SP is positioned as opponent and helper respectively in the two narratives, showing a direct conflict between the two narratives. This leads to the conclusion that RH’s implementation strategy is NOT represented in the physicians’ narratives. There is also a difference in the way the narratives position themselves narratively in the two staff groups, despite the fact that none of the staff groups find that SP is functioning well and that both staff groups have many critical issues. The nurse group is dominated by a professionalism discourse in relation to patient care where they will let nothing “get in the way” for the good nursing and its reputation. They use externalizing language which have the potential for thick conclusions, but the nurses narratives is very orientated against very concrete problem solving and do not seem to be based on a reflection of the overall problem. Based on that, the thick conclusions do not appear in the nurse’s narratives even though the use externalizing language. The nurses make a selective perception of the narratives in the organizational narrative landscape, which fits into the professionalism discourse they use, as it is meaningful to nurses in their everyday life where SP has become a most radical factor. The doctors are dominated by a “medical discourse”, where it is essential to them to have a monopoly on the doctor’s medical professionalism, including the medical input to be built into SP. The doctors do not feel that they have been participating in the process of implementation of SP, which produces internalizing parlance with a clear blame game, and there is no opening up to viewing the importance of the narratives to the organization, nor to having a closer look at the social interaction in the clinical group, or for a selfreflexion by the individual doctor. The physicians’ narratives are problem loaded which limits physicians’ perspectives and make the situation seem hopeless. This is reflected in several thin conclusions, such as “SP is totally unfit for use”, “the cooperation with SP will never be good – that’s all over”, and “leaders, administrators and IT workers will NEVER be able to understand a clinical doctor’s world”. In summing up, it can be stated that the message in the leadership narrative speaks more into the nurses’ professionalism discourse than into the doctors’ medical professionalism discourse, and this can be a contributory factor as to why the implementation strategy is seen as part of the nurses’ narrative and not of that of the doctors. It can be questioned if the representation of the implementation strategy in the nurses narratives is actually because “the strategy worked”, or just a coincidence.

UddannelserMaster of Public Governance , (Masteruddannelse) Afsluttende afhandling
Antal sider64
VejledereMads Mordhorst