Ward rounds as a way of organising a function have existed as long as hospitals themselves. The way ward rounds are organised and conducted have over time undergone changes due to the development in diagnostics, care, shorter lengths of stay in the hospital, and general developments in society and broadly in the health sector. In medical wards current organisation and conduct of ward rounds results in frustration amongst health care providers that are striving to deliver a high quality of (health) care (QoC). Their quest is in line with wishes and demands from the political, managerial and administrative function systems on delivery of QoC in the hospital sector. Very limited evidence exists on the impact of current organisation and conduct of ward rounds on QoC in Denmark and elsewhere today. In this thesis are borrow into ward rounds in four Danish medical departments with an emphasis on the Medical Department at Roskilde Hospital. The study has been performed with a critical realistic perspective and focuses on two themes in the analyses: The different appearances of the patient and waste of time. These two themes are analysed with the use of the theory on polyphonic organizations and the actor-network theory (ANT). The study’s empiric data have been generated using quantitative, qualitative and document-based data. The study’s qualitative data have been extracted from open text fields in questionnaires, selfethnographic observations and individual semi-structured interviews. The analyses show that the theory on polyphonic organisations and ANT supplements each other well in throwing light over the chosen themes. It is shown that the Medical Department and the hospital as such do not have a primary codification that can guide the organisation and conduct of ward rounds. Further, it is demonstrated how the polyphony results in waste of time and have negative impact on the ward rounds’ delivery of QoC. Furthermore, it is demonstrated that ward rounds can be described as temporary networks that are established by human and non-human actors on a daily basis. The two selected theories are, however, unable by themselves or jointly to shred light over all elements of ward rounds conducted in today’s medical departments. The patient is made present to the physician in physical and non-physical forms over the working day. This fact undermines the current thinking about the content of ward rounds, it has become meaningless. As an alternative I suggest the introduction of the term ward round function, which encompasses the totality of the many forms the patient is being presented to the physician and the relations between the patient, the physician and other actors. I further suggest using ward round function as a concept in future work aiming at establishing evidence for the optimal organisation and conduct of the inevitable and important function ward rounds are in today’s hospitals.
|Uddannelser||Master of Public Governance , (Masteruddannelse) Afsluttende afhandling|