Bounded by repertoires and roles : communication through multiple ICTs in a health care organization
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Health care has become the largest employer in the United States, and health care organizations are looking to ICTs as a solution to facilitate interprofessional communication and patient care. Yet extant findings show mixed results on the efficacy of ICT use for coordination, and little is known about how health care professionals use their collection of ICTs, as opposed to a singular device, to communicate. Inspired by the theoretical underpinnings of communication media repertoires and boundary theory, this dissertation provides an empirical link between the use of multiple ICTs, that are both organizationally-issued and personally-owned, and the complexities of coordinating patient care. Drawing on qualitative data collected from observations, interviews, and focus groups at a pediatric hospital in the Southern U.S., this research investigates the communicative practices of different teams of allied health professionals—an underexplored population making up approximately 60% of the health care workforce. Differences in technological access, managerial expectations, and workflows emerged within and across the professional groups in the health care organization studied. The findings reveal how allied health professionals experienced repertoire misalignment, a situation where ICTs and routines of use clashed. Furthermore, many people were overloaded by learning which ICTs their colleagues used and how they used them— defined as communication load issues—which impeded the efficiency and quality of their work. This dissertation further shows how ICT repertoires are situated at the crossroad of multiple role boundaries, complicated by organizational rules and norms that were inconsistent across teams. These allied health professionals held strong professional identities, and they were asked—or required—to use personal mobile phones for work purposes. When organizational, professional, and personal boundaries were at odds, employees did not feel empowered to enact their ICTs in ways that privileged professionalism or personal preferences. Thus, although the use of ICT repertoires can facilitate communication within and across professional teams, this dissertation exposes how health care professionals’ work practices are being challenged and constrained by organizational demands for ICT repertoire use
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