Within wide-ranging quality improvement agendas, patient involvement in health care is widely accepted as crucial. Ward rounds that include patients' active participation are growing as an approach to involve patients, ensure safety, and improve quality. An emerging approach to studying quality improvement is to focus on “clinical microsystems,” where patients, professionals, and information systems interact. This provides an opportunity to study ward rounds more deeply. A new model of conducting ward rounds implemented through quality improvement work was studied, using the theory of practice architectures as an analytical tool. Practice architecture focuses on the cultural-discursive, social-political, and material-economic conditions that shape what people do in their work. Practice architecture is a sociomaterial theoretical perspective that has the potential to change how we understand relationships between practice, learning, and change. In this study, we examine how changes in practices are accomplished. The results show that practice architecture formed co-productive learning rounds, a possible model integrating quality improvement in daily work. This emerged in the interplay between patients through their “double participation” (as people and as information on screens), and groups of professionals in a ward round room. However, social interplay had to be renegotiated in order to accomplish the goals of all ward rounds.
Futurum, Academy for Health and Care, Region Jönköping County, Department of Medical and Health Sciences, Medical Faculty, Linköping University and The Jönköping Academy for Improvement of Health and Welfare, School of Health Sciences, Jönköping University, Jönköping, Sweden (Dr Thörne); The Jönköping Academy for Improvement of Health and Welfare, School of Health Sciences, Jönköping University, Jönköping, Sweden (Dr Andersson-Gäre); Department of Clinical Sciences Intervention and Technology Karolinska Institutet, Stockholm, Sweden (Dr Hult); and Department of Medical and Health Sciences, Medical Faculty, Linköping University, Linköping, Sweden (Dr Abrandt-Dahlgren).
Correspondence: Karin Thörne, MD, Futurum, Academy for Health and Care, House B4 Region Ryhov Hospital, Region Jönköping County, Sweden (firstname.lastname@example.org).
The authors declare no conflict of interest.
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