The interplay of roles and routines : situating, patterning, and performances in the emergency department

Sammanfattning: This thesis took its point of departure in the lack of research regarding the intricate and important relationship between roles and routines. With roles and routines providing individuals with enough discretion to accomplish work while ensuring consistency, the overall research question posed was: how do roles and routines interplay to enable flexible performances? This question was operationalized through three sub questions: (1) why are roles and routines flexible, (2) how do roles and routines interplay, and (3) what contextual aspects influence which patterns come into play? The purpose was to increase the understanding of the interplay of roles and routines in organizations.The theoretical basis was built up in three steps. First, the foundations of roles and routines were explored separately, laying the basis for further conceptualizations. Second, overlaps of role and routine studies were explored, highlighting their contributions to current understandings. Third, through a joint discussion of the fields, commonalities between the two areas were put forth. Central to this were the ontological foundations in performances, and re-enacting the duality of structure and agency. The theoretical work resulted in a conceptual framework, which integrated roles and routines and served as the basis for unpacking and furthering an understanding of their interplay.In order to fulfil the purpose, and in line with the view on roles and routines as patterns of action, an organizational ethnography of an emergency department at a Swedish university hospital was conducted. Due to its characteristics, this setting represented a unique opportunity to study the interplay. Primarily based on observations, a total of 25 field visits (136,5 hours), 19 interviews, and hundreds of documents, served as the empirical material, which was analysed through iterative rounds of coding. Narratives, visual mapping, and narrative networks, were analytical strategies used in progressively moving from an understanding of the context to the identification of role and routine patterns.Furthering the developed conceptual framework, the findings showed how roles and routines interplay in, and through, performances. Depending on individual, interpersonal, and environmental aspects, scripted and unscripted patterns are situated in performances, which trigger role and routine patterning. Summarized in an integrated framework, which highlights the key findings, this thesis showed how the interplay of roles and routines provides organizations with stability and flexibility. This has implications not only for role and routine theories, but also organization theory in general. Implications, regarding the organizing of work at emergency departments, and other organizations, as well as for educators, the society and governments were also outlined.