Rules and resources: a structuration approach to understanding the coordination of children's inpatient health care.
OBJECTIVE
This paper presents findings from a multi-method study exploring the process of care coordination in children's inpatient health care.


BACKGROUND
Existing work on care coordination is typified by "black-box" type studies that measure inputs to and outcomes of care coordination roles and practices, without addressing the process of coordination.


METHODS
Using questionnaires, interviews and observation to collect data in multiple sites in the United Kingdom and Denmark between 1999 and 2005, the study gathered the perceptions of staff and compared these with observed practice. Giddens' structuration theory was used to provide an analytical and explanatory framework.


RESULTS
Current care coordination practice is diverse and inconsistent. It involves a wide range of clinical and non-clinical staff, many of whom perceive a lack of clarity about who should perform specific coordination activities. Staff draw upon a wide range of different material and non-material resources in coordinating care, the use of which is governed by largely tacit and informal rules.


CONCLUSIONS
Care coordination can be usefully conceptualized as a "structurated" process--one that is continually produced and reproduced by staff using rules and resources to "instantiate" or bring about care coordination through action. Potentially negative implications of this are manifested in diversity and inconsistency in care coordination practice. However, positive aspects such as the opportunity this provides to tailor care to the needs of the individual patient can be realized.
Beringer
Antonia J
AJ
Centre for Child & Adolescent Health, University of the West of England, Hampton House, Cotham Hill, Bristol, UK. antonia.beringer@uwe.ac.uk
Fletcher
Margaret E
ME
Taket
Ann R
AR
D001291:Attitude of Health Personnel; D002648:Child; D002662:Child Health Services / Q000458:organization & administration*; D002669:Child Welfare; D002673:Child, Hospitalized; D003299:Cooperative Behavior; D003718:Denmark; D036262:Empirical Research; D006801:Humans; D007297:Inpatients; D007400:Interprofessional Relations; D008962:Models, Theoretical; D010564:Personnel, Hospital; D006113:United Kingdom