Achieving Continuity of Care: A Study of the Challenges in a Danish and a US Hospital Department

Abstract

Continuity of care is a central topic for healthcare practice and is closely related to issues of collaboration. Thus, studying continuity of care from a CSCW perspective can help us understand what makes continuity of care in practice. In this paper, we show how collaborative technologies are appropriated differently in two cases, one in Denmark and the other in the US. We illustrate how this appropriation is dependent on challenges particular to the organizational context of work. Studying the practices in two different hospital departments we found that in practice achieving continuity of care depends on two main characteristics in the organization of work, namely (1) the constitution of roles and (2) the responsibility for care linked to the appropriation of collaborative technologies. These characteristics of the organization of work create different solutions to the challenges of discontinuity when physicians appropriate mundane collaborative technologies: patient records and pagers. To understand how continuity of care is achieved in practice we have to study the appropriation of technologies, the paper argues, and by comparing across cases we may begin to discern challenges that cut across context—and their different origins.