Coordination of physicians' operational activities:a Contingency perspective

Purpose - The purpose of this paper is to investigate the impact of three different dimensions of customer-induced uncertainty and task uncertainty on the mix of physicians' coordination practices.Design/methodology/approach - An improvement and research project are combined resulting in 16 case studies in different departments from one university hospital. The paper relies mainly on patient data from hospitals' registration systems and on 140 dialogues between two physicians reflecting on their coordination practices.Findings - Hospital units rely on time-structured oral communication supplemented with feedback in cases of high levels of input variety, whereas severity of illness and service intensity increase the use of unstructured oral coordination practices. High levels of customer-induced uncertainty reduce coordination by standardization of work processes. Supplementing verbal communication with written medical records has become an inherent part of coordination practices. Non-surgical units rely mostly on time-structured meetings, whereas surgical units use both time-structured and unstructured meetings to deal with customer-induced uncertainty.Research limitations/implications - The empirical part of this paper is limited to hospital units that are functionally organized. A further refinement and extension of measures for the contingency factors could help to better understand coordination practices.Practical implications - The paper offers hospitals in-depth understanding of how customer-induced uncertainty and task uncertainty affect physicians' coordination practices.Originality/value - The paper contributes to the knowledge on medical coordination from a contingency perspective. Further, the paper contributes to alternative methodologies in terms of data gathering as dialogues between organizational members are the main data source.