‘We Can Only Request What's in Our Protocol’: Technology and Work Autonomy in Healthcare

Abstract

This paper explores the tension between standardization and autonomy raised by the implementation of new technology in healthcare organisations. The theoretical frame of this study is grounded in the impact of new technologies on work organisation, routinization and autonomy across settings. Empirically it presents evidence from two NHS Trusts in England that implemented a national Electronic Patient Record (EPR). The paper aims to reinvigorate the debate on the tension between standardization and autonomy in professional workplaces such as healthcare. It argues that the implication of technology in professional work conditions processes of task routinization that constrain autonomy, and enables reallocation of discretion between professional groups. We argue that routinization is not restricted to low-skill work but may travel across contexts and be evidenced in high-skill work environments. The interplay between routinization and autonomy is also useful in drawing insights concerning the dynamics of change that occur in professional work.