DIVISION-OF-LABOR IN CLINICAL MICROBIOLOGY - COOPERATION AND FRAGMENTATION

The aim of the study was to describe clinical microbiological practice s in a hospital setting. A grounded theory was developed from qualitat ive data in two steps: initial participant observation to describe the clinical work-flow, and a main case study based on in depth interview s and analyses of work practices using a video-based stimulated recall technique. Six physicians, 2 senior medical laboratory technologists and one head nurse were interviewed in depth based on their organizati onal positions. Stimulated recall interviews were conducted with 11 nu rses, 6 secretaries, 6 medical laboratory technologists, and 3 physici ans. An informal clinical microbiological 'workgroup' was found to co- operate around two physical objects: the microbiological sample and th e laboratory request form. Work organization was divided into planning , based on science and legislations, and performance based on traditio n and local supervision. None of the practitioners had a total overvie w of an analysis cycle, all being occupied with a discrete part of pla nning, practical work and information management. The conclusion of th e study is that fragmentation in the division of labour may be a criti cal hindrance to development in clinical microbiology. If a common str ategy is not shared between specialities and professions, even minor c hanges in routines by individual practitioners may influence patient o utcome.