Tinkering Around Healthcare Infrastructures: Nursing Practices and Junction Work

Introduction of healthcare infrastructures is often accompanied by workarounds, persistence of paper-based documents and of technologies that the innovation was intended to replace, raising the question as to whether they are by-products or intrinsic to infrastructure innovation processes. This work, through a longitudinal case study of a hospital information system long in use, investigates their origin, their role in enabling the system’s affirmation, and the difficulty of eliminating them. Through a qualitative methodology, semistructured interviews and ethnography, we reconstruct the history of the system and the information management practices around it. Our analysis reveals that the effectiveness of the tool implemented derived largely from 'junction work' performed by the nurses, and which ensured the flow of data among different electronic and paper-based information systems. Moreover, in carrying out their junction work the nurses intervened to modify, enrich and complete the information contained in the different systems.