Positioning and change in a hospital ward

This paper focuses on communication about hygiene in a hospital ward and with the relevant infection control organization. The purpose of this paper is to examine the function of the hygiene coordinator as a key change agent and the communicative challenges and role conflicts implied in her practice. The author suggests strategies for improving communication on hygiene on ward level.

The empirical material consists of interviews and recordings of communicative events in relation to a breakout of dangerous bacteria in the ward. Change communication is used as a contextualizing frame of understanding, and positioning theory and analysis are applied to shed light upon the core challenges of communicating as a change agent when the coordinator’s professional position and collegial relations do not support it.

It is shown how these challenges are connected to positional dilemmas regarding professional hierarchies and collegial relations. In order to have the hygiene coordinator gain authority and achieve empowerment in her function, additional documentation and training are needed, and communication efforts between the department management and the hygiene coordinator need strengthening. Furthermore, the hygiene area should be connected to the hospital’s overarching purpose of saving lives.

These findings point to the importance of taking communication on the departmental level into consideration in relation to change strategies, and they highlight the centrality of strategic positioning practices in a work environment which is organized in professional groups and according to distributed responsibilities.