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

The National Health Service (NHS) system in England has been subject to successive IT-led reforms, designed to ‘modernize’ the way healthcare is provided. The implications of these reforms for healthcare professionals’ work have been studied from a range of perspectives (e.g. inter-professional roles, values and the contested process of change). Yet little attention has been paid to the implications of information technology for healthcare professionals’ work autonomy and task discretion. The present study seeks to fill this gap by examining the impact of new electronic patient records on work standardization, autonomy and discretion. We report evidence from two case studies of NHS Trusts that implemented a national electronic patient record, the National Care Record Service, a part of the National Programme for Information Technology (NPfIT) in the NHS in England. The paper argues that standardization of tasks and routinization of work is not limited to low-skill sectors, but is a possible consequence even in ‘high-skill’ healthcare sectors, in which professionals are usually expected to be able to ‘work around’ new systems by upholding their professional values. Specifically, it shows that the introduction of IT limited the work autonomy and task discretion for both nurses and clinicians by engendering routinization, through computerisation, of three aspects of healthcare professional work namely the delivery of care; the conduct of healthcare professionals and the interaction between healthcare professionals and patients. It concludes that although there is evidence of reallocation of discretion between different professional groups and opportunities for workarounds (albeit limited), new information technologies tend to constrain professional autonomy and discretion without necessary realizing efficiency gains as espoused by managers.