Improvising Prescription: Evidence from the Emergency Room
通过急诊室的实地观察，研究揭示了在高度标准化的医疗环境中，专业人员如何在遵守规程的同时进行必要的即兴发挥，并探讨了这种双重性如何强化标准化压力。
Global medical practice is increasingly standardizing through evidence‐based approaches and quality certification procedures. Despite this increasing standardization, medical work in emergency units necessarily involves sensitivity to the individual, the particular and the unexpected. While much medical practice is routine, important improvisational elements remain significant. Standardization and improvisation can be seen as two conflicting logics. However, they are not incompatible, although the occurrence of improvisation in highly structured and institutionally complex environments remains underexplored. The study presents the process of improvisation in the tightly controlled work environment of the emergency room. The authors conducted an in situ ethnographic observation of an emergency unit. An inductive approach shows professionals combining ostensive compliance with protocols with necessary and occasional ‘underlife’ improvisations. The duality of improvisation as simultaneously present and absent is related to pressures in the institutional domain as well as to practical needs emerging from the operational realm. The intense presence of procedures and work processes enables flexible improvised performances that paradoxically end up reinforcing institutional pressures for standardization.