Using artifacts for practices tuning and performance refining. The Nursing Record artifact between affordance and agency: A case study.

The paper presents an analysis of the role of artifacts in mediating tacit, implicit and informal knowledge embedded in people’s practice, routines and taken-for-granted activities. Working on organizational artifacts is shown as relevant opportunity for exploring the relationship between affordance and agency in the workplaces. Methods Healthcare organizations furnish interesting insights about contexts in which a plurality of actors are involved in change processes, coping with pressures for reorganization applied by institutional stakeholders and policy-makers, and challenged to update their operational systems in response to new technologies and procedures. The paper refers to an action research which took place in a Hospital of Northern Italy, during a reorganization aimed at changing the paradigm of healthcare delivery. The contribution highlights the main phases of the intervention, focusing on the revision process of the Nursing Record as crucial artifact. Results The results point out the bridging function of inscriptions as boundary objects, supporting the progressive process of shaping a shared knowledge and a common sense. Writing the Record entails a professional accountability both as social responsibility for own daily activity and as responsivity to the relational and transactive processes in which practitioners are engaged.