How Hospitals Work: New Understandings Using Practice Theory

How to improve the delivery of health care within hospitals is a central question for policymakers, managers, clinicians, and the public. Conventional approaches to improvement have largely focused on either systems or individual behaviors. But social practice theory provides an alternative way of understanding how modern hospitals work, going beyond conventional explanations and pointing to new modes of intervention. The authors examine two cases to demonstrate how practice theory offers a way to move beyond binary understandings and explore such issues as what practices are at play, how those practices are helpful and to whom, what types of competence, meaning, and infrastructure support those practices, and how the linkages that support those practices can be strengthened or weakened to change outcomes.