When organisational stability conceals fragility: Sustaining work and compensatory labour in healthcare

Healthcare organisations rely on extensive everyday work to keep technologies functioning in clinical practice. Healthcare professionals routinely coordinate activities and compensate for organisational gaps in order to maintain care continuity. Yet technologies may appear stable and integrated while the work required to sustain them remains fragile, unevenly distributed and dependent on individuals. Existing implementation research provides stronger explanations for how practices become embedded than for what happens to the work required to sustain them once they appear organisationally stable. Implicitly, this literature often assumes that as practices stabilise, the work required to sustain them becomes absorbed into organisational routines and infrastructures. We know considerably less about why this organisational absorption occurs in some settings but not in others. This article examines why sustaining work becomes collectively supported in some settings while remaining fragile and individualised in others. Drawing on a comparative qualitative study of two medical technologies within a Swedish university hospital, we analyse how healthcare professionals sustained clinical activity through coordination, adjustment and repair. Although both technologies relied on similar professional effort, they developed different organisational trajectories. In one setting, sustaining work became embedded within shared organisational arrangements. In the other, it remained tied to individuals and had to be repeatedly recreated in response to fragmented responsibility, unstable material support and weak organisational legitimacy. The findings show that sustaining work became easier to support collectively where responsibility anchoring, material support and legitimacy aligned. Where these conditions remained fragmented, organisational continuity depended on compensatory labour. Organisational continuity should therefore not be mistaken for organisational support. By shifting attention from implementation to how sustaining work becomes unevenly organised after organisational stabilisation, the study contributes to research on healthcare coordination, professional work, organisational durability and healthcare resilience.