Institutional ethnography, social organization, wound care, wound clinics, counter-cartography


Under the banner of continuous quality improvement, process mapping has become an increasingly routine feature of healthcare administration. Driven by demands to improve efficiency through standardization, nurses’ knowledge of their often-unpredictable work is routinely changed to fit within graphical representations that depict it as objectively controllable. Tensions that arose as I attempted to apply my knowledge as a specialist nurse in the rapidly changing area of outpatient wound clinics formed the direction for my institutional ethnography (IE) inquiry. As a student new to IE, I encountered challenges as I tried to explain to my informants how Dorothy Smith’s alternative sociology offered a unique way to explicate how their work is being organized. Recognizing that confusion arose when the term “mapping” was used to identify a key analytic process in both quality improvement projects and IE, I searched for a way to articulate how the two approaches are distinct. Parallels and divergences I discovered between the focus of the "countercartography" movement and the problematic emerging in my own study helped me not only to acknowledge my own participation in the ruling relations, but to better appreciate how using IE offered the potential to create a quite different picture of nurses’ wound work— one which challenges the official versions of their world on paper.

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