Organizational routine design in a hospital: a narrative-based study of ostensive routine dimensions in the making

Whereas the routine dynamics literature has highlighted the importance of building shared or compatible understandings when designing organizational routines, little attention has been granted to how such ostensive dimensions may emerge in pluralistic settings where organizational understandings are heterogeneous. Drawing on antenarratives, we study the emergence over time of the ostensive dimensions of different routines in the emergency care unit of a public hospital. We find that the emergence of ostensive dimensions may follow different patterns, which can promote or inhibit the compatibility in understandings, depending on whether they foreground specific aspects of performing the routine or whether they address the legitimacy of the routine. The insights contribute to the research on routine design by bringing processuality and multiplicity into the understanding of ostensive dimensions emergence and by identifying mechanisms explaining the emergence of understandings with different compatibilities.