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Cons uc ing esponsibili y in social in e ac ion : an analysis o esponsibili y alk in
hospi al adminis a i e g oups
© Pennanen & Mikkola, 2018
Published e sion
Pennanen, E eliina; Mikkola, Leena
Pennanen, E., & Mikkola, L. (2018). Cons uc ing esponsibili y in social in e ac ion : an analysis
o esponsibili y alk in hospi al adminis a i e g oups. Quali a i e Resea ch in Medicine and
Heal hca e, 2(3), 154-164. h ps://doi.o g/10.4081/q mh.2018.7114
2018
In oduc ion
Responsibili y is a ea u e o all kinds o social s uc-
u e, om small social uni s o la ge socie al con ex s.1,2
Responsibili y o wo k pe o mance, objec i es, asks,
and du ies is also a c ucial aspec o wo k and o ganiza-
ions. Ye al hough his ela ional concep is an es ablished
elemen o indi iduals, g oups, o socie ies,1li le is
known abou how esponsibili y is cons uc ed in social
in e ac ion. This s udy aims o desc ibe and unde s and
esponsibili y cons uc ion in social in e ac ion in hospi al
adminis a i e g oups.
The pe o mance o a hospi al’s a ious sys ems (such
as adminis a ion) and in e ela ed uni s (such as depa -
men s) a ec he pe o mance o he o ganiza ion as a
whole.3In he daily wo k o hospi als, esponsibili y is a
signi ican cons uc , o en conno ing medical esponsi-
bili y. In his ega d, sa e in o ma ion sha ing, mul i-p o-
essional collabo a ion, and decision-making in ela ion
o pa ien ca e all equi e ca e ul conside a ion in e ms
o esponsibili y and i s dis ibu ion.4-6 Ye , al hough ad-
minis a i e g oups o m an essen ial basis o o ganiza-
ional pe o mance, ea lie g oup and eam s udies in
hospi al o ganiza ions ha e ended o concen a e on
heal hca e eams.7,8 Responsibili y cons uc ed in social
in e ac ion in adminis a i e con ex s, o ins ance, bal-
ancing he di e en expec a ions o medical and admin-
is a i e wo k,8,9 may make he esponsibili y in social
in e ac ion in adminis a i e wo k a mo e complex phe-
nomenon o deal wi h.
Adminis a i e g oups, like he many kinds o manage-
men g oups and s a g oup mee ings, can be desc ibed as
esou ce g oups, which pe o m adminis a i e and expe -
ise-based wo k. They hus o en bea a lo o esponsibili y
in o ganiza ions. Responsibili y is no only a signi ican o -
ganiza ional aspec bu also an impo an socie al heme.
Responsibili y is a signi ican issue a bo h o ganiza ional
and socie al le els. In Finland, as in o he No dic coun ies,
a wide- anging s a e- unded public sec o deli e s se ices
like educa ion and heal hca e. Consequen ly, adminis a i e
g oups play a cen al ole in socie y, as hey a e esponsible
Cons uc ing esponsibili y in social in e ac ion:
an analysis o esponsibili y alk in hospi al adminis a i e g oups
E eliina Pennanen, Leena Mikkola
Depa men o Language and Communica ion S udies, Uni e si y o Jy askyla, Finland
ABSTRACT
The ole o esponsibili y in hospi als is undeniable. Al hough adminis a i e g oups a e essen ial o o ganiza ional pe o mance,
p e ious g oup and eam s udies o esponsibili y in hospi al o ganiza ions ha e concen a ed mainly on heal hca e eams. This s udy
aims o desc ibe and unde s and esponsibili y cons uc ion in he social in e ac ion in hospi al adminis a i e g oup mee ings, based
on obse a ion and analysis o se en adminis a i e g oup mee ings in a Finnish hospi al. Ca ego ies gene a ed by hema ic con en
analysis we e compa ed wi h esponsibili y ypes. The indings show ha esponsibili y is cons uc ed by c ea ing co- esponsibili y,
aking indi idual esponsibili y, and cons uc ing non- esponsibili y. Ac ion and ole and ask esponsibili ies eme ged as ypes om
he in e ac ion. To suppo employee in ol emen in esponsibili y p ocesses, hey mus also be p o ided wi h su icien esou ces o
deal wi h ha esponsibili y and o manage i s di e en dimensions. These insigh s can be u ilized o imp o e adminis a i e g oups.
Co espondence: E eliina Pennanen, Depa men o Language and
Communica ion S udies, Uni e si y o Jy askyla, PO Box 35, FI-
40014 Uni e si y o Jy askyla, Finland.
E-mail: [email p o ec ed]
Key wo ds: Adminis a i e g oups; Hospi al; Responsibili y; So-
cial in e ac ion; Wo kplace communica ion.
Con ibu ions: he p esen a icle is pa o he i s au ho ’s doc-
o al disse a ion ha was p epa ed unde he supe ision o he
second au ho .
Con lic o in e es : he au ho s decla e no po en ial con lic o in-
e es .
Funding: he au ho s epo g an s om he Uni e si y o Jy-
askyla, Facul y o Humani ies, and om he Finnish Wo k En i-
onmen Fund (112304) du ing he conduc o he s udy.
E hical s a emen : he s udy was app o ed by he Cen al Finland
Hospi al Dis ic . The e hical p inciples o he Finnish Ad iso y
Boa d on Resea ch In eg i y (2015) we e ollowed.
Recei ed o publica ion: 2 Oc obe 2017.
Re ision ecei ed: 27 Augus 2018.
Accep ed o publica ion: 28 Augus 2018.
This wo k is licensed unde a C ea i e Commons A ibu ion Non-
Comme cial 4.0 License (CC BY-NC 4.0).
©Copy igh E. Pennanen and L. Mikkola, 2018
Licensee PAGEP ess, I aly
Quali a i e Resea ch in Medicine & Heal hca e 2018; 2:154-164
doi:10.4081/q mh.2018.7114
[page 154] [Quali a i e Resea ch in Medicine & Heal hca e 2018; 2:7114]
Quali a i e Resea ch in Medicine & Heal hca e 2018; olume 2:154-164
Non-comme cial use only
o main aining pe o mance in hese public o ganiza ions.
This socie al dimension also links adminis a i e esponsi-
bili y o ins i u ional issues.
The heo e ical pe spec i e adop ed he e is in o med
by Lamme s and Ba bou ’s ins i u ional heo y o o ga-
niza ional communica ion.10 The concep o ins i u ion
can be used o desc ibe o ganiza ions, go e ning bodies,
and some adi ional p o essions (e.g., medicine), as well
as p ac ices, ules, beha io s, belie s, o ways o hinking
ha can be cha ac e ized as con inuing o ixed. As au-
ho i y, s a us, o powe is o en emphasized, ins i u ions
ex end beyond he pa icula o ganiza ion; o example,
he hospi al ins i u ion includes no only he o ganiza ion’s
a ious uni s and p o essions bu ce ain ixed ways o be-
ha ing, hinking, ac ing, and app o ing o jus i ying be-
ha io s and belie s.10
Because ins i u ions a e c ea ed, ep oduced, and sus-
ained by social p ocesses, communica ion plays a c ucial
ole.10 In he p esen s udy, he hospi al is app oached as
an ins i u ional sys em, in which ce ain ixed p ac ices
and belie s guide pe o mance.10 The c ea ion and dis i-
bu ion o esponsibili y can be unde s ood as one aspec
o hese ixed p ac ices, p ocesses, and beha io s. Fo in-
s ance, p o essional oles en ail ce ain adi ional ap-
p oaches o esponsibili y a wo k; doc o s bea medical
esponsibili y, and his a ec s how esponsibili y is pe -
cei ed in o he hospi al wo k con ex s, e lec ing he in-
s i u ional na u e o hospi als.
The pe spec i es o he ins i u ional heo y emphasize
he meaning o adminis a i e g oups, such as manage-
men g oups and o s a g oup mee ings, in o ganiza ions.
Ra he han pe o ming manu ac u ing o ope a ional
p ocesses, adminis a i e g oups p oduce a ious e-
sou ces – o example, by coo dina ing, o ganizing, de-
eloping, inno a ing, and c ea ing knowledge – and a e
commonly esponsible o main aining o ganiza ional
p ocesses.11 Adminis a i e g oups may be bo h s a egic
and execu i e.12,13 Because o hei esou ce- ela ed ole,
hese g oups a e cen al o meaning in he p ocesses and
ou comes o o ganiza ions and hei membe s.14,15 Admin-
is a i e g oups a e commonly esponsible o ce ain o -
ganiza ionally de ined ma e s, and he dimensions o ha
esponsibili y a e cons uc ed h ough social in e ac ion
wi hin hese g oups – o ins ance, when coo dina ing
wo k.11 Ins i u ional o ganizing is adjus ed h ough com-
munica ion, and he ins i u ional hie a chy is also es ab-
lished h ough hese communica i e o ganizing
p ocesses.10 I ollows ha social in e ac ion in adminis-
a i e g oups e lec s bo h he pa icipan s’ quali ies and
he ins i u ion beyond he o ganiza ion, which also a ec s
g oup beha io . Social p ocesses such as esponsibili y
c ea ion can he e o e be seen o encompass bo h g oup
and ins i u ional le els. In hospi als, whe e esponsibili y
and i s dis ibu ion play a c ucial ole, i becomes impo -
an o unde s and he p ocesses o esponsibili y con-
s uc ion in social in e ac ion.
Ea lie esea ch on esponsibili y
Responsibili y s uc u es social eali y, and as a social
cons uc ion, i is also ela ional. Fo p esen pu poses, we
adop Lenk’s1 de ini ion o esponsibili y as a ela ional
cons uc – ha is, esponsibili y a ises when “someone
is esponsible o somebody o some hing in iew o an
add essee (objec o esponsibili y) in ela ion o a no -
ma i e c i e ion wi hin a speci ic ealm o esponsibili y
and ac ion” (p. 212).1Addi ionally, many esponsibili y-
ela ed phenomena a e in e connec ed (e.g., in e nal/ex-
e nal con ol and accep ing/denying esponsibili y).2
Responsibili y is also an a ibu ional concep , whe e
someone holds someone else accoun able.16,17
In o ganiza ional s udies, esponsibili y is o en s ud-
ied in e ms o he social esponsibili y o a business o
o ganiza ion.18,19 Business e hics pe spec i es ha e also
in o med in es iga ions o in e nal s akeholde s (e.g., ob-
liga ions be ween employees and employe s) and ex e nal
s akeholde s (e.g., esponsibili y o cus ome s).20 How-
e e , his esea ch has ended o ocus on esponsibili y
as some hing ixed o s able a he han as a dynamic
p ocess ha is c ea ed, main ained, o changed in social
in e ac ion. In in ao ganiza ional s udies o eams and
g oups, esponsibili y means accep ing o denying espon-
sibili y as pa o he eam’s o g oup’s ac i i ies – o ex-
ample, being in cha ge o acili a ing o imp o ing he
eam’s wo k.21 The dis ibu ion o esponsibili y has also
been s udied in he con ex o esponsibili y o a ion
h ough collabo a ion among g oup membe s22 and o e-
sponsibili y sha ing, as in eam empowe men and mo i-
a ion a ising om a sense o esponsibili y o o
owne ship o he wo k.23 By ocusing on g oup ac i i ies,
such s udies ha e enhanced ou unde s anding o a ge ed
and sha ed esponsibili y. Howe e , he e is li le unde -
s anding o how esponsibili y is cons uc ed among peo-
ple inside o ganiza ions, o o he o ms ha such
esponsibili y may ake. Tha in o ma ion would help o
cla i y he a ious aspec s o esponsibili y and o suppo
employees in dealing wi h i .
In heal hca e con ex s, he e m esponsibili y o en
e e s o medical o e hical accoun abili y. I is impo an
o p ope ly unde s and who is in cha ge o wha , as any
lack o cla i y abou esponsibili ies h ea ens he sa e y
o in o ma ion-sha ing p ocesses.6In pa icula , espon-
sibili y is cen al o hando o hando e si ua ions – an-
si ions in ca e du ing which pa ien in o ma ion, au ho i y,
and esponsibili y a e ans e ed be ween uni s, depa -
men s, employees, o shi s.6,24 Hando communica ion
a ec s pa ien sa e y24 and o ganiza ional e hics in exe-
cu ing o he p ocesses such as communica ion o c i ical
in o ma ion.5Responsibili y in heal hca e con ex s is also
discussed in e ms o sha ed decision making, as o in-
s ance when pa ien s collabo a e wi h heal hca e p o es-
sionals in making decisions abou hei ca e.25,26 These
s udies ocus on speci ic si ua ions and on he p ac ices
o heal hca e eams. A he adminis a i e le el, he e is
[Quali a i e Resea ch in Medicine & Heal hca e 2018; 2:7114] [page 155]
A icle
Non-comme cial use only
e idence ha engaging and empowe ing hospi al s a
membe s in o ganiza ional decision making can con-
ibu e o a posi i e pa ien sa e y clima e and posi i e o -
ganiza ional ci izenship.27 This inding sugges s ha
esponsibili y alk in adminis a i e g oups can suppo
impo an ins i u ional asks by g ounding pe o mance.
Howe e , his neglec ed ela ional pe spec i e has no ye
add essed he ypes o esponsibili y discussed and con-
s uc ed in adminis a i e a enas.
The p esen s udy b oadens his a ea o esea ch by
explo ing how esponsibili y is cons uc ed in adminis a-
i e g oups and he ypes o esponsibili y cons uc ed.
Lenk1iden i ied h ee ypes o esponsibili y: ac ion, ole
and ask, and uni e sal mo al esponsibili y. Ac ion e-
sponsibili y e e s o accoun abili y o he ou comes and
consequences o a gi en ac ion. Role and ask esponsi-
bili y ela es o ul illing he du ies and expec a ions as-
socia ed wi h a speci ic ole o ask a wo k o elsewhe e.1
Role du ies may be assigned o in o mal; in o ganiza ions,
hey may be linked o ins i u ional ole esponsibili ies
such as leade ship.1Uni e sal mo al esponsibili y may
be ei he di ec o indi ec .1Di ec mo al esponsibili y
ela es o someone’s ac ions and hei consequences in a
speci ic con ex ;1indi ec esponsibili y a ises a a mo e
collec i e le el and encompasses he ac ions o o he s,
linking o g oup esponsibili y o co- esponsibili y.1The
p esen s udy applies Lenk’s1ca ego ies o ac ion, ole
and ask, and uni e sal mo al esponsibili y o he hospi al
con ex , which as an ins i u ion includes a ious le els o
dis inc and ela i ely ixed oles and asks, and aises
many mo al and e hical ques ions.
Aim o he s udy
The s udy seeks o desc ibe and cla i y esponsibili y
cons uc ion as a communica i e phenomenon in hospi al
adminis a i e g oup mee ings by add essing he ollow-
ing esea ch ques ions.
i) How is esponsibili y cons uc ed h ough social in-
e ac ion in hospi al adminis a i e g oup mee ings?
ii) Wha ypes o esponsibili y (ac ion, ole and ask,
uni e sal mo al esponsibili y) eme ge om social in-
e ac ion in hospi al adminis a i e g oup mee ings?
Fo p esen pu poses, esponsibili y is seen o be c e-
a ed h ough social in e ac ion, which is unde s ood as a
complex, si ua ed, and mu ual p ocess, in which wo o
mo e people exchange messages o c ea e sha ed mean-
ings and accomplish social goals (p. 151).28 In heal hca e
o ganiza ions, social in e ac ion is essen ial o c ea ing
and main aining ela ionships, p ocessing in o ma ion,
and c ea ing an o ganiza ional cul u e.3Mo eo e , many
o he ac i i ies ha o m pa o o ganiza ional li e
eme ge om social in e ac ion and he ela ionships c e-
a ed h ough he p ocesses o communica ion.29 To add o
knowledge in his ega d, he p esen s udy app oaches e-
sponsibili y as a neu al phenomenon a he han cha ac-
e izing i as posi i e o nega i e.
Ma e ials and Me hods
Da a collec ion
Based on a quali a i e design, obse a ion and ideo-
and audio- eco ding we e used o collec da a a se en ad-
minis a i e g oup mee ings o one ope a ional uni in a
la ge Finnish public hospi al. This o med pa o a la ge
esea ch p ojec explo ing social in e ac ion p ac ices in
hospi al o ganiza ions (Social In e ac ion P ac ices and
Well-Being a Hospi al Wo kplace, TSR112304). The uni
was selec ed on he basis o a s a ed willingness o pa ic-
ipa e. All e en s occu ed na u ally and exis ed independ-
en ly in he hospi al wo kplace wi hou he esea che s’
in e en ion;30 his quali a i e me hod o na u alis ic ob-
se a ion ob ains da a as unob usi ely as possible.31
The da a we e collec ed be ween Augus 2012 and
May 2013. The esea che who ga he ed he da a a ended
he mee ings bu did no pa icipa e in he discussions.
Da a we e ga he ed om i e managemen g oup mee -
ings o he ope a ional uni and om wo employee co-
ope a ion mee ings. The managemen g oup comp ised
10 membe s, bu only 6-8 a ended each mee ing. These
mee ings we e chai ed by he di ec o in cha ge o he
uni , who was also i s chie physician. The o he membe s
included he depa men ’s senio physician, head nu ses
and hei depu ies, ou membe s o he nu sing s a , and
a sec e a y who eco ded he minu es o he mee ing. The
agenda add essed adminis a i e ma e s such as esou c-
ing and acili a ion o he uni ’s wo k; i s basic s uc u e
o he agenda was always he same and included inances,
acancies, and opical issues ela ed o he uni . These
mee ings we e held mon hly, each las ing 45-70 minu es.
Da a we e eco ded using a 360° pano amic came a; in
o al, 4 h 35 m o da a we e eco ded.
In Finland, ac -on coope a ion in unde akings o ms
pa o labo legisla ion. The law includes a nego ia ion
obliga ion, which means ha coope a ion should be ne-
go ia ed in unde akings in ol ing 20 employees o mo e
and whe e ce ain changes a e planned.32 Al hough such
nego ia ions a e o en in e p e ed as e mina ions, a ge s
do no always include s a educ ions bu commonly ad-
d ess collec i e de elopmen o he o ganiza ion’s ope a-
ions and employee in ol emen in decisions ela ed o
hei wo k.32 Bo h employe and employees (o hei ep-
esen a i es) should be p esen a such nego ia ions.32 In
he uni obse ed o he pu poses o his s udy, coope a-
ion nego ia ions we e o ganized in ela ion o changes
conce ning se ices, wo k me hods, and wo k hou s,
among o he issues.
The employee coope a ion mee ings om which da a
we e collec ed we e he only ones o ganized by he uni
du ing he nine-mon h pe iod o da a collec ion. The 20 a -
endees a each mee ing included employees ( egis e ed
nu ses, p ac ical nu ses, o ice sec e a ies, a depa men al
sec e a y, and employees who assis ed in nu sing wo k),
manage s ( he chie physician, he head nu se, and he head
[page 156] [Quali a i e Resea ch in Medicine & Heal hca e 2018; 2:7114]
A icle
Non-comme cial use only
nu se’s depu ies), employee ep esen a i es, and a labo
union ep esen a i e. The mee ings we e audio- eco ded,
as pano ama ideo eco ding was no possible because o
he mee ing oom acili ies and he la ge numbe o pa ic-
ipan s. The i s employee coope a ion mee ing las ed 1
hou and 3 minu es, and he second las ed 35 minu es. To al
eco ded da a om he managemen g oup and employee
coope a ion mee ings amoun ed o 6 h 13 m.
The s udy ollowed he na ional guidelines o e-
sea ch e hics: espec ing pa icipan au onomy, a oiding
ha m, and p o ec ing p i acy and da a.33 In Finland, an
e hical e iew is no usually needed when he esea ch
pa icipan s a e adul s who olun ee o pa icipa e and
when he s udy does no expose hem o excep ionally
s ong s imuli o possible ha m. On ha basis, no IRP ap-
p o al was sough .
Analysis
The analysis was pe o med in wo phases. To answe
he i s esea ch ques ion, he aim was o de e mine how
esponsibili y is cons uc ed h ough social in e ac ion in
adminis a i e g oup mee ings. To answe he second e-
sea ch ques ion, he aim was o iden i y which o Lenk’s
ypes (ac ion, ole and ask, o uni e sal mo al esponsi-
bili y) would eme ge om hese in e ac ions.1
Thema ic con en analysis was used in bo h phases o
analysis.34,35 A e iden i ying, coding, and ca ego izing
any pa e ns in he da a,35 he aim was o iden i y he ypes
o esponsibili y1 hese p ocesses c ea ed. The analysis o-
cused on pa e ns in he da a ha could be ecognized and
in e p e ed,34 based on wha happened in he in e ac ions
be ween a endees a each mee ing, concen a ing on
hemes ha could be iden i ied a he explici , seman ic
le el (wha was said) and hose occu ing a he la en , in-
e p e i e le el (wha happened in he dynamics o he in-
e ac ion).34,36 The uni o analysis was hus ei he a
meaning uni ha consis ed o exp essions o s a emen s
ha we e pa o he same main meaning36 o an episode
o he in e ac ion ha comp ised mo e han one pa icipa-
ion.37 While he analysis ocused p ima ily on e bal
communica ion, in e p e a ions also ook accoun o non-
e bal communica ion, as his o ms pa o he o ali y in
which sha ed meanings a e c ea ed.38
The eco ded mee ings we e i s ansc ibed, ead,
and wa ched o lis ened o in hei en i e y. The da a we e
coded by making no es o become amilia ized; he ini ial
lis o codes ga he ed ideas om he da a ha we e o im-
media e in e es wi hin he s udy amewo k and objec-
i es.34,35 The dynamics o in e ac ion we e highligh ed
du ing his phase, and episodes in which esponsibili y
was aken, sha ed, denied, a oided, o o he wise nego i-
a ed we e iden i ied and selec ed o analysis. A e he
coding phase, he da a we e ca ego ized on he basis o
sha ed meaning. The aim was o in e p e he dynamics
o he in e ac ion – in o he wo ds, o analyze wha hap-
pened when esponsibili y- ela ed hemes a ose in he
mee ings. The ca ego ies we e labeled as sha ing espon-
sibili y, aking esponsibili y, and emo ing esponsibili y.
The ca ego ies we e hen e iewed and e ined, and he
essence o he in e ac ion was iden i ied.34 A his phase,
he coded da a ex ac s we e ead h ough and conside ed
whe he hese we e cohe en in ela ion o he da a se , o
one ano he , and o he esea ch objec i es. This led o he
c ea ion o subca ego ies and enaming o he main ca e-
go ies o mo e accu a ely cap u e hei meaning as c ea -
ing co- esponsibili y, aking indi idual esponsibili y, and
cons uc ing non- esponsibili y.
Following he induc i e analysis, he second phase o-
cused on iden i ying he di e en ypes o esponsibili y
eme ging om social in e ac ion in he mee ings, based on
Lenk’s1ca ego ies (ac ion, ole and ask, and uni e sal
mo al esponsibili y) and e e ing o he explici le el o
in e ac ion. Ac ion esponsibili y included ma e s ela ed
o ac ions, beha io s, o hei consequences.1Role and ask
esponsibili y ela ed o ole ul illmen o asks and du ies.1
Uni e sal mo al esponsibili y included he e ec s o he
agen ’s ac i i y on he well-being o o he s.1These di e en
o ms o esponsibili y we e iden i ied in ela ion o he ca -
ego ies om he i s phase o analysis, using quali a i e
con en analysis o iden i y he in e ac ion p ocesses
h ough which each was cons uc ed. The us wo hiness
o his analysis was s eng hened by discussing me hods
and in e p e a ions wi h colleagues in he esea ch g oup.
The esul s a e p esen ed hema ically, based on he
main ca ego ies; bo h esea ch ques ions a e add essed in
pa allel as hey o m a cohe en ensemble. The da a ex-
amples p esen ed in his a icle we e ansla ed by he au-
ho s om Finnish in o English. The ansc ip s we e
anonymized o ensu e ha pa icipan s and depa men s
could no be iden i ied. In he examples, names o he
uni s and ea men s a e eplaced by xxx.
Resul s
The mee ing pa icipan s cons uc ed esponsibili y by
c ea ing co- esponsibili y, aking indi idual esponsibili y,
and cons uc ing non- esponsibili y. Table 1 p esen s he
indings in ela ion o esponsibili y cons uc ion and he
esponsibili y ypes ha eme ged om social in e ac ion
du ing adminis a i e mee ings.
C ea ing co- esponsibili y
The p ocess o c ea ing co- esponsibili y en ailed
sha ing o esponsibili y be ween wo o mo e pe sons o
was wa an ed by ins i u ional ac o s such as o ganiza-
ional policies. A endees c ea ed co- esponsibili y
h ough in e ac ion by i) engaging someone else in he e-
sponsibili y o ii) commi ing hemsel es o he esponsi-
bili y. In his way, esponsibili y was no solely in he
hands o he pa icipan ad ancing he iewpoin o idea
bu was sha ed wi h someone o some hing else.
[Quali a i e Resea ch in Medicine & Heal hca e 2018; 2:7114] [page 157]
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Non-comme cial use only

The p ocess o co- esponsibili y c ea ion occu ed wi hin
he dynamics o in e ac ion. A he con en le el, pa icipan s
o en explici ly s a ed ha someone o some hing would pa -
icipa e in sha ing he esponsibili y wi h hem, and o he pa -
icipan s esponded by accep ing his. Cons uc ion o
co- esponsibili y did no include ejec ion o sha ed espon-
sibili y, and a endees showed accep ance by acknowledging
he ma e add essed and mo ing on o he nex opic, o by
s a ing ha he ma e was accep able o hem.
Pa icipan s engaged ano he pa y in a esponsibili y
by posi ioning someone o some hing else as co- esponsi-
ble wi h hem, s a ing ha someone o some hing else sup-
po ed he ma e ha hey p esen ed o ha someone o
some hing would join hem in aking ca e o he ma e .
In exp essing ha someone o some hing else sup-
po ed he p esen ed ma e , pa icipan s e e ed o an in-
di idual o en i y ha ag eed and so sha ed he
esponsibili y. Pa icipan s o en alluded o a highe le el
in he o ganiza ional hie a chy (occupied by a pe son o
g oup) o o ins i u ional ea u es such as hospi al policies
o collec i e labo ag eemen s ha sha ed hei iewpoin .
In da a example 1, he depu y engages bo h someone and
some hing else in co- esponsibili y by e e ing o ano he
manage and a collec i e labo ag eemen suppo ing he
p esen ed pe spec i e.
Da a example 1
Depu y (D) 1: So, I asked [how] he head nu ses o
depa men 000 […] deal wi h his issue. I mean, hey
ace his same issue in hei depa men ; […] hei em-
ployees need o wo k in a ious places,—- So, she said
hey had long nego ia ions abou his wi h employee ep-
esen a i es […] o […] mon hs, and […] concluded ha
you could no include a el ime in you wo k hou s. —
- I would hen be de ined like his. O […] acco ding o
he [collec i e] labo ag eemen , i would un o una ely
go like his.
In e e ing o o he head nu ses and hei in o ma ion
and o a collec i e labo ag eemen , D1 demons a es ha
someone o some hing else sha es esponsibili y. In his
way, D1 c ea es co- esponsibili y.
In he p ocess o exp essing ha someone o some-
hing else would ake ca e o he ma e oge he wi h he
pa icipan p esen ing i , ano he pa y is aken o co-sha e
he esponsibili y o an ac ion o ac i i ies. By men ion-
ing sha ed esponsibili y, he pa icipan s made he issues’
p og ess isible o one ano he . In da a example 2, he
chie physician posi ions he sec e a y as co- esponsible
o checking he schedules.
Da a example 2
Chie physician (CP): Anyway, a coope a ion mee ing
will be o ganized he e in ou o ice. I will now ake place
in Ap il, bu we will hen check he exac da e wi h Anne.
When he CP says “we will check he exac da e wi h
Anne,” Anne is posi ioned as co- esponsible o ensu ing
he igh schedules; in o he wo ds, he CP does no bea
his esponsibili y alone.
[page 158] [Quali a i e Resea ch in Medicine & Heal hca e 2018; 2:7114]
A icle
Table 1. Responsibili y cons uc ion p ocesses and ypes o esponsibili y.
Responsibili y Posi ioning Social in e ac ion p ocess Message con en Type o esponsibili y
cons uc ion
C ea ing Posi ioning someone o Engaging someone else Someone/some hing else Task and ole
co- esponsibili y some hing else as in esponsibili y suppo s he ma e
co- esponsible wi h
he pa icipan s
Someone/some hing will ake Ac ion
ca e o he ma e oge he
wi h he pa icipan
Posi ioning onesel as Commi ing onesel o Taking ca e o he ma e Ac ion
co- esponsible wi h esponsibili y oge he wi h someone else
someone else
Taking indi idual Responsibili y bea e Con i ming esponsibili y Taking ca e o some hing Ac ion
esponsibili y ha will happen
Bea ing esponsibili y o Ac ion
some hing ha happened
ea lie
Cons uc ing Messenge Dis ancing onesel om Unwillingness o ake Task and ole
non- esponsibili y esponsibili y esponsibili y and shi ing
i o someone o some hing
else
Incompe en /unsu e Re using esponsibili y Gi ing easons o no aking Task and ole
o one’s posi ion esponsibili y
Non-comme cial use only
Commi ing onesel o he esponsibili y was ano he
way o cons uc ing co- esponsibili y. The pa icipan s
showed ha hey could o would sha e he esponsibili y
by exp essing ha hey would ake ca e o he ma e o-
ge he wi h he a endee who spoke o i o wi h someone
else who was no p esen a he mee ing.
Types o esponsibili y
C ea ing co- esponsibili y en ailed dimensions linked
o ac i i ies, asks, and oles. S a ing ha someone o
some hing else suppo ed he ma e ela ed o ask and
ole esponsibili y, as his easoning was based on he s a-
us o he pe son o g oup. This is demons a ed in da a
example 1, whe e D1’s easoning is based on s a us. D1
e e s o o he head nu ses (ha ing he s a us o leade )
and o a collec i e labo ag eemen (ha ing he s a us o
a o mal ule o law). S a ing ha someone would ake
ca e o he ma e along wi h he pa icipan was a o m
o ac ion esponsibili y, as he p ocess ocused on ac i i-
ies. In da a example 2, CP e e s o ano he pe son (Anne)
who will be esponsible o he ac ion along wi h CP.
In hese esponsibili y ypes, in o ma ion played a sig-
ni ican ole as a dimension o ac ion esponsibili y. In a
hospi al con ex , in o ma ion can be seen o es ablish, e -
i y, and jus i y an ac ion, whe e expe ise o ms he basis
o ope a ions and hei quali y. Men ioning ha someone
o some hing else suppo s he p esen ed ma e is a o m
o ole and ask esponsibili y. The easoning was based
on ole du ies o ul illmen o a ce ain ole o ask, as
well as ins i u ional ole esponsibili ies, as he a endees
e e ed o ep esen a i e oles such as ha o manage .
Commi ing onesel o esponsibili y is a o m o ac ion
esponsibili y, as i ocuses on u u e ac i i ies and aking
ca e o hem.
A endee s a us and he opic unde discussion seem o
de ine pa icipa ion in he in e ac ion p ocesses associa ed
wi h cons uc ing co- esponsibili y. Someone wi h expe -
ise on he discussed ma e o c eden ials o in luence o h-
e s, such as a manage o a membe o a ce ain p ojec
g oup, was engaged in he esponsibili y. An expe on he
ma e unde discussion commi ed hemsel es o i s ela ed
hemes, and he discussion opic speci ied he c ea ion o
co- esponsibili y. When discussing challenging si ua ions
(e.g., some d awbacks a wo k), a endees indica ed ha
hei iewpoin was sha ed and suppo ed by someone o
some hing else (da a example 1).
Taking indi idual esponsibili y
In aking indi idual esponsibili y, pa icipan s hem-
sel es assumed esponsibili y o a ce ain ac ion o i em
o in o ma ion, and esponsibili y was c ea ed in he com-
munica i e p ocesses o con i ming. In hei in e ac ion,
pa icipan s explici ly s a ed ha hey we e in cha ge o
some hing. Indi idual esponsibili y was also nego ia ed
wi h o he a endees in si ua ions whe e he o he s a gued
and showed suppo o he pe son who was ying o ake
indi idual esponsibili y.
By posi ioning hemsel es as esponsibili y bea e s,
pa icipan s con i med h ough hei in e ac ion ha he
esponsibili y was hei s by exp essing ha one would
ake ca e o some hing ha would happen o ha one
would ake esponsibili y o some hing ha happened
ea lie . In da a example 3, a nu se con i ms ha espon-
sibili y o hei lapse o memo y is hei own.
Da a example 3
Nu se (N) 9: Oh, guess wha ? I o go o igu e ha
hing ou . Well, I will ask and le you know nex ime how
i is supposed o be done.
By indica ing o o he s ha hey would ake ca e o
he ma e , he indi idual’s esponsibili y was also made
isible o hem. The p ocedu e o w i ing he mee ing
minu es suppo ed his kind o indi idual esponsibili y
c ea ion; al hough he sec e a y w o e he minu es
h oughou he mee ing, i was highligh ed ha key issues
needed o be ca e ully no ed, and he esponsibili ies we e
o en associa ed wi h hose. Da a example 4 illus a es his
kind o in e ac ion.
Da a example 4
D2: Well, le ’s w i e i down ca e ully now so ha i
will be aken in o accoun .
By exp essing he impo ance o w i ing down a signi -
ican heme, D2 akes esponsibili y. Taking no es also
made esponsibili ies isible a uni o o ganiza ional le el,
and minu es we e sha ed wi h o he wo k g oups and s a
membe s. The esponsibili y was con i med mainly by he
head nu se and chie physician, who also had he o mal
powe o p oceed wi h he ac i i ies in hei uni .
Taking esponsibili y o some hing ha happened ea -
lie was also co e ed by exp essing ha one would ake
esponsibili y o one’s ac ions. This occu ed when pa -
icipan s ecognized and explained hei own e o s – o
ins ance, no doing some hing ha hey we e supposed o
do. In hese cases, accoun abili y o a mis ake was no
shi ed o some hing o someone else bu was p esen ed
as one’s own aul . This kind o esponsibili y- aking won
suppo om o he pa icipan s, who esponded wi h ac-
cep ance. They showed suppo by jus i ying he e o in
e ms o ex e nal ac o s, and he na u e o he wo k (e.g.,
oo much adminis a i e wo k, complex hospi al policies)
was used o explain someone’s memo y lapse. By show-
ing accep ance, he o he s jus i ied he indi idual’s mis-
ake and di used indi idual esponsibili y.
Types o esponsibili y
Ac ion esponsibili y became isible in con i ming
ha one ook esponsibili y o one’s ac ions, and u u e
and pas dimensions o esponsibili y eme ged. S a ing
ha one would ake ca e o some hing was linked o he
[Quali a i e Resea ch in Medicine & Heal hca e 2018; 2:7114] [page 159]
A icle
Non-comme cial use only
u u e, whe e a pa icipan said ha hey would p og ess
a ask o du y ou side he mee ing. This is he case in da a
example 3, whe e he pa icipan says ha hey will ake
ca e o some hing ou side he mee ing and will in o m
o he s abou i a he nex mee ing. The pas dimension
eme ges in he p ocess o aking esponsibili y o one’s
ac ions, as he ac ion o i s consequences a e explained.
Howe e , ask and ole esponsibili y we e also seen o
eme ge om hese p ocesses i he ac o posi ioned as e-
sponsibili y bea e was conside ed. In many cases, he
head nu se o chie physician accoun ed o hei pas ac-
ions o he consequences, and o he s jus i ied i , so di -
using indi idual esponsibili y.
Cons uc ing non- esponsibili y
Pa icipan s cons uc ed non- esponsibili y by shi ing
esponsibili y om hemsel es (o om hei own uni o
g oup) o someone o some hing else.The p ocess oc-
cu ed in he dynamics o he in e ac ion, which included
a mu ual nego ia ion o gi ing o o e ing esponsibili y
bu no aking i . Responsibili y was emo ed by i) dis-
ancing hemsel es and ii) e using esponsibili y. These
p ocesses c ea ed he dimensions o willingness and he
oppo uni y o in luence wo k- ela ed ma e s and ake e-
sponsibili y a wo k.
Pa icipan s dis anced hemsel es om esponsibili y
by posi ioning hemsel es as messenge s deli e ing
someone else’s message. This unwillingness o ake e-
sponsibili y eme ged when someone s a ed ha he sha ed
in o ma ion o iewpoin was no hei own bu came
om someone o some hing else. O en, he posi ion o
messenge was highligh ed by eading a message, such as
he minu es o ano he mee ing. In his way, he pa ici-
pan dis anced hemsel es om he esponsibili y, shi ing
i o he message sende o o an ins i u ional body (such
as ano he managemen g oup), whose in o ma ion he
pa icipan was only epo ing. In da a example 5, a nu se
dis ances he sel om esponsibili y by b inging up a
opic o iginally sugges ed by ano he nu se. A he end,
howe e , she men ions ha all o he o he nu ses also
suppo he ma e .
Da a example 5
N10: Well, I am saying his on behal o Ma Ma son.
This hing abou hese depu yships is ha hey a e con-
duc ed in heal h cen e s. I will now ead his in i s en i e y,
so ha i will be p esen ed co ec ly as he has ph ased i .
So [s a s o ead]: “Because o he expansion o he pe -
o mance o he hospi al, we ace a new kind o si ua ion.
The depu yships a e illed on a olun a y basis.” […]
[ eads he whole message explaining he laws o he new
si ua ion in de ail and hen con inues]. All in all, so ha
hese depu yships can be co e ed wi hou any di icul y,
Ma sugges s ha he a el ime o o he owns o hese
nu sing depu y assignmen s should be included in wo k
ime, and ha olun ee s who a e willing o a el o
heal h cen e s would be asked [ o ake] hese assignmen s
in he i s place. He hinks ha i would be good o ha e
10 o 15 nu ses eady o ake hese depu y posi ions o en-
su e ha we can also co e ou aca ion pe iods. Ma
hen adds: [ eads] “Fo mysel , I hink he op ion o wo k-
ing in heal h cen e s oo en iches my job, and I will also
be happy o ake hese assignmen s in he u u e. I hope
he issues I’ e aised will be conside ed” [s ops eading].
As all o us xxx nu ses b oadly sha e hese hough s, i
would be eally good i a el ime could be included in
ou wo k hou s, as a elling ex ends he leng h o he
wo king day by se e al hou s.
In ha example, he nu se claims o be epo ing
some hing on behal o someone else, so dis ancing hem-
sel es om esponsibili y. E en ually, he esponsibili y
acqui es a collec i e dimension, as he nu se says ha “all
o us xxx nu ses b oadly sha e hese hough s.”
Rejec ing/ e using o ake esponsibili y occu ed in an
in e ac ion in which esponsibili y was o e ed o someone
who declined i , o whe e i was expec ed o be accep ed
bu a eason was gi en o no doing so. Pa icipan s did
his by exp essing hesi ancy abou hei posi ion.
Pa icipan s posi ioned hemsel es as incompe en by
explaining ha hey had insu icien in o ma ion o ake
esponsibili y – o ins ance, o make a decision. They
easoned ha , because o hei posi ion in he o ganiza-
ion, hey lacked he necessa y in o ma ion, ei he be-
cause someone else was in cha ge o he ask o because
hey did no ecei e he in o ma ion om someone al-
hough hey had eques ed i . In hese in e ac ions, pa -
icipan s e used esponsibili y by s a ing ha hey could
no de e mine he igh decision o how o pe o m he
ask o du y in ques ion. They also a ionalized hei e-
usal by e e ing o insu icien oppo uni ies o ake e-
sponsibili y o o hei lack o c eden ials. In his way,
he pa icipan s posi ioned hemsel es as unsu e o hei
posi ion. These p ocesses also ela ed o di using e-
sponsibili y – o ins ance, he chie physician migh i s
y o ans e he esponsibili y o a nu se, who would
e use and y o hand i back.
In da a example 6, he chie physician o e s espon-
sibili y o he nu ses by saying ha hey can decide o
hemsel es how o handle a case in ol ing new ea men
p ac ices. Howe e , one nu se e uses he esponsibili y
and ies o in ol e someone else in deciding o con i m-
ing wha o do.
Da a example 6
CP: So, hey will need some pa ien s o hese aining
sessions. Pa ien s, xxx pa ien s. Because hey ha e di e -
en kinds o equipmen he e, and hey [nods owa d N1]
and you [nods owa d N3] don’ know how o use hem.
N3: Well, yeah.
[…]
N3: Wha kinds o ea men , and how many o hem, a e
needed?
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A icle
Non-comme cial use only
CP: Jus wha e e you ha e. I guess you jus need o go
h ough he appoin men lis s and pluck he xxx pa ien s
om he e; his can be done o e he e, and hen ask he
s a who a e he e in hese aining sessions.
N3: Umm.
CP: How abou ou nu ses – is i possible o hem o pa -
icipa e?
N3: Yes, i is.
[…]
CP: Yes, so pa ien s a e needed hen, o e he e.
N3: How many pa ien s?
PJ: You know be e you sel es.
N3: I is […]
N1: I will be like […]
CP: So many pa ien s ha i won’ mean ushing a ound,
bu i should be possible o eally concen a e on hem
[N3: I wish I knew…]. I hink he aine can ell you.
N3: Mmm.
This da a example illus a es esponsibili y ejec ion;
he CP o e s i , bu he nu ses do no ake i . Ins ead, hey
say hey a e unsu e, and hey y o ge someone else o
decide he igh numbe o pa ien s. In he end, he CP
akes he esponsibili y by deciding ha he aine can
ell hem. In his way, he CP also di uses esponsibili y
by deciding ha someone else can decide and p o ide he
nu ses wi h he igh in o ma ion.
Types o esponsibili y
Task and ole esponsibili y eme ged in e using e-
sponsibili y by dis ancing onesel om i . Responsibili y
was shi ed o someone o some hing else, e e ing o a
ole o ask ha explained he con en o he message. In
his way, esponsibili y was pe cei ed o all elsewhe e
and no o he indi idual epo ing he ma e .
Responsibili y was o en emo ed a ins i u ional o
o ganiza ional le el, whe e a manage could shi i o
highe managemen (“ hey decide”) o o he employees
(“you know be e how i should be done in p ac ice”).
Equally, employees could ans e i o manage s (“We a e
no su e how his should be done”). The na u e o nu sing
wo k o manage s’ wo k, o ganiza ional s uc u es, he
hospi al cul u e, o a lack o ce ain y abou u u e
changes we e used o posi ion onesel as someone who
could no o would no ake esponsibili y, o was o he -
wise unsu e abou how o decide, ac , o pe o m. Respon-
sibili y was also di used a a mo e abs ac le el, as i was
no always speci ied o nego ia ed o whom he esponsi-
bili y was shi ed.
To conclude, adminis a i e wo k encompasses many
elemen s o esponsibili y. Responsibili y was cons uc ed
by c ea ing co- esponsibili y, aking indi idual esponsi-
bili y, o cons uc ing non- esponsibili y. While ac ion e-
sponsibili y and ole and ask esponsibili y eme ged om
hese in e ac ions, he da a did no include uni e sal mo al
esponsibili y. These indings a e discussed in he nex
sec ion.
Discussion
Ou esul s sugges ha collec i e esponsibili y is em-
phasized in hospi al adminis a i e g oups. E en indi id-
ual esponsibili y cons uc ion was linked o collec i e
esponsibili y, as i in ol ed ins i u ional membe ships
and e e als; in his way, esponsibili y cons uc ion be-
came collec i e.1 This migh be explained in e ms o in-
s i u ional ole esponsibili ies, as esponsibili y o en
seemed ep esen a ional, as in ul illing he ole o leade
and i s associa ed obliga ions, expec a ions, and espon-
sibili ies.1Collec i e esponsibili y was also c ea ed by
di using esponsibili y, whe e o he s jus i ied an indi id-
ual’s ac ions o hei consequences. This indica es espon-
sibili y managemen , whe e people a emp o egula e
hei eelings o guil by a ionalizing he ac ion and i s
consequences, so pu ing a ibu ions o esponsibili y in o
pe spec i e. I is impo an o no e ha hese jus i ica ions
do no always deny accoun abili y bu o e easons o
educing o emo ing blame and liabili y.39 This kind o
esponsibili y di usion can also be in e p e ed as a o m
o social suppo ha helps employees o manage anxie y
and s ess a wo k.29
The indings also e ealed ins ances o non- esponsi-
bili y, cons uc ed by dis ancing onesel and e using o
ake esponsibili y. Fo example, posi ioning onesel as a
messenge may be a s a egy o sa ing onesel by declin-
ing esponsibili y o some con o e sial ma e . Mon-
ada39 no ed ha , by using his kind o s a egy, one can
p o ec onesel agains blame, sanc ions, and eelings o
guil and sel -blame. Howe e , ou indings also sugges
ha esponsibili y may be ejec ed on g ounds o a lack
o abili y o esou ces, which may also accoun o he
indings ega ding esponsibili y denial. Fo ins ance,
nu ses may e use o ake esponsibili y because hey lack
he necessa y esou ces o deal wi h i , as hei e e yday
wo k wi h pa ien s is o en based on someone else’s e-
ques s and decisions. In his way, ins i u ional oles may
also de e mine in ol emen in an adminis a i e con ex .
The p esen indings also illumina e he in e es ing
ole o empo ali y, as esponsibili y was c ea ed in bo h
pas and u u e dimensions. The esul s suppo Bi n-
bache ’s17 iew ha esponsibili y can ela e o pas ac-
i i ies o hei consequences o o p oducing ce ain
condi ions o a speci ic ma e . These p ocesses can p o-
duce he sha ed eali y o an o ganiza ion’s pas and u-
u e. In e ac ions ha e lec he pas and an icipa e he
u u e can also con ibu e o he ixed na u e o ins i u ions
ha main ain hei s uc u e by c ea ing accep ed unde -
s andings o he wo k and he wo kplace. This also links
o he ela ional le el o he wo kplace; as well as p o id-
ing he con ex in which social in e ac ions occu , ela-
ionships also en ail pa e ns, bounda ies, and ins i u ions
ha a e c ea ed and e ol e h ough dynamic in e ac ion.29
As compa ed wi h oles, which a e o en pe cei ed as el-
a i ely s a ic, posi ions a e epheme al as collec ions o be-
[Quali a i e Resea ch in Medicine & Heal hca e 2018; 2:7114] [page 161]
A icle
Non-comme cial use only