Coordinating Flexible Performance During Everyday Work: An Ethnomethodological Study of Handoff Routines

Our paper examines the challenge of coordinating flexible performance during everyday work. We draw on routine dynamics and ethnomethodology to examine how intensive care unit (ICU) physicians coordinate their actions—flexibly yet intelligibly—as they handoff patients at change of shift. Through our analysis of interview and video data, we demonstrate how physicians use the sequential features of the handoff routine—i.e., the expected moves and their expected sequence—to adapt each performance of the routine to the unique needs of each patient. We show the need for ongoing coordinating despite a strongly shared ostensive pattern and we illustrate how participants use the sequential nature of the ostensive pattern of the routine as a resource for flexible performance, to manage sequential variation and the sufficiency of moves at transitions. Our findings contribute to the routine dynamics and coordination literatures by providing a more nuanced understanding of how mutual intelligibility is achieved through coordinating, whereby participants create the conditions to move forward with a common project.