To Örebro University

The role of organisational routines, defined as “repetitive, recognisable patterns of interdependent actions, carried out by multiple actors” (Feldman & Pentland, 2003:95), in primary healthcare cannot be underestimated in that they are shown to not only uphold stability and continuity at work but also foster patient and workplace safety (Rytterström et al., 2011; Johansson et al., 2019). Routines constitute mindful and effortful accomplishments( Pentland & Rueter, 1994), which healthcare practitioners, such as doctors and nurses, must constantly enact while finding some sense of meaningfulness, or at least relevance, to do so. If practitioners find routines meaningless, there is a high risk that they will not be maintained, which can have clear negative consequences. Despite the criticality of routines for healthcare practice, the intricate relationship between meaningfulness and routines is shrouded in darkness, which is what motivates this research. More specifically, in this paper, we delve into the intrinsic-extrinsic tensions of perceived meaning in routines, considering both routine process and outcome. Theoretically, we build on the well-established foundations of organisational routines (e.g., Pentland &R ueter 1994; Feldman, 2000; 2016; Feldman & Pentland, 2003) in combination with the conceptual distinction between internal and external drives or motives (Morris et al., 2022). Empirically, the paper is qualitative in nature and based on 25 semi-structured interviews conducted with three occupational groups in three primary healthcare units in the same region in northern Sweden. The collected material has been analysed inductively using the notion of intrinsic-extrinsic tensions as sensitising concept (Bowen, 2006). The paper illustrates that primary health workers often struggle with tensions of meaning when narrating their experiences of organisational routines. While a routine can be intrinsically perceived as meaningless, the same routine can be perceived as extrinsically meaningful. We argue that this tension is triggered by a misalignment between the idea of the routine and its intended outcome, on the one hand, and the actual routine performance, on the other hand. While the routine performance is intended to contribute to achieving the routine outcome and maintain the overall routine pattern, the latter do not directly materialise in a way that reminds routine participants of the meaning behind their performances. Even if routine actions usually follow a meaningful order (Feldman et al., 2016), routine actions per se may not be perceived as meaningful. Our findings further show that practitioners do not always keep track of the routine pattern and outcome when performing routine actions, which may lead to perceiving the routine performance as meaningless. Our paper contributes to the literature on routine dynamics by identifying intrinsic-extrinsic tensions of meaning in routines which may jeopardise routine maintenance. This study has practical implications for the design of routines (Pentland & Feldman, 2008) that not only are efficient and effective but also bring intrinsic and extrinsic meaning to the work of healthcare practitioners.