Walking the tightrope: how rebels “do” quality of care in healthcare organizations

PURPOSE: The purpose of this paper is to empirically explore and conceptualize how healthcare professionals and managers give shape to the increasing call for compassionate care as an alternative for system-based quality management systems. The research demonstrates how quality rebels craft deviant practices of good care and how they account for them. DESIGN/METHODOLOGY/APPROACH: Ethnographic research was conducted in three Dutch hospitals, studying clinical groups that were identified as deviant: a nursing ward for infectious diseases, a mother–child department and a dialysis department. The research includes over 120 h of observation, 41 semi-structured interviews and 2 focus groups. FINDINGS: The research shows that rebels’ quality practices are an emerging set of collaborative activities to improving healthcare and meeting (individual) patient needs. They conduct “contexting work” to achieve their quality aims by expanding their normative work to outside domains. As rebels deviate from hospital policies, they are sometimes forced to act “under the radar” causing the risk of groupthink and may undermine the aim of public accounting. PRACTICAL IMPLICATIONS: The research shows that in order to come to more compassionate forms of care, organizations should allow for more heterogeneity accompanied with ongoing dialogue(s) on what good care yields as this may differ between specific fields or locations. ORIGINALITY/VALUE: This is the first study introducing quality rebels as a concept to understanding social deviance in the everyday practices of doing compassionate and good care.