Starting from scratch

Background Health care organizations are constantly creating new work to achieve evolving goals such as digitalization, equity, value, or well-being. However, scholars have paid less attention to how such work becomes “work” in the first place, despite implications for the design, quality, and experience of work and, consequently, employee and organizational outcomes. Purpose The aim of this study was to investigate how new work becomes enacted in health care organizations. Methodology A longitudinal, qualitative case study on the enactment of entrance screening—a new operation in response to COVID-19—in a multihospital academic medical center was performed. Results Entrance screening comprised four tasks, whose design was initially influenced by institutional guidelines (e.g., Centers for Disease Control and Prevention recommendations) and clinical experts. Organizational-level influences (e.g., resource availability) then became more prominent, necessitating multiple feedback–response loops to calibrate the performance of entrance screening. Finally, entrance screening was integrated into existing operations of the organization to ensure operational sustainability. The treatment of entrance screening as an operation changed over time—initially seen as infection control work, it eventually bifurcated into patient care and clerical work. Conclusion The enactment of new work is constrained by the fit between resources and its intended output. Furthermore, the schema of work influences how and when organizational actors calibrate this fit. Practice Implications Health care leaders and managers should continuously update their schemas of work so that they can develop more sufficient and accurate representations of the employee capabilities that are required for the performance of new work.