Davina Allen

(she/her)

Publication

• Date
• Type

Research

Research Overview

I am a sociologist of healthcare organisation and delivery, with a longstanding interest in nursing, socio-technical systems, and service improvement.  My research explores the organisational components of healthcare practice, with a particular focus on the work of nurses, healthcare quality and safety, and the coordination of care.

Over a research career spanning 34 years, have worked with national and international colleagues across disciplines - including medicine, dentistry, psychology, sociology, mathematics, and health economics - to build a substantial programme of research. My work has been supported by major funders including the ESRC, NIHR, Health Foundation, Norwegian Research Council, and Canadian Institute for Health Research. These awards reflect the applied relevance and theoretical innovation of my research.  I am committed to mentoring early career researchers and strengthening research capacity in nursing and allied health professions.

Current Research Areas

The Invisible Organisational Components of Nursing Work

A central theme in my research is the invisible organising work of nurses - the coordination, prioritisation, and relational labour that underpins safe and effective care but often goes unrecognised in formal systems. This work is critical to healthcare delivery and patient safety yet remains poorly understood and undervalued in workforce planning and service design.

This programme of research was initiated through a foundational ethnographic study, supported by a Health Foundation Improvement Science Fellowship, which examined the organising practices of nurses and their role in sustaining care systems. A key outcome of this study was the development of Translational Mobilisation Theory (TMT), a sociological framework for analysing collective action in complex organisational settings (https://www.translationalmobilisationtheory.org). TMT is a grounded theory which provides a conceptual lens for understanding coordination in emergent organisational processes.

This research laid the groundwork for the development of the TRACT Toolkit, a digital resource designed to support the management and measurement of nurses’ organisational contributions and a  textbook, Care Trajectory Management: Foundations for Organising Work in Nursing—the first of its kind to address organisational competence in nursing.

Explore the digital resources: https://theinvisibleworkofnurses.co.uk/

Patient Safety and Organisational Systems

Patient safety is a central concern in healthcare policy and practice, and my research addresses the organisational and workforce factors that shape outcomes. I focus on how nurses’ professional judgement, coordination work, and system-level interventions contribute to safer care environments.  Recent studies have focused on paediatric early warning systems and safe nurse staffing.  Both are theoretically informed by Translational Mobilisation Theory.

Early Warning Systems and Paediatric Safety

The NIHR funded PUMA study (Paediatric early warning system Utilisation and Morbidity Avoidance) investigated the development, implementation, and evaluation of a system-wide improvement programme for paediatric early warning systems. Conducted in four hospitals, the study combined interrupted time series analysis with ethnographic case studies to assess how organisational conditions affect the detection and response to clinical deterioration in children.

Findings highlighted the limitations of track-and-trigger tools in isolation and emphasised the need for whole-systems approaches to safety. The study offers a framework for ongoing system improvement and has implications for clinical practice, policy, and future research.

• 📘 Allen, D. et al. (2022). Development, implementation and evaluation of an evidence-based paediatric early warning system improvement programme: the PUMA mixed methods study. BMC Health Services Research, 22(1), Article 9. https://doi.org/10.1186/s12913-021-07314-2

Safe Nurse Staffing

The Pro-Judge study, funded by the RCN Foundation explored how nurses use professional judgement in staffing decisions across six hospitals in England and Wales.  It aimed to open up the "black box" of nurse staffing systems and led to the development of CUSIAT, a tool that helps nurses articulate complex contextual conditions affecting staffing needs.

Find out more about the study findings :

English https://youtu.be/9kmt--b4r3c

Welsh http://youtu.be/mFdhrgn0R_M

This work complements my broader research into the organisational components of nursing work, including the invisible labour nurses perform to sustain care systems. It aligns with the development of the TRACT Toolkit, which supports the management and measurement of nurses’ organising contributions for workforce planning.

Care Coordination and Service Integration

Care coordination is a longstanding focus of my research, encompassing the relational, organisational, and systemic work required to connect services and support patients across boundaries of care. My studies have examined how roles and responsibilities are negotiated across health and social care, how transitions are managed between paediatric and adult services, and how care pathways are constructed and enacted in practice.

Early work explored the division of labour in health and social care in patients who had suffered a first acute stroke.  This was followed by a study on the transition from paediatric to adult diabetes services, which highlighted the challenges of continuity and identity across institutional boundaries.  Subsequent research on care pathways examined their use as technologies of coordination and control, revealing both their potential and limitations in shaping patient journeys.

Most recently, the Making Connections study - undertaken as part of a Health Foundation Improvement Science Fellowship - investigated the socio-material practices through which patients are made and care is mobilised.  This research forms the basis of my forthcoming book, Beyond Pathways: Making Patients and Mobilising Care, which offers a new conceptual framework for understanding coordination work in contemporary healthcare systems.

Summary of Research Awards

2023 - Piloting and market testing of the TRACT Toolkit, ESRC IAA placement award.

2023 - Piloting and market testing of the TRACT Toolkit, ESRC, IAA award.

2022 - Development of an electronic application and web resource to support the management and measurement of the organisational components of nursing work: The TRACT Toolkit, ESRC CROSS Funding Award (Chief Investigator)

2021 - Development of electronic application and web resource to support the management and measurement of the organisational components of nursing work: The TRACT Toolkit, ESRC, Impact Accelerator Award (Chief Investigator)

2021 - Development and evaluation of a digitised educational platform to address a gap in nurse education on preparation for the organisational components of the nursing role, ESRC, IAA NPIF ABC (Chief Investigator)

2019 - Pro-Judge: An Ethnographic Examination of Nurses' Professional Judgement in Nurse Staffing Systems in England and Wales (Chief Investigator) - RCN Foundation 

2019 - NIPT Wales: Understanding and improving the new landscape of prenatal screening, Health and Social Care Wales (PI: Dr Heather Strange, co-applicant and mentor)

2019 - The 'politics' of a changing institutional ecology: coordination, prioritization and labour in Norwegian health, care and welfare services, Norwegian Research Council (co-applicant)

2018 - Workforce Behaviours in Healthcare Systems, THIS Institute (PhD studentship, with Professor Paul Harper)

2017 - Cardiff University Health and Social Care Improvement Research Network

2017 - Evaluation of Freedom to Speak up Guardians, NIHR HS&DR (PI: Dr Aled Jones)

2017 - Evaluation of Cancer Care Pathways, Norwegian Research Council

2017 - Feasibility and Acceptability of a new Clinical Pathway for the Identification of Non-Responders to Glaucoma Eye Drops (the TRIAGE study), NISCHR Research for Patient Benefit (PI: Prof Heather Waterman)

2017 - Prioritizing Care: Emerging dilemmas in the Norwegian care service landscape (pricare), Norwegian Research Council

2017 - One common ICT platform in the health care service: Interdisciplinary cooperation through shared journal information (PhD studentship), NTNU

2017 - Exploring personal responsibility for infection prevention and antimicrobial resistance in acute and community hospitals (EMPEROR) PhD Studentship, KESS PhD studentship (With Prof Dinah Gould)

2016 – Making Nurses’ Organising Work Count - ESRC, Impact Accelerator Account Award

2015 - Improving Access to Care and Treatment for Patients with Hip and Knee Pain at the Primary/Secondary Interface, NISCHR RfPPB (PI: Dr Kate Button)

2015 - An Actor Network Analysis of Patient Experience Data, NIHR HS&DR (PI: Sara Donnetto, Kings College London)

2015 - An Evaluation of Alcohol Treatment Centres: Implications for Service Delivery, Patient Benefit and Harm Reduction,  NIHR HS&DR (PI: Prof Simon Moore)

2014 - PUMA: Paediatric Early Warning System Utilisation and Mortality Allowance (Chief Investigator), NIHR HS&DR 

2014 - Delaying institutionalization, sustaining families: Comparative case studies of care at home for older people with dementia, Canadian Institute for Health Research, (PI: Dr Christine Ceci)

2013 - Lean, Agile or Leagile? A feasibility study to explore and compare the utility of pathway technologies, The Health Foundation Improvement Science Fellowship (Collaborator and mentor to Sharon Williams)

2013 - Design, development and pre-piloting of The Parent Learning Needs and Preferences Assessment Tool (PLAnT): a mixed methods study in the 13 UK Children’s Kidney Units, Kids for Kidney,  (PI: Veronica Swallow, University of Manchester)

2011 - Connecting for Service Improvement: Understanding departmental and organisational interfaces (Principal Investigator: Davina Allen) The Health Foundation

2011 - The organising work of nurses (Principal Investigator: Davina Allen)

2005 - The social organisation of ICP development: an ethnography (Principal Investigator: Davina Allen)

2008 - 'Evidence into practice: evaluating a child-centred intervention for diabetes medicine management' (Principal Investigator: Anne Williams) NIHR Service Delivery and Organisation Programme  

2007 - 'Mental health services in transition' WORD and The Health Foundation   (Principal Investigator: Ben Hannigan)

2007 - 'Health, medicines and health-care choices made by children, young people and their carers' NIHR Service Delivery and Organisation Programme   (Principal Investigator: Anne Williams)

2006 - 'The Transition from paediatric to adult diabetes services: What works for whom and in what circumstances?' NIHR Service Delivery and Organisation Programme  (Principal Investigator: Davina Allen)

Biography

I am a sociologist of healthcare organisation and delivery, with research interests in nursing, socio-technical relations in systems of work, and service improvement.  Over the years, I have collaborated with colleagues across medicine, dentistry, psychology, sociology, mathematics, and health economics to build a substantial programme of research on healthcare organisation and delivery.  I have held various senior leadership roles and contributed to building research capacity in nursing, allied health professions, and health services.

I joined Cardiff University in 1996 as a Research Fellow in the School of Nursing, during the final year of my PhD.  My doctoral research - an ethnographic study of the day-to-day negotiation of nursing role boundaries in a District General Hospital - was supervised by Professor Robert Dingwall and Professor Veronica James at the University of Nottingham. Funded by a Department of Health studentship, it formed part of a national strategy to strengthen research capacity in nursing, midwifery, and allied health professions. This study laid the foundation for my enduring interest in the social organisation of healthcare work and my commitment to develop the research basis of nursing.

Honours and awards

2021         Fellow of the Learned Society of Wales

2018-2023         Adjunct Professor, Faculty of Nursing, University of Alberta

2016-2025         Professor II Centre for Care Research NTNU, GjØvik, Norway

2016         Fellow of Academy of Social Sciences

2016         Q Community member

2016         ‘Inside bed management’: Ethnographic insights from the vantage point of UK hospital nurses, nominated by Sociology of Health & Illness for Thinking Allowed Ethnography Award

2013         Health Social Care Wales Faculty Lead Researcher

2012         Best Developmental Paper, British Academy Management Conference, Cardiff

2011         Improvement Science Fellowship (The Health Foundation)

2003         ‘The Nursing-Medical Boundary: A Negotiated Order?’ (1997) Sociology of Health & Illness 19 (4): 498-520, in the top thirty high impact papers to be published in the first 25 years of the journal.

2001         ‘The Nursing-Medical Boundary: A Negotiated Order?’ (1997) 19 (4): 498-520 - nominated by Sociology of Health & Illness for the American Sociological Association Medical Sociology Group Eliot Freidson Outstanding Publication Award.

1998         Sociology of Health & Illness ‘New Writer’s Prize’ for: ‘The Nursing-Medical Boundary: A Negotiated Order?’ (1997) 19 (4): 498-520.

1991         University of Nottingham ‘Arthur Radford’ prize for undergraduate dissertation: ‘Nursing Discontent’

1987         University of Nottingham Undergraduate Exhibition

Professional memberships

Academic positions

Committees and reviewing

Advisory/Steering Groups

• Steering Group Member - Creating patient-centred infrastructures to enhance informed consent and improve patient experience of radiotherapy for gynaecological cancer (NIHR) (2024-).
• Scientific Committee - RN2BLEND (2019-2023) 
• Advisory Board Member - 'do admission avoidance intermediate care schemes contribte to systainable healthcare services? Norwegian Research Council.
• Advisory Board Member - 'Beyond the Margins', funded by the Alzheimer's Society (Charlotte Clarke, University of Edinburgh) (2018-2021).
• Advisory Group Member for RCN Strategic Alliance for Nursing Research
• Invited participant in the seminar on healthcare cultures organised as part of phase II of the Public Inquiry into Paediatric Cardiac Surgery at the Bristol Royal Infirmary. Prepared two 'points for discussion' papers published in the final report (Kennedy 2001).
• Advisory Group Member: Department of Health Policy Research Programme, commissioned study: Implementation, impact and costs of policies for safe staffing in acute trusts (University of Southampton, University of Bangor)
• Steering Group Member: MENOS 4 Trial (Fenlon, University of Southampton)
• International Advisory Panel: Revision of the Standards for Quality Improvement Reporting Excellence (SQUIRE) publication guidelines, supported by the Robert Wood Johnson Foundation (US) and the Health Foundation (UK). (2013)

Editorial Board Membership

• Elected member of the Editorial Board for the Journal Sociology of Health and Illness (2000-2003). Judged "New Writers Prize" (2000-2003). Re-elected (2003-2006). 
• Editorial Advisory Board Member (invited) Journal of Health Services Research and Policy (2012-2018)
• Nominated and then elected member of the Publications Committee for Symbolic Interaction (2013-2014)
• International advisory board for the Policy Press series on The Sociology of Health Professions: Future International Directions, Mike Saks and Mike Dent (editors) (2017-

Journal Editorship

• Co-editor Sociology of Health and Illness (October 2012-2018, awarded through a competitive process)
• Co-editor (with Alison Pilnick) Sociology of Health and Illness Monograph – The Social Organisation of Healthcare Work (2005, awarded through a competitive process)
• Co-editor (with Jeffrey Braithwaite, Jane Sandall and Justin Waring) Sociology of Healthcare Safety and Quality (2016 - awarded through a competitive process)
• Co-editor (with David Hughes) The Francis Series, Sociology of Health and Illness Virtual Special Issue

Research Grant Commissioning Board Membership

• Welsh Office for Research and Development (social care) small grants committee (1998)
• Welsh representative on the DOH COREC Panel to consider Student Research in NHS and Social Care (2002-2004).
• Invited member of Nursing and Midwifery Commissioning Board subgroup of the National Co-ordinating Centre for NHS Delivery and Organisation Research and Development (NCCSDO) Programme (2006-2009)
• NIHR-SDO Commissioning Board Member (2009-2011)
• NIHR-HRDR Commissioning Board Member (2012-2015)
• Canadian Institute for Health Research, Commissioning Board Member (2016)
• French National Institute for Cancer Research, Commission Board Member (2015)
• The Health Foundation selection panel for Institutional PhD studentships (2015).
• The Health Foundation Cohort 4 Improvement Science Fellowship Peer Review Panel (2016)

Peer Review

• Referee for Journal of Sociology of Health and Illness; Social Sciences in Health; Health; Social Problems, Social Science and Medicine; Gender, Work and Organisation; Symbolic Interaction; Nursing Inquiry, Journal of Substance Use, Journal of Health Services Research and Policy, Lancet, Diabetic Medicine, International Journal of Nursing Studies, BMJ Quality and Safety, Journal of Nursing Management
• Manuscript and book proposal reviewer for Routledge, Sage, Open University Press and Balliere Tindall
• Referee for Welsh Office for Research and Development; NIHR Health Technology Assessment Programme; The Health Foundation; Department of Health Nursing Fellowship Scheme; ESRC; Canadian Social Science and Humanities Research Council

Supervisions

I am interested in supervising students in the areas of:

• The organising work of nurses - https://theinvisibleworkofnurses.co.uk
• Caring roles and responsiblities - lay and professional
• Healthcare improvement studies
• Healthcare quality and safety 
• Healthcare technologies
• Translational Mobilisation Theory https://www.translationalmobilisationtheory.org/
• Care coordination and service integration
• Workforce and the division of labour
• Nurse staffing systems
• Patient trajectory studies
• Safe nurse staffing
• Nursing and new technologies

Past projects

• Karen Visser - A situational analysis of community physical activity participation by children and young people with neurodisability.
• Elizabeth Evans- The Identification of Clinically Relevant Indicators to Support Diagnostic Recognition of Adult Hip Dysplasia
• Ben Hannigan- Health and Social Care for People with Severe Mental Health Problems: An Ethnographic Study
• Georgina Hourahane- Expertise and the Role of the Consultant Nurse
• Linda Parfit - First Impressions on Admission to the Acute Setting: Patients’ Perspectives
• Bronwen Davies - The Influence of Childcare Responsibilities on Access to Mental Health Services for Women with Mental Health Problems
• Fiona Rawlinson - An Exploration of Stakeholders’ Views of the Purpose of Palliative Day Care Services
• Paddy Scot- A Discourse Analysis of Expert Information Giving in Nursing Newsgroup Discussions
• Nicola Evans- Exploring the Contribution of Safe Uncertainty in Facilitating Change
• Judith Carrier- Nurses’ Use of Evidence-Based Guidelines in Primary Care
• Sue Taylor- The Research Component of the Consultant Nursing Role
• Dominic Roche- Involving Patients in Healthcare Safety: A Realistic Evaluation
• Moyra Journeaux- Nostalgic Constructions of Nurse Education: Sanitizing the Past or Learning from the Past - A Discursive Exploration