Coordinating Care in Context: Boundaries, Informal Work, and Surveillance in a Ghanaian Hospital

Hospitals are complex institutions where clinical, social, and cultural practices intersect. In Ghanaian hospitals, interactions are shaped by multilingual communication, professional hierarchies, cultural norms, and community expectations. Drawing on five months of ethnographic fieldwork, this study examines coordination of care in a Ghanaian hospital to understand how boundaries (i.e., professional hierarchies, communication barriers, community accountabilities), ruling relations, and power dynamics influence care. Institutional ethnography (IE) was implemented. Participants were purposively sampled, and data were collected through participant observation, documentary materials, and interviews with nurses (n = 11), patients (n = 21), and caregivers (n = 11). Thematic and IE analyses trace how boundaries and professional hierarchies, informal economies, and multilayered surveillance (“medical,” “social,” and “community” gazes) organize care work through institutional texts and how nurses, patients, and caregivers access or deliver care. The findings showed that boundaries at the Yendi Hospital were simultaneously rigid and negotiable, with informal economic activities compensating for institutional resource constraints. Communication work was central to navigating linguistic and cultural diversity, while surveillance from within and beyond the hospital-shaped behaviour and accountability. These everyday practices revealed how institutional texts and societal forces co-produce the conditions of care, with implications for teamwork, patient–provider relationships, and hospital governance.