Polypharmacy is an Organizational Practice

At Northwood, polypharmacy isn’t just a process—it’s an organizational practice, an intricate web of overlapping and interconnected routines that defines the rhythm of life within the facility. This practice-arrangement is the unseen engine driving the organization, upheld through countless daily rituals: completing the bi-annual medication forms, distributing pills, residents counting their doses at the dining table, or quietly rejecting what’s handed to them. Polypharmacy isn’t a word that gets tossed around often, but its fingerprints are everywhere—shaping conversations, decisions, spaces, and lives.

My research reimagines polypharmacy as an organizational practice, moving beyond the clinical or numerical to expose its deeper roots and implications. At Northwood, polypharmacy isn’t just something that happens; it’s something everyone—residents, healthcare professionals, administrators—is doing. It’s a practice that organizes people, relationships, and routines, and in turn, leaves indelible marks on the institution itself.

Polypharmacy creates a delicate dependency. Residents rely on medications to manage their conditions, while healthcare practitioners depend on the institutional structures—and the medicolegal work of forms and routines—that sustain this flow. But this dependency has a cost. Residents, the most vulnerable players in this system, are largely shut out of decisions about the medications that define their daily lives. Meanwhile, the routines designed to maintain the flow of medications impose a heavy burden of treatment—one that’s as emotional as it is physical.

Through the smallest details—the completion of a bi-annual form, the placement of a medication cart, the conversations between nurses and physicians—it becomes clear how polypharmacy is woven into the organizational fabric. The residential floors hum with activity, a tangled web of humans, objects, forms, and regulations, all working together to keep medications flowing.

Ultimately, my research circles back to one fact: in 2017, 4,927 doses of medication were distributed in a single day at Northwood, across 303 residents (more on this in a separate post). What allows this flow to exist? What structures and routines hold it in place? And what are the consequences for those living and working within its grasp?

What I found was a collective, organizational practice—a deeply embedded, stable arrangement that choreographs the lives of residents and practitioners alike. Polypharmacy isn’t just an element of care at Northwood—it’s a system, a culture, a way of life.