Gloria Lankshear

Decision-making, uncertainty and risk: Exploring the complexity of work processes in NHS delivery suites

Abstract The concept of the ‘risk society’ has focused on growing uncertainties about the benefits of scientific innovation and the reliability of professional judgement. Paradoxically, this has gone hand in hand with reductions in the actual risk associated with many activities and is often accompanied by demands for a technological fix. These contradictory impulses are especially evident in maternity care. While maternal and infant mortality rates have fallen, risk conscious patients are increasingly concerned about the possibility of professional mistake or malpractice. As a result, further categories of risk are created for organizations and professionals, particularly in relation to expensive litigation. Against this background, the paper reports on an ethnographic study of two delivery suites in which a computerized decision support system will be implemented. In the paper, we attempt to highlight some of the intricacies of work processes in delivery suites, specifically involving decision-making, risk, uncertainty, professional autonomy and medical knowledge. Our findings suggest a range of complexities that may considerably complicate the implementation of the computerized decision support system when it finally emerges and becomes embedded in delivery suites.

On the poverty of a priorism: technology, surveillance in the workplace and employee responses

Abstract Many debates about surveillance at work are framed by a set of a priori assumptions about the nature of the employment relationship that inhibits efforts to understand the complexity of employee responses to the spread of new technology at work. In particular, the debate about the prevalence of resistance is hamstrung from the outset by the assumption that all apparently non‐compliant acts, whether intentional or not, are to be counted as acts of resistance. Against this background this paper seeks to redress the balance by reviewing results from an ethnographic study of surveillance‐capable technologies in a number of British workplaces. It argues for greater attention to be paid to the empirical character of the social relations at work in and through which technologies are deployed and in the context of which employee responses are played out. In particular, it suggests that the resistance/compliance couple is too blunt an analytic instrument to capture the richness of those social relations. It argues, moreover, that there is an urgent need to reinstate the social in analyses of workplace relations just as respondents in the study frequently found themselves struggling to reinstate the social dimensions of work in the face of individualizing technologies. At the same time all parties to working social relations bring with them to the workplace understandings and definitions of legitimacy that have their origins at least partly outside the world of work. These definitions of legitimacy exercise a powerful influence on employee responses. Nowhere is this clearer than in the context of privacy where our respondents’ expectations and understandings diverged significantly from those to be found in much academic literature and social commentary—itself frequently framed in terms of a range of a priori assumptions about the priority attached to privacy at work.

Technology and ethical dilemmas in a medical setting: Privacy, professional autonomy, life and death

A growing literature addresses the ethicalimplications of electronic surveillance atwork, frequently assigning ethical priority tovalues such as the ‘right to privacy’. Thispaper suggests that, in practice, the issuesare sociologically more complex than someaccounts suggest. This is because manyworkplace electronic technologies not designedor deployed for surveillance purposesnevertheless embody surveillance capacity. Thiscapacity may not be immediately obvious toparticipants or lend itself to simpledeployment. Moreover, because of their primaryfunctions, such systems embody a range of otherfeatures which are potentially beneficial forthose utilising them. As a result, more complexethical dilemmas emerge as different desired ‘goods’ compete for priority in thedecision-making of individuals and groups. From a sociological point of view this raisesinteresting questions about the way ethicaldilemmas arise in the context of the ongoingsocial relationships of work. The paperexplores these issues using data from a studyof the development and implementation of acomputerised instructional package in amaternity setting. This medical settingillustrates clearly how seeking to assignethical priority to a particular concern, suchas the ‘right to privacy’, cannot butoversimplify the real day to day dilemmasencountered by participants. At the same time,the example of the instructional packagedemonstrates that it is difficult to predict inadvance what ethical issues will be raised bytechnologies that almost always turn out tohave a range of capabilities beyond thoseenvisaged in their original designspecification.

Women farmers in south‐west England

Abstract There has been research on women running businesses and on women as farmers’ wives, but little is known about women farmers—women running their own businesses within the rural economy. This paper reports on long interviews with nine women farmers in the South West of England. All had become involved in farming during or as a result of marriage, but at the time of the interviews all were business‐women in their own right, running farms or substantial independent businesses within a farming enterprise. The paper looks at their lives in terms of the power inherent in their positions on the one hand and the necessary interaction of domestic and farming obligations on the other. We also point out the importance of women farmers in a rural economy and the gender‐specific difficulties which they face.

Engagement and early termination of contact with a community-based early intervention service for personality disorder in young adults

Background: Few studies have examined factors associated with continuity of care in a community‐based early intervention service for personality disorder in patients aged 16–25.

“I Don’t Want to Live Like This Anymore”: Disrupted Habitus in Young People “At Risk” of Diagnosis of Personality Disorder

This article reports on interview data gathered from 27 young people involved with a street-level service for young people considered “at risk” of diagnosis of personality disorder. Interviews with a self-selecting sample of young people explored the events that led to their initial contact with the service. Using Silverman’s twin-track approach, narrative analysis provided a description of “how” these young people describe their lives in terms of “I don’t want to live like this anymore” while “what” they describe provides an often harrowing account of dangerous relationships and social isolation. In the process, we draw on a theoretical framework developed from the work of Pierre Bourdieu, particularly, his notion of crisis. This is used to locate individual experiences in a broader social context and to suggest that policy and intervention aimed at reducing crisis, promoting reflexivity, and supporting stable adult relationships are key to developing less destructive life styles.

Time, Place and Settings: Negotiating Birth, Childhood and Death

This chapter examines, through three case studies, how new health technologies are changing the material and social conditions of critical moments of life’s transition: birth, childhood development and the end of life. New and emerging health technologies are surrounded by ambivalence and risk: they promise a greater degree of ‘human’ agency over the bodily processes of birth, childhood illness and death (by enabling ‘discrete’ surveillance, maintenance of function or increased comfort), but at the same time may be perceived to take on ‘a life of their own’, placing new constraints around those affected by them (Beck, 1992). These new constraints have essentially social consequences and thus stand in a relationship of perpetual tension with the individual and bodily orientation of the particular health technologies at hand. This tension is, in part, related to the symbolic significance of birth, childhood and death within our culture: a significance which extends far beyond the sum of the material and physical transformations wrought by them (Eder, 1996). Culturally, we tend to place value on representations of birth, childhood or death that can be represented as untrammelled by medical technology: we set great store by ‘natural’ birth and death, unfettered childhood and the location of the healthy child within a well functioning and relationship-centred family.

Crisis and Loss in the Social Experiences of Young Adults with Undiagnosed Personality Disorder

This qualitative study focuses on the social experiences of a group of young women and men who engaged with a street level organization providing an early intervention service for young people “at risk” of diagnosis of personality disorder. Semi-structured interviews provided a range of insights into their lives which are characterized by difficult relationships and a range of risky and self-harming behaviors. Analysis produced three themes that highlight the onset of difficulties and dysfunctional relationships, the triggers for the current episode of difficulties, and the quality of family and other forms of support. This provided an overarching view of social circumstances that are embedded with crisis embodied by self-harm and a sense of loss for an “imagined” or “idealized” family that is symbolized by dysfunctional and abusive relationships.