Kajsa Lindberg

Objects-in-Use and Organizing in Action Nets A Case of an Infusion Pump

In this article, the authors engage in, and contribute to, the discussion about the role of objects (material arrangements) in processes of organizing. The point of departure of the study was a critical incident at a hospital when a drop infusion pump failed. By following the action, that is, to apply an action net perspective, initiated by incident aiming to secure the ongoing care and treatment of patients on the ward, the authors are able to illustrate the relation between objects-in-use (such as boundary objects) and ongoing organizing practices, and how such organizing activities are dependent on, and conditioned by, material arrangements and objects. Furthermore, they also show that objects, far from being stable entities, are also being constructed, deconstructed, and reconstructed—dependent on what is appropriate in a specific time and place, and as part of ongoing organizing.

Look What's Back! Institutional Complexity, Reversibility and the Knotting of Logics

Through a comparative historical study of community pharmacy in the UK, Italy, Sweden and the USA, the authors examine what happens to institutional arrangements designed to resolve ongoing conflicts between institutional logics over extended periods of time. It is found that institutional arrangements can reflect the heterogeneity of multiple logics without resulting in hybridization or dominance. Because logics remain active, similar conflicts can reappear multiple times. It is found that the durability of the configurations of competing logics reflects the characteristics of the polities in which fields are embedded. The dominance of any societal institutional order leads to more stable field-level arrangements. The authors suggest that the metaphor of institutional knots and the related image of institutional knotting are useful to capture aspects of this dynamic and to foreground the discursive and material work that allows multiple logics to coexist in local arrangements with variable durability.

Multiple institutional logics in union–NGO relations: private labor regulation in the Swedish Clean Clothes Campaign

Conflicts between labor unions and nongovernmental organizations (NGOs) often impede private labor regulatory attempts to protect worker rights at supplier factories. Based on a study of a failed private regulatory attempt for Swedish garment retailers, we contribute to existing research into union–NGO relations by demonstrating how conflict arises because unions and NGOs act upon different institutional logics. We also contribute to the institutional logics perspective by challenging the current emphasis on either coexistence or conflict among multiple logics, and showing the heterogeneity in how multiple logics manifest on a local level, how this could shift over time, and suggesting an empirically derived typology of manifestations of multiple logics.

Performing boundary work: The emergence of a new practice in a hybrid operating room

This paper addresses the processes of boundary work, in relation to the introduction of new technology, unfolding during the emergence of new medical practices. Inspired by Gieryns fluid and practical view of boundaries and boundary work, and by Actor-Network Theorys description of scripting processes, we study the processes of negotiating and (re-)constructing boundaries in order to reveal both the interactions between different kinds of boundary work and their situatedness in the context of the emerging practice. We conducted a longitudinal and qualitative study of a generic Hybrid Operating Room at a Swedish university hospital, where sophisticated imaging devices are combined with open surgery procedures in a single room; consequently, medical requirements regarding radiology, surgery and anesthesia, as well as the specificities of the new technology, all need to be met at the same time. The study shows how the visibility of boundaries is a result of as well as a condition for boundary work, how boundary work is a dynamic and iterative process, and how it unfolds in a recursive relationship between practice and boundaries.

Powerless positions, silenced voices? – critical views on health and social care management

PURPOSE The purpose of this paper is to provide background to this special issue and consider how critically oriented research can be applied to health and social care management. DESIGN/METHODOLOGY/APPROACH Basic principles of critical management studies are introduced briefly to frame subsequent papers in this issue. FINDINGS In order to identify the wicked problems and darker sides of the care field, there is a need to study things in alternative ways through critical lenses. Giving a voice to those in less powerful positions may result in redefinition and redesign of conventional roles and agency of patients, volunteers and professionals and call into question the taken-for-granted understanding of health and social care management. ORIGINALITY/VALUE The special issue as a whole was designed to enhance critical approaches to the discussion in the field of health and social care. This editorial hopefully raises awareness of CMS and serves as an opening for further discussion on critical views in the research on management and organization in this field.

One Table – Several Practices: Material Controversies in the Hybrid Operating Room

In Chapter 3, Lindberg and Walter present a study of the introduction and use of a ‘hybrid operating room’ at a major Swedish hospital. Hybrid operating rooms are complex as they are both technology and knowledge intensive, and imply the collaboration of several disciplinary groups with different specializations and multiple understandings. Based on field material from an ethnographically inspired longitudinal study, the authors describe negotiations between the stubborn materiality of the table used in this particular room and the need to perform safe medical procedures, based on previous experiences gained in their separate practices. The table was translated into a multifunctional tool that brought about new types of flexibility, enabling as well as restricting what and how can be done in the hybrid room.

Engaging Material Resources: Nursing Work in Leukaemia Care

Traditionally the health care sector has been characterized by the dependence of strong professional groups organizing, evaluating and delivering the health care services. Such professional work has often been attributed to the individual body, where professional know-how and skills are to be found. Reporting on a study of nursing work in a leukaemia ward of a Swedish regional hospital, it has been demonstrated that the conventional view of nursing as primarily involving bedside care, organized around the patient and through social relations, accommodates only a subset of nurses’ work. In addition to face-to-face care and patient interaction, nursing work is the melding of a great number of actors with different domains of expertise to safeguard the health care status of the patient, spatially distributed, temporally fragmented, and performed and mediated through the utilization of a number of material resources and technologies outwith the everyday lives of the patients.

Standardizing: The Introduction of Evidence-Based Methods into Drug Abuse Treatment

Today’s society is often called the knowledge society, and there is a strong conception that what we do must be based on the best knowledge available. Technological development contributes towards the aim that knowledge must be inscribable and storable so that it may be transferred and used in other contexts (i.e., that knowledge must be transferrable in time and space). This is also noticeable in the care sector, where the notion of evidence-based medicine (EBM) has had a major impact. EBM emphasizes that professional work in medicine should be based on scientific criteria in order to reduce uncertainty in clinical practices (Learmonth and Harding, 2006). The basic idea is that the treatments and methods used must be based on the best knowledge available and that it is possible to produce universally valid knowledge. It is thus a matter of how scientific knowledge can be translated into practice. Doing systematic reviews can also be seen as a response to the information overload characterizing today’s society. EBM, then, constitutes a strategy for creating overview and transparency in the flow of knowledge. Additionally, it is becoming more and more common for knowledge, which is summarized and translated into guidelines and methods, to be inscribed into computer-based programs. The notion of evidence-basing has also gained an increasingly prominent role as regards policy formulation, research agendas and during the allocation of financial resources, enabling us now to talk sooner about evidence-based activities in health care (Lambert et al., 2006).

Assembling Health Care Work

The title of this book includes the word ‘assembling’, a term that we shamelessly poached from Latour’s (2005) introduction to actor-network theory. The verb assembling is a evocative term as it suggests that something is being brought together, compiled, put into action in an almost haphazard manner, as a form of bricolage or tinkering, using what is at hand. Such a view of ‘the social’ (Latour, 2005) or health care work is in conflict with common-sense thinking assuming that society is once and for all firmly being settled. As, for instance, Carruthers and Babb (1996: 1556) remark, social institutions such as money works best when they can be taken for granted, when they can simply be assumed. Institutions also rest, Carruthers and Babb (1996: 1558) argue, on the combination of naturalization and forgetfulness — a mindful forgetting of the work and negotiations initially needed to put the institution into place. Against such views, the verb assembling is indicating an entirely different view, a dynamic and fluid image of how society and social organization is an ongoing accomplishment characterized by the continuous mobilization of equally abstract and concrete resources. In the first two chapters of the book, the principal resources mobilized in health care work are institutional resources, the totality of abstract norms, beliefs, ideologies, assumptions guiding and structuring everyday work, and material resources, the tool, machines, equipment, biological specimens and so forth, being used.

Introduction: Organizing Health Care Work in Late Modernity

The contemporary period is undoubtedly deeply entangled with the advancement of the technosciences, helping human beings to lead a completely different life from that of just a few generations ago. The capacity to move the human body over continents in a few hours, which would have taken months some centuries ago, or the capacity to communicate directly with family or friends on the other side of the globe are, for instance, two accomplishments of technoscience. What would have appeared as mere magic in the medieval period is today barely noticed as technologies such as the aeroplane or the telephone are taken for granted as they become part of the infrastructure of everyday life. When we can travel from London to New York and back in less than 24 hours and still have time for shopping and lunch, we have definitely managed to “dominate nature” in terms of shrinking distances and taming geographical spaces. In the specific domain of the life sciences dealing with biological processes and biological organisms, similar remarkable accomplishments have been reported. Human reproduction is supported by sophisticated in vitro fertilization procedures, humans may acquire new organs from recently deceased individuals, and active molecular substances are brought into the human body, helping to regulate biological pathways that have ceased to function.