Lars Walter

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.

The role of organizational objects in construction projects: the case of the collapse and restoration of the Tjörn Bridge

The construction industry immutably produces built environments that directly influence the everyday lives of human beings. Nevertheless, materiality, defined as intransient physical matter socially enacted in the form of artefacts and objects as well as built constructions, is often overlooked and simply regarded as passive and inert matter. In contrast, a growing body of literature recognizes the agency of materiality and examines how materiality and agency are co-produced. When examining a spectacular event like the collapse of the Tjörn Bridge on Sweden’s west coast, it is argued that organizational objects are capable of interpellating various actors, thus enabling informed and adequate action. The concepts of the organizational object and interpellation are thus useful analytical terms when examining construction project organization, helping scholars of the construction industry and practising managers to rethink the role of materiality as something that both acts and is acted upon.

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.

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.

The dual role of the Public Employment Service: to support and control

2 A policy for the new job market 25 Jessica Lindvert 3 The dual role of the Public Employment Service: to support and control 41 Lars Walter 4 Public employment officers as brokers and therapists 53 Julia Peralta 5 A labour market of opportunities? Specialists assess work ability and disability 65 Ida Seing 6 Temporary staffing: balancing cooperation and competition 85 Gunilla Olofsdotter 7 Transition programmes: a disciplining practice 104 Ilinca Benson

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.

Organizing Health Care Work: Co-Aligning Institutions and Materiality

Modern, contemporary health care is inextricably bound up with the advancement of first the sciences and then, from the beginning of the nineteenth century, the life sciences including medicine, physiology and chemistry. At the same time as health care needs to be understood within the context of the scientific revolution and the gradual institutionalization of scientific procedures, modern health care is also the outcome of the democratization of health and the emergence of the welfare state. Health care work is not strictly determined by advancement of the life sciences but is also largely a matter of making informed political choices on what actions to take and what areas to target. Being part of the political economy of public health, health care organizations differ across nations and regions, but they share the elementary predicament of making use of limited resources to seemingly unlimited human needs. The later modern period has been referred to as an information society, an attention economy, a post-materialist society, and a wide scope of such defining labels have been proposed. It would also be fair to speak of contemporary, late modern society as a society governed by the possibilities of the life sciences and the possibilities for maintaining life, restoring biological functions and rejuvenating human bodies through various therapies and procedures.