Signe Vikkelsø

ICT and Integrated Care: Some Dilemmas of Standardising Inter-Organisational Communication

There is a growing interest in the issues of how to organise healthcare work along individual patient cases rather than along the demarcation lines of healthcare organisations. Health information systems, such as electronic patient records, are seen as important change agents, since they are asserted to help the coordination of care across organisations through fast and accurate exchange of clinical data. The paper explores how a semi-standardised discharge letter is employed to communicate about the patient between two organisational settings, the hospital and the general practitioner. It is shown that the discharge letter plays a double role as informational tool and accounting device. And it is argued that further standardisation of the discharge letter content – in order to facilitate electronic exchange – is likely to strengthen the letter’s role as a tool for organisational accountability and weaken it as a clinical tool. The paper concludes that this finding adds to the theoretical understanding of how computers support cooperative work, and that understanding how healthcare professionals present themselves as accountable and trustworthy should be of major concern when designing healthcare ICTs.

Description as Intervention: Engagement and Resistance in Actor-Network Analyses

Some decades ago it was a common complaint that social science was not neutral but political, producing scientific results that were leftist or conservative statements in disguise. Currently, the concern is rather that much social science has moved away from action, from practical usefulness, instead producing sterile abstractions and selfreferential conversations or staying at the level of description and anecdote-telling. Both of which, it is assumed, are of little practical use. On political and administrative levels this concern has given rise to a strong focus on the usability or applicability of social science. And within social science there is a growing interest to develop new theories and methods in order to establish closer links between research and other practices. Concepts such as ‘mode 2’ (Gibbons et al., 1994; Nowotny et al., 2003) and ‘engaged scholarship’ (Van de Ven, 2007) signal this ambition. Similarly, action-research is being revived to counter the ‘overly quietist tradition of knowledge generation which has developed in the modern era’ (Reason and Bradbury, 2001, p. xxiii). The theme of this special issue can be seen as a response to this changing situation. Within STS the idea of action-orientation can be used as an umbrella term for texts which propose that STS research also engages in real-life experiments alongside practitioners in order to explore, evaluate and articulate a world that continues to change. This ‘interventionist’ methodology seeks in various ways to combine the request for helping practice with the role of the trickster, who constantly shifts sides from one stakeholder to the other and explores the way their concerns can be practically reconciled in a politically sensitized way (Rip, 1994; Pors et al., 2002; Zuiderent, 2002). But is it really the case that social science has to re-invent itself and find whole new scientific practices in order to become useful and ready for action? In this paper, I will Science as Culture Vol. 16, No. 3, 297–309, September 2007

IN BETWEEN CURING AND COUNTING: PERFORMATIVE EFFECTS OF EXPERIMENTS WITH HEALTHCARE INFORMATION INFRASTRUCTURE

Performance standards and accountability pervade modern healthcare. According to Michael Power, this may signify a new rationality of governance characterized by control of controls, which affects practices not by direct intervention, but through the processes by which practices are made auditable. The paper addresses this thesis by exploring the construction of a Danish standard for electronic patient records. It is shown that making healthcare auditable activates deep tensions between programs of clinical practice, quality control, evidence based medicine, and casemix funding, resulting in an ambiguous and unstable standard. During this process, however, particular notions of patients, diseases, and diagnoses emerge as undisputed innovations, which may come to survive the subsequent career of the standard. The paper discusses the performative effects of these innovations and argues that information infrastructure has become an analytically important site for exploring the substantial effects of new rationalities of governance in healthcare.

Reflections: On the Lost Specification of ‘Change’

The notion of ‘change’ has become pervasive in contemporary organizational discourse. On the one hand, change is represented as an organizational imperative that increasingly appears to trump all other concerns. On the other hand, change is addressed as an abstract, generic entity that can be theorized, categorized, evaluated and acted upon without further specification. In this article, we argue that this combination of absolutism and abstraction has some unfortunate consequences for the precise assessment and practical management of particular organizational changes. Based on re-readings of two classic, but partially forgotten contributions within organization theory – the work of Wilfred R. Bion on group assumptions and the work of Elliott Jaques on ‘requisite organisation’ – we suggest that contemporary discussion of organizational change could benefit considerably from regaining a lost specificity; an empirical grounding in the detailed description of content, purpose and elements of change as a prerequisite for any normative appraisal or critique.

Mobilizing Information Infrastructure, Shaping Patient-Centred Care

Purpose – This paper seeks to explore the challenges and transformations in healthcare resulting from building information infrastructures for patient‐centred care.Design/methodology/approach – Four types of information infrastructures are analysed with special attention given to the efforts and controversies related to their mobilization and to their consequences for patient‐centred care. Data are gathered through a literature review and by empirical research.Findings – The development of information infrastructures for patient‐centred care requires mobilization of technical, legal, clinical and ethical standards as well as a change in organizational and professional boundaries. Furthermore, the mobilization of information infrastructures entails unexpected transformation in the nature of patients, professionals, health records and consultations.Practical implications – Patient‐centred information infrastructures call for institutional innovation and decision making regarding basic structures and relatio...

PROVOCATIVE CONTAINMENT AND THE DRIFT OF SOCIAL-SCIENTIFIC REALISM

The post-World War II period gave rise to a large number of social-scientific techniques for investigating and intervening in social reality. A particular group of these, exemplified here by the experiments of Moreno, Lewin, Bion, Milgram and Zimbardo, worked by establishing suggestive micro-realities in which participants were exposed to, or experimented with, selected ‘social problems’. We investigate the nature of these techniques – being simultaneously highly artificial and disturbingly realistic – and propose the notion of ‘provocative containment’ to understand their operation and effects. We point to five ingredients of their characteristic mode of operation – expressionism, incitement, trauma, distillation and technology – and argue that they do not serve to represent a simplified version of social reality, but rather to ‘realize’ particular forms of social life intrinsic to the medium of provocative containment.

Social Technologies: Cross-Disciplinary Reflections on Technologies in and from the Social Sciences.

In this introduction, we explore the relevance to critical psychology of the ideas about technology that have come from science and technology studies (STS), which we argue allow a new look at a classic theme in critical approaches in psychology. Rather than seeing psychical and social reality as objective realities, critical psychologists have approached them as the products of historically situated practices, intimately tied up with the circumstances of their production. We suggest that this metaphor of production can be developed in new ways by investigating tools, methods, and phenomena within psychology through the optic of STS. At the same time, STS may also gain from turning to psychology, since it has predominantly focused on the natural sciences and may be inspired to adjust its analytical approach to people and technology through this encounter. We position the notion of social technology both in relation to assumed distinctions between the natural and the social world and in relation to critiques of these assumptions. With the concept of social technology, we argue for investigating the instruments of psychology and social science with equal attention to the way so-called “technical” and “human” elements work together, and sometimes fail, to constitute particular effects.

The Clinical Work of Secretaries: Exploring the Intersection of Administrative and Clinical Work in the Diagnosing Process

Diagnostic work is often defined by the skill of clinicians whereas the contributions of non-clinicians, for example secretaries, tend to fade into the background. The secretaries are deeply involved in diagnostic work through the eligible administration of patients in the collaborative electronic information systems. This study explores the secretaries’ role in diagnostic work, focusing specifically on the context of diagnosing cancer. It identifies four key activities of secretaries that are essential for diagnosing patients: We argue that the secretaries’ role is positioned at the intersection of clinical and administrative practices and not limited to support of articulation work of clinicians and administrative work. Secretaries also carry out activities that fall under the core definition of clinical work. This clinical dimension of the secretaries’ work, we argue, should be embedded in the design of collaborative systems to support the diagnosing process.

Exploitation, Exploration and Exaltation: Notes on a Metaphysical (Re)turn to ‘One Best Way of Organizing’

For many years within Organization Studies, broadly conceived, there was general agreement concerning the pitfalls of assuming a ‘one best way of organizing’. Organizations, it was argued, must balance different criteria of (e)valuation against one another – for example ‘exploitation’ and ‘exploration’ – depending on the situation at hand. However, in recent years a pre-commitment to values of a certain sort – expressed in a preference for innovation, improvisation and entrepreneurship over other criteria – has emerged within the field, thus shifting the terms of debate concerning organizational survival and flourishing firmly onto the terrain of ‘exploration’. This shift has been accompanied by the return of what we describe as a ‘metaphysical stance’ within Organization Studies. In this article we highlight some of the problems attendant upon the return of metaphysics to the field of organizational analysis, and the peculiar re-emergence of a ‘one best way of organizing’ that it engenders. In so doing, we re-visit two classic examples of what we describe as ‘the empirical stance’ within organization theory – the work of Wilfred Brown on bureaucratic hierarchy, on the one hand, and that of Paul Lawrence and Jay Lorsch on integration and differentiation, on the other – in order to highlight the continuing importance of Marchs argument that any organization is a balancing act between different and non-reducible criteria of (e)valuation. We conclude that the proper balance is not something that can be theoretically deduced or metaphysically framed, but should be based on a concrete description of the situation at hand.

Core task and organizational reality

Reflecting a wider trend in the social sciences, the field of organization studies has adopted an increasingly general and metaphysical vocabulary to guide and frame its analyses of life and dynamics in organizations. Where classic organizational analyses would describe organizations in terms of core objects such as ‘task’ and ‘coordination,’ contemporary organization studies emphasize, much like other social science disciplines, broader topics such as ‘network,’ ‘identity,’ and ‘change.’ The paper argues that this altered focus and vocabulary is accompanied by a diminished ability to specify and intervene into the practical reality of organizations. It further argues that a disciplines core objects are not anachronisms to be discarded with, but crucial for specifying reality in ways that have proven practically relevant and still are.