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Vezyridis Paraskevas

Critiquing complex sociotechnical networks in clinical settings: some ontological challenges

Abstract

The complex and multicultural environment of the hospital institution requires the collaboration of a variety of health and administrative professionals in order to ensure and enhance the quality of clinical outcomes(1,2), the efficient delivery of healthcare(3), the containment of the associated costs(4) as well as for the smooth and unobstructed operation of the organisation and the realisation of its goals1. Importantly, information and communication technologies (ICT), an integral part of today’s healthcare organisations, aim to support this new multidisciplinary paradigm of healthcare provision(5).

However, clinical information systems have not been fully integrated into health systems around the world. Using as a case study the implementation of a clinical information system for patient registration and tracking in a busy emergency department this paper addresses the epistemological and practical challenges by deploying a strict critical sociological approach to the examination. Such systems will most likely modify and/or replace, work tasks, information flows, visibilities as well as relations among professionals(6). Social, economic and political interests will empower the attempt by these groups to gain control over this access and to affect the shape, use and functioning of the system(7).

On the other hand, critical sociology is still struggling to close the gap between theory and practice(8,9). In addition, it has been acknowledged that critical information systems research in its determination to reveal the political, social, historical and cultural conditions that affect or even driven technological mediated organisational changes has somehow left relatively untouched the materiality of the artifacts(10,11). Therefore, it has been extensively argued that one way to overcome critical theory’s insensitivity towards the size and the value of these technologies, is by expanding its definition as to incorporate other, more empirically oriented frameworks of inquiry(9,12,13).

Particularly in IS, it is believed that a perspective based on actor-network theory (ANT)(14) could provide the researcher with a fruitful methodological approach(15) for the symmetrical examination of human and non-human actors(16,17) in order to increase the investigative value of the ‘missing masses’(16) that are often ignored or treated merely as tools of oppression, domination or control(13). Notably, by concentrating on the ‘translation’(17) that takes part during the implementation of a clinical technological solution the researcher is, then, able to track, analyse and critique in more detail the problematisation for the proposed solution, the ‘devices’ and strategies that were used to enroll the actors, the practices of the representatives and especially how any issues of resistance are being handled by the network.

The paper concludes by expanding the discussion around the possibility of reformulating the critical research project, in its empirical inquiry, as to place a strong emphasis on the increased intertwining of social and technical agencies. On the other hand, it is also argued that it is time for ANT to focus more on the products of technology, particularly of ICT (i.e. accumulation of information), and how they come to redefine memberships and actor-networks through ‘updated translations’.

References:

  1. Krogstad, U., Hofoss, D. and Hjortdahl, P. (2004) Doctor and nurse perception of inter-professional co-operation in hospitals. International journal for quality in health care: journal of the International Society for Quality in Health Care / ISQua, 16(6): p.491-497
  2. Knaus, W.A., Draper, E.A., Wagner, D.P. and Zimmerman, J.E. (1986) An Evaluation of Outcome from Intensive Care in Major Medical Centers. Annals of Internal Medicine, 104: p.410-418
  3. Ogbimi, R.I. and Adebamowo, C.A. (2006) Questionnaire survey of working relationships between nurses and doctors in University Teaching Hospitals in Southern Nigeria. BMC Nursing, 5: p.2
  4. Hojat, M., Nasca, T.J., Cohen, M.J.M., Fields, S.K., Rattner, S.L., Griffiths, M., Ibarra, D., Alcorta-G de Gonzalez, A., Torres-Ruiz, A., Ibarra, G. and Garcia, A. (2001) Attitudes toward physician–nurse collaboration: a cross-cultural study of male and female physicians and nurses in the United States and Mexico. Nursing Research 50: p.123–128
  5. Sicotte, C., Champagne, F., Contandriopoulos, A., Barnsley, J., Béland, F., Leggat, S., Denis, J., Bilodeau, H., Langley, A., Bremond, M. and Baker. R. (1998) A Conceptual Framework for Analysis of Health Care Organizations’ Performance. Health Services Management Research, 11(1): p.24–41
  6. Dykstra, R. (2002) Computerized physician order entry and communication: reciprocal impacts. Proceedings / AMIA ...Annual Symposium. AMIA Symposium, p.230-234
  7. Berg, M. (2001) Implementing information systems in health care organizations: myths and challenges. International journal of medical informatics, 64(2-3): p.143-156
  8. Alvesson, M. and Willmott, H. (1992) Critical Management Studies. London: Sage Publications
  9. Alvesson, M. and Deetz, S. (2000) Doing Critical Management Research. London: Sage Publications
  10. Monteiro, E. (2000) Monsters: From systems to actor-networks. In: Braa, K., Sorenson, C. and Dahlbom, B. (Eds) Planet Internet. Lund: Studentlitteratur, p.84-93.
  11. Orlikowski, W. and Iacono, S. (2001) Research commentary: desperately seeking the IT in IT research-a call for theorizing the IT artifact. Information Systems Research, 10(2): p.121-134.
  12. Brooke, C. (2002) What does it mean to be critical in IS research? Journal of Information Technology, 17: p.49–57.
  13. Doolin, B. and Lowe, A. (2002) To reveal is to critique: actor-network theory and criticial information systems research. Journal of Information Technology, 17(2): p.69-78.
  14. Latour, B. (1987) Science in Action: how to follow scientists and engineers through society. Cambridge, MA: Harvard University Press
  15. Walsham, G. (1997) Actor–Network theory and IS research: current status and future prospects. In: Lee, A.S., Liebenau, J. and DeGross, J.I. (Eds) Information Systems and Qualitative Research. London: Chapman & Hall, p.466–480.
  16. Latour, B. (1992). Where are the missing masses? The sociology of a few mundane artifacts. In: W. E. Bijker & J. Law (Eds.), Shaping technology / Building society: Studies in sociotechnical change. Cambridge, MA: MIT Press, p.225-258
  17. Callon, M. (1986) Some elements of a sociology of translation: domestication of the scallops and the fisherman of St Brieuc bay. In: J. Law (ed) Power, action and belief: a new sociology of knowledge. London: Routledge, p.96-232
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