Objects-in-use and Organizing in
Action Nets:
A Case of an Infusion Pump
20151021
Lars Walter
Why this
• To illustrate how theory, method an research
focus is are interrelated and interdependent
• To illustrate how a particular theoretical and
methodological perspective can help us to
learn and produce “new knowledge”
The Swedish Healthcare sector
• Until the mid 1990s was based on a
public monopoly,
• Mainly financed by tax revenues
• produced by regional county councils
• 500.000 thousand employees (10%)
The setting
• The site of this study was a ward at a regional hospital
in the west of Sweden
• Owned and managed by the regional authority
• A this time, the hospital was a full scale acute hospital
• Specialist in various types of blood diseases
• The Responsibility at the ward was shared between a
physician (medical) and a heed nurse (administrative)
• Has a staff of 28, 16 nurses and 12 assistant nurses 16
beds
• The ward includes a surgery providing daytime care
Some theoretical and
considerations
Performativity - Starting point
A Latour:ian view…
Ostensive an performative as different
ontological positions (views of the world)
Ostensive definition:
• Social actors “exists”
within a defined society
• Actors are informants of
aspects of society
• Possible to detect a full
and true picture
Performative definition:
• Actors are define in
practice what society is
• A full picture do not exist
• Researchers talks to all
actors equally and make
account for their
practical definitions of
society
Implications for management studies
• Organizations as ongoing accomplishment
• Makes organizations conceptual and symbolic
and the fabric used in building them is
dependent on its use and attributed meaning
• Construction -ones: Performativity –
continues
• Agency is distributed, disrupted an ongoing
• Can be made stable and durable when
adapting objects, routines, institutions and
social material aspects
Organizations are at best stabilized action nets!
For us this is important because:
• It links methodology with useful theoretical
concepts. In this way it is more of a practical
take then scientific/political stand
• It also has implications for method and what to
study
– Actions and interactions
– The role of objects, technology and other
sociomaterial resources.
– Agency - as distributed, disrupted and tentative
Organizing in Action Nets
• Organizing consists in connecting
various collective actions and
objects, according to a pattern
legitimate at a given time and in a
given place
• An action net may involve a great
variety of organizations or
organized groups of people of a
loose or temporary nature
• It is a general concept referring less
to entities created by the practice
of management and more with
useful ways of studying that
practice
Back to the story
The infusion pump
• Used in cancer treatment when giving
chemotherapy
• Higgy regulated and controlled use
• Routine procedure at this particular ward
• A generic type of infusion pump
• Provided from a company we call Medone
The purchasing process
• Centralized purchasing organization called
Westma
• Purchasing committee
• Decision based om a set of criteria's such
as “Effectiveness in treatment” and price
• Standardized us of medical equipment the
regional level
The role of the pharmacy
•
•
•
•
Provides medical equipment to the ward
Responsible for safety
Altered the way the infusion pump was used
Introducing a new part of equipment provided by
Medtwo
The incident
• The equipment was in use for two years with
out problems
• A nurse noticed that the pump was seconds
away from injecting air in the patients blood
stream
• The treatment was instantly stopped
• Immediately recognized as a serious event
The pump as a black box
• Silent
• An established practice in its use
• Connected people from different worlds (tool,
equipment representing a cost, sales revenue,
etc.)
• Made it possible to coordinate from a distance
• Connects groups and actors in an “action net”
The well functional pump becomes a boundary
object in a stabilized action net
Initiating an investigation
•
•
•
•
Reconstructing events locally
Involving the hospital pharmacy
Ruling out mal practice
No indication of anything wrong with the
equipment
Will this happen again? Is this an incident
related to this particular equipment, or is
there a more general problem?
Expanding the investigation
•
•
•
•
A problem with this particular pump or?
Involving the suppliers – reputation was a stake
Elaborated investigation of the parts
Refusal to accept responsibility as one peace of
equipment
• Different consequences for the two suppliers
• The end of the enquire with out answering the
questions!
Deconstructing an action net
• A boundary object made visible
• Transformed from an infusion pump to an object
of inquiry
• Introduced new, precisely hidden perspectives
a
• Mobilized new groups to act
• Old positions and roles was contested and
reconfigured
A deconstructed action net, as were the object they
acted on
Continued work on the ward
•
•
•
•
•
Further incidents were stoped
The need for providing treatment
Routines of monitoring the pumps
The replacement of pumps
A decision made locally based on safety
Action precedence
• As the object dissolved in different objects, so
did the claims for jurisdiction
• Stopped functioning as a boundary object
• New actions precedence were established –
Safety rules!
• The emergence of a new action-net
National recommendations
• The incident was reported to The
National Board of Health and Welfare
and to the MPA, the national authority
for the control of medicine and drugs
• Several similar reports had been
reported, resulting in national
recommendations of use for this type of
infusion pump and regulated against the
particular configuration of equipment
used at the ward.
A parallel story
•
Actions connecting the local to the outside
world
The incident inscribed and stabilized – make
them work over time and space
Some conclusions
• A story of processes that often remains hidden
• A story of change, were some action were no longer
appropriate and new and new actions were included (in
the action net)
• An illustration of organizing as an ongoing
accomplishment
• Organizing is a practice, embedded in a particular place
and space
• Objects are constructed when enacted
• Some actions and objects my help stabilizing action nets
making them into formal organizational structures