Objects-in-use and Organizing in Action Nets:

A Case of an Infusion Pump

20151021Lars 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”

• 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 Swedish Healthcare sector

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• Mobilized new groups to act• Old positions and roles was contested and

reconfigured

A deconstructed action net, as were the object they acted on

a

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.

• Actions connecting the local to the outside worldThe incident inscribed and stabilized – make them work over time and space

A parallel story

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