Infrastructure revisited : an ethnographic case study of how health information infrastructure shapes and constrains technological innovation

Background: Star defined infrastructure as something other things “run on”; it consists mainly of “boring things.” Building on her classic 1999 paper, and acknowledging contemporary developments in technologies, services, and systems, we developed a new theorization of health information infrastructure with five defining characteristics: (1) a material scaffolding, backgrounded when working and foregrounded upon breakdown; (2) embedded, relational, and emergent; (3) collectively learned, known, and practiced (through technologically-supported cooperative work and organizational routines); (4) patchworked (incrementally built and fixed) and path-dependent (influenced by technical and socio-cultural legacies); and (5) institutionally supported and sustained (eg, embodying standards negotiated and overseen by regulatory and professional bodies). Objective: Our theoretical objective was, in a health care context, to explore what information infrastructure is and how it shapes, supports, and constrains technological innovation. Our empirical objective was to examine the challenges of implementing and scaling up video consultation services. Methods: In this naturalistic case study, we collected a total of 450 hours of ethnographic observations, over 100 interviews, and about 100 local and national documents over 54 months. Sensitized by the characteristics of infrastructure, we sought examples of infrastructural challenges that had slowed implementation and scale-up. We arranged data thematically to gain familiarity before undertaking an analysis informed by strong structuration, neo-institutional, and social practice theories, together with elements taken from the actor-network theory. Results: We documented scale-up challenges at three different sites in our original case study, all of which relate to “boring things”: the selection of a platform to support video-mediated consultations, the replacement of desktop computers with virtual desktop infrastructure profiles, and problems with call quality. In a fourth subcase, configuration issues with licensed video-conferencing software limited the spread of the innovation to another UK site. In all four subcases, several features of infrastructure were evident, including: (1) intricacy and lack of dependability of the installed base; (2) interdependencies of technologies, processes, and routines, such that a fix for one problem generated problems elsewhere in the system; (3) the inertia of established routines; (4) the constraining (and, occasionally, enabling) effect of legacy systems; and (5) delays and conflicts relating to clinical quality and safety standards. Conclusions: Innovators and change agents who wish to introduce new technologies in health services and systems should: (1) attend to materiality (eg, expect bugs and breakdowns, and prioritize basic dependability over advanced functionality); (2) take a systemic and relational view of technologies (versus as an isolated tool or function); (3) remember that technology-supported work is cooperative and embedded in organizational routines, which are further embedded in other routines; (4) innovate incrementally, taking account of technological and socio-cultural legacies; (5) consider standards but also where these standards come from and what priorities and interests they represent; and (6) seek to create leeway for these standards to be adapted to different local conditions

Sociological Reasoning: Towards a Past-Modern Sociology

Building a bridge between sociological theory and methodology, Sociological Reasoning develops an original typology of approaches to social scientific theory and research that is distinguished by its openness and reflexive awareness of rhetorical and methodological aspects of knowledge claims. Stones argues that contemporary social theory and postmodernism are both to be distinguished from sociological modernism by the sensitivity they each show to the rich, diverse and complex nature of the social world; and yet, in terms of the epistemology and methodology of the research process, both are found to be wanting. He argues instead for a sociology that is rigorous, modest and sceptical, which accepts that it works with fragments of the real rather than with complete stories

Refusing the realism-structuration divide

In this article I will reject the idea put forward in Margaret Archer's Realist Social Theory: The Morphogenetic Approach (Archer, 1995) that realist social theory and structuration theory, as developed by Anthony Giddens, are incompatible and mutually exclusive theoretical approaches (see Archer, 1995: 14 and passim; also Archer, 1988). I shall argue that their ontological positions are compatible; perfectly so for the most part, and redeemably so for the rest. Archer's extended critique of structuration theory, I argue, is a mistaken one. It misunderstands both the purpose and the letter of structuration theory and, in doing so, misses an opportunity to forge an alliance with an approach that could add a greater complexity and sophistication to realist social theory at several key points. On the other hand there is an array of valuable insights and conceptual innovations in Archer's realist social theory that structuration theory could equally profit from, many of them relating to a (rather extensive) domain that theorists sympathetic to structuration theory had already pinpointed as this approach's 'missing institutional link' (Cohen, 1989: 207- 10; Thrift, 1985: 618)

Why current affairs needs social theory : an illustrative case study of rights’ abuses in Burma

This paper is part of a wider project on social theory and current affairs, which is directed both at the academic researchers and at the wider audience for news and current affairs accounts. With respect to readers and viewers of news and current affairs the aims of the project are unashamedly pedagogical, intending to develop the capacity of audiences to engage more effectively with current affairs texts, from television news through documentaries to academic commentaries in periodicals such as the New York Review of Books or in book--‐length tomes. I will set out some of the key, generalizable, concepts of the approach in this paper, although some aspects of the argument will have to be alluded to rather than spelt out due to the limitations of space. The critical power of the concepts will be demonstrated through an illustrative analysis of a short Agence France--‐Presse (AFP) report from August 2009 on international reaction to rights’ record of the Burmese junta

Rights, social theory and political philosophy : a framework for case study research

The purpose of this chapter is to outline a research framework that can begin to bring together the insights of both social theory and political philosophy to address rights issues. Their separation is a significant weakness that runs through much of the literature on rights. On the one hand, approaches to rights from the perspective of political philosophy are too often uprooted from any concern with the social, cultural, historical, political and economic specificity of particular cases. Approaches from the perspective of social theory and sociology, on the other hand, have a tendency to adopt the rhetoric of the moral high ground without any effort to engage in the king of sustained moral argument associated with political philosophy. One of the reasons for the invidious division of labour is the volume and complexity of the relevant literatures in each field and the difficulty of know where to start. It is these problems that I address, and I do so by developing some preliminary guidelines for case study research. Such research can explore the field by dividing it into more manageable, bitesized, portions that are less daunting and less forbidding. The idea would be to develop research strategies into rights issues that are explicitly informed by social theory and by political philosophy, but that radically limit their object of study. The aspect of rights under scrutiny would be limited in having a precise focus - guided by very clear questions or specific problems about the legitimacy of rights claims and/or the feasibility of their implementation. The studies would also be limited in drawing, self-consciously, only on carefully delimited aspects of social theory and political philosophy, thus making realistic demands on the researcher, who will still have to master a testing range of literatures and skills. The intention would be for a series of such piecemeal studies, each produced by a more integrated social theory/political philosophy approach, not only to offer valuable insights of their own but also to provide the foundations for subsequent cross-study work on rights

Action and agency

At the most elemental level, action refers simply to the practices of human beings: to what they do. At a more complex level it can refer not just to individuals but also to the practices of collective actors, those sharing characteristics, such as being members of a particular class, age group, gender, or other social categories such as the homeless, the unemployed and so on. Collective actors can, in turn, be distinguished from what Margaret Archer in Realist Social Theory calls corporate agents. These are groups of actors who have organised themselves around certain interests in order to pursue strategic interests. They typically articulate shared interests, organise for collective action and can often command serious attentions in decision-making arenas. No matter which category they belong to, actors possess a capacity for action. Agency is the dynamic element within an actor that translates potential capacity into actual practice. Action and agency are typically contrasted with social structures that are seen as the constraining and/ or enabling social conditions in which action takes place

Mobile phones and the transformation of public space

This article can be used to foster a general awareness of how social norms govern behaviour in various places. There could be a brief class discussion in which students are asked to identify examples of how people should (or should not) behave in the following places. * A queue * The student common room * A place of worship (there are, of course, different norms for different types of places of worship, and this in itself could prove an interesting comparison) * On a bus, train or plane (examples of 'air rage' might figure here) * In a public library * In one's own home and in someone else's home * At a football match (as a spectator) Teachers may well wish to use other or additional examples. Students should also be asked how strongly they feel about themselves behaving differently in the various places from the ways they have identified. Would they feel embarrassed, ashamed, indifferent etc? Having discussed the examples, students should then be asked to observe, on occasions when they are in any of the places identified, the extent to which the norms they have identified are, in fact, followed. They should also be asked to observe people using mobile phones, to identify the 'types' described in the article. They should be given about a week to do this, and then a further discussion should take place regarding their observations. They might then be asked to write a few paragraphs on social norms, how they are learned, and how far they govern social behaviour. They should also try to identify other examples of changing norms in public spaces, e.g. skateboards, laptops

Sociology's unspoken weakness : bringing epistemology back in

Following the sustained criticism of positivism and empiricism in the social sciences through the 1960s and 1970s, social theory turned its attention resolutely towards ontology. This ontological turn' has provided sociology with an enviably rich and diverse palette of understandings emerging from a variety of theoretical traditions. This development has been accompanied, however, by a failure to construct a parallel epistemology with which to translate the variety, fullness and nuance of ontological concepts into strong and defensible empirical accounts. The article signals the complex nature of the consequent challenge and presents the components of a new epistemological framework designed to enable the social sciences to respond to it. Grounded theory is taken as an example of how an influential prior approach attuned to the role of concepts in making sense of empirical data could be constructively integrated into the new epistemology while being greatly strengthened by it. The article concludes with a critical discussion of John Law's After Method. Closely associated with Actor Network Theory (ANT), Law offers a hard case' against which to pitch my argument. This is because he holds that the subjective, contingent and assembled' character of knowledge renders both undesirable and impossible the project of epistemological rigour I present as both possible and essential

Disembedding

Disembedding refers to the way in which contemporary social practices can no longer be primarily defined by their grounding, or embeddedness, in the local context of a restricted place and time. Social practices are now, in large part, removed from the immediacies of context, with the relations they involve typically being stretched over large tracts of time and space. Local experiences and events are shaped by processes taking place on the other side of the world, and vice versa. These are processes, moreover, that are primarily impersonal and abstract