Theorising big IT programmes in healthcare: Strong structuration theory meets actor-network theory
Theorising big IT programmes in healthcare: Strong structuration theory meets actor-network theory
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DOI：
10.1016/j.socscimed.2009.12.034
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发表时间：
2010-05-01
影响因子：
5.4
通讯作者：
Stones, Rob
中科院分区：
文献类型：
--
作者：
Greenhalgh, Trisha;Stones, Rob
英国国民健康服务体系正在努力应对各种大型和有争议的IT计划。我们试图发展一个更清晰的理论视角的问题“发生了什么-在宏观，中观和微观层面-当政府试图现代化的医疗服务的帮助下，大IT？“使用临床工作微观层面的数据片段的例子，我们考虑了结构化理论和行为者网络理论（ANT）如何结合起来为实证研究提供信息。吉登斯（1984）认为，社会结构和人类能动性是递归联系和共同进化的。ANT研究动态网络中人与技术之间的关系。它考虑了话语如何被写入软件的数据结构和决策模型，使某些网络关系不可逆转。Stones（2005）的强结构化理论（SST）是对Giddens工作的改进，系统地关注实证研究。它认为人类代理人在动态网络的位置联系的做法。四方方法考虑[a]外部社会结构（行动的条件）; [B]内部社会结构（代理人的能力和他们对社会世界的“了解”）;[d]当他们反馈到位置-实践网络时的结果。与早期的结构化理论和ANT不同，SST坚持有纪律的概念方法，并将其与经验证据联系起来。在本文中，我们适应SST的技术方案的研究，从材料相互作用和ANT集成元素。例如，我们认为，位置实践网络可以是一个社会技术的，其中技术与人类可以作为“演员”进行研究。人类代理人，其复杂的社会文化框架，需要在社会实践中实例化技术。技术人工制品中铭刻和嵌入的结构相关属性限制并使人类能动性成为可能。医疗保健IT计划的命运可以根据这些因素之间的相互作用来研究。(C)2010爱思唯尔有限公司版权所有。
The UK National Health Service is grappling with various large and controversial IT programmes. We sought to develop a sharper theoretical perspective on the question "What happens - at macro-, meso- and micro-level - when government tries to modernise a health service with the help of big IT?" Using examples from data fragments at the micro-level of clinical work, we considered how structuration theory and actor-network theory (ANT) might be combined to inform empirical investigation. Giddens (1984) argued that social structures and human agency are recursively linked and co-evolve. ANT studies the relationships that link people and technologies in dynamic networks. It considers how discourses become inscribed in data structures and decision models of software, making certain network relations irreversible. Stones' (2005) strong structuration theory (SST) is a refinement of Giddens' work, systematically concerned with empirical research. It views human agents as linked in dynamic networks of position-practices. A quadripartite approach considers [a] external social structures (conditions for action); [b] internal social structures (agents' capabilities and what they 'know' about the social world);]cl active agency and actions and [d] outcomes as they feed back on the position-practice network. In contrast to early structuration theory and ANT, SST insists on disciplined conceptual methodology and linking this with empirical evidence. In this paper, we adapt SST for the study of technology programmes, integrating elements from material interactionism and ANT. We argue, for example, that the position-practice network can be a socio-technical one in which technologies in conjunction with humans can be studied as 'actants'. Human agents, with their complex socio-cultural frames, are required to instantiate technology in social practices. Structurally relevant properties inscribed and embedded in technological artefacts constrain and enable human agency. The fortunes of healthcare IT programmes might be studied in terms of the interplay between these factors. (C) 2010 Elsevier Ltd. All rights reserved.