Rationalizing Medical Work

Advocates argue that they will make medical practice more rational, more uniform, and more efficient and that they will transform the "art" of medical work into a "science." Critics argue that formal tools cannot and should not supplant humans in most real-life tasks.

Today we face the painful reality of the prevalence of chronic, rather than acute, diseases. The technologies developed to manager long-term, incurable illnesses have radically and irrevocably altered the organizational structure of health care, presenting us with a frequently bewildering array of medical specialties. Social Organization of Medical Work offers essential insight into this new era of health care.Through richly documented, often gripping case studies, Anselm Strauss and his co-authors show us exactly how health workers are confronting the problems created by chronic disease and coping with today's highly technologized hospitals. They guide us through the various hospital work sites, describing in detail the kinds of tasks performed by medical personnel, the interactions of staff members with each other and with patients, and the overall resulting patient treatment and response.Focusing on the concept of illness trajectory, the authors vividly illustrate the complex, contingent nature of modern medical work. For example, open heart surgery keeps ill persons alive and may even improve them symptomatically, but those who do survive must face an uncertain future in terms of the physiological consequences of the surgery and the drugs required. They also have to adjust t altered lifestyles. In the new introduction, Anselm Strauss discusses the continuing importance of this work to sociologists, medical scholars, and medical professionals.

This book presents a sociomaterial perspective on work and organizational practices within the operating room. Looking at medical work from a sociological perspective and drawing on ethnographic observations conducted in a hospital's operating block, this book analyses the entanglements of humans and technologies in the execution of everyday activities. It highlights how the sociomateriality of work and organizational practices manifests in the encounters between operators and material artifacts and in the way objects and technologies participate in processes and practices of organizational communication. Objects and technologies are also shaped by these very practices, giving rise to a recursive relationship wherein technology, communication, and organizing are intertwined. A sociomaterial understanding of organizational and working practices explains the role of objects and technologies in the generation and enactment of professional knowledge, while questioning how power materializes through the interaction of humans and technical objects. This book will be of great interest to scholars, students, and practitioners interested in how sociomaterial perspectives can inform organization studies and reshape our understanding of the intricate relationships between humans and technologies in healthcare settings.

The advanced technologies being used in diagnosis and care within modern medicine, whilst supporting and making medical practices possible, may also conflict with established traditions of medicine and care. What happens to the patient in a technologized medical environment? How are doctors', nurses' and medical scientists' practices changed when artefacts are involved? How is knowledge negotiated, or relations of power reconfigured? Technology and Medical Practice addresses these developments and dilemmas, focusing on various practices with technologies within hospitals and sociotechnical systems of care. Combining science and technology studies with medical sociology, the history of medicine and feminist approaches to science, this book presents analyses of artefacts-in-use across a variety of settings within the UK, USA and Europe, and will appeal to sociologists, anthropologists and scholars of science and technology alike.

Risky Work Environments provides new insights into the multiple and dynamic trajectories of both near misses and mistakes in complex work environments, based on actual case examples. It also studies the interactions between various activity systems or work practices (design, maintenance, incident investigation, regulation, operation) and their consequences for operational performance. The role of rules and regulations is explored, considering the consequences of deviations and the limitations of enforced compliance. Further, the book explains how to search for, think about and act on information about vulnerability, near misses and mistakes in a way that emphasizes accountability in ways that are not punitive but instead responsible, innovative and provide opportunities for learning. Writing from different disciplines and theoretical perspectives, the contributors analyse working in risky environments which include air traffic control, offshore mining, chemical plants, neo-natal intensive care units, ship piloting and emergency call dispatch centres. In each chapter the authors present rich empirical data and their analyses illustrate a variety of ways in which, despite imperfect systems, safety and resilience is created in human action. In the chapters where the focus is on error or mistakes, the analysis undertaken reveals the logic of actions undertaken at the time as well as their constraints. The contributors are all active researchers within their disciplines and come from Australia, Finland, France, Norway and the Netherlands. The book will be of direct interest to safety scientists, researchers and scientists, as well as human factors practitioners working in complex technological systems.

An unflinching look at the unique challenges posed by complex technologies we cannot afford to let fail—and why the remarkable achievements of civil aviation can help us understand those challenges. Nuclear reactors, deep-sea drilling platforms, deterrence infrastructures—these are all complex and formidable technologies with the potential to fail catastrophically. In Rational Accidents, John Downer outlines a new perspective on technological failure, arguing that undetectable errors can lurk in even the most rigorous and “rational” assessments of these systems due to the inherent limits of engineering tests and models. Downer finds that it should be impossible, from an epistemological viewpoint, to achieve the near-perfect reliability that we require of our most safety-critical technologies. There is, however, one such technology that demonstrably appears to achieve these “impossible” reliabilities: jetliners. Downer looks closely at civil aviation and how it has reckoned with the problem of failure. He finds that the way we conceive of jetliner reliability hides the real practices by which it is achieved. And he shows us why those practices are much less transferrable across technological domains than we are led to believe. Fully understanding why jetliners don't crash, he concludes, should lead us to doubt the safety of other “ultra-reliable” technologies. A unique and sobering exploration of technological reliability from an STS perspective, Rational Accidents is essential reading for understanding why our most safety-critical technologies are even more dangerous than we believe.

How do we understand health in relation to society? What role do social processes, structures and culture play in shaping our experiences of health and illness? How do we understand medicine and healthcare within a sociological framework? Drawing on international literature and examples, this new edition of Key Concepts in Medical Sociology: · Systematically explains the concepts that have preoccupied medical sociology from its inception, and which have shaped the field as it exists today. · Includes new entries, such as pandemics and epidemics, the environment, intersectionality, pharmaceuticalization, medical tourism and sexuality. · Begins each entry with a definition of the concept then examines its origins, development, strengths and weaknesses, and concludes with suggested further reading for independent learning. Key Concepts in Medical Sociology is essential reading for students in medical sociology as well as those undertaking professional training in health-related disciplines.

Presenting a new way of thinking about the risks of medical innovation, this volume considers the issues from a social historical perspective, and studies specific cases in their respective contexts.