University College London, London N19 5LW, United Kingdom.
Soc Sci Med. 2010 May;70(9):1285-94. doi: 10.1016/j.socscimed.2009.12.034. Epub 2010 Feb 12.
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 approcach considers [a] external social structures (conditions for action); [b] internal social structures (agents' capabilities and what they 'know' about the social world); [c] 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.
英国国家医疗服务体系正在努力应对各种大型且颇具争议的 IT 项目。我们试图从更具理论性的视角来探讨这个问题：“当政府试图借助大型 IT 来实现医疗服务现代化时，会在宏观、中观和微观层面上发生什么？”我们使用了临床工作微观层面的数据片段作为例子，考虑了结构化理论和行动者网络理论（ANT）如何结合起来为实证研究提供信息。吉登斯（Giddens）（1984 年）认为，社会结构和人类能动性是递归关联且共同演变的。ANT 研究将人与技术联系起来的动态网络中的关系。它考虑了话语如何被刻写在数据结构和软件的决策模型中，从而使某些网络关系不可逆转。斯通（Stones）（2005 年）的强结构化理论（SST）是对吉登斯工作的细化，系统地关注实证研究。它将人类代理视为动态的位置-实践网络中的链接。四部分方法考虑 [a] 外部社会结构（行动条件）；[b] 内部社会结构（代理的能力和他们对社会世界的“了解”）；[c] 主动代理和行动；[d] 作为反馈回到位置-实践网络的结果。与早期的结构化理论和 ANT 不同，SST 坚持有纪律的概念方法论，并将其与实证证据联系起来。在本文中，我们为技术项目研究改编了 SST，整合了物质互动主义和 ANT 的元素。例如，我们认为位置-实践网络可以是一个社会技术网络，其中技术与人类一起可以被视为“行动者”。具有复杂社会文化框架的人类代理需要将技术实例化为社会实践。技术人工制品中刻写和嵌入的结构相关属性限制和赋能人类能动性。可以根据这些因素之间的相互作用来研究医疗保健 IT 项目的命运。
