Below is from a summary of Engestrom in the FTP files
ftp://weber.ucsd.edu/pub/lchc/chapters/engestrom
"A later study (Engestrom, 1991) explored how professionals in a health
center transformed their work. The results of document review, oral
histories, interviews, and videotapes of doctor-patient consultations
revealed a number of inner contradictions within the health center practice.
For example, very rigid rules were used to classify patients visiting the
center according to consultation types, although patients were assigned to
physicians arbitrarily. Careful analysis indicated that such inner
contradictions caused discoordinations of interactions among workers and
between workers and tools in following the scripts and plans of the
practice. Similarly, contradictions were observed to cause ruptures,
breaking the intersubjective understandings between workers. The collective
practice addressed the contradictions by creating a new model for the
activity system. The new model included the formation of multi-professional
physician teams, new rules for classifying and assigning patients, and the
use of interactional data bases for case histories."
This caught my attention from both reading Star and Bowker's book and some
of Bill's theorising on Activity Systems. For me, there are parellells here
with how Star and Bowker describe "boundry object" and Engestrom's emphasis
on inner contradictions.
What is really on my mind with the Engestrom (1991) study is that the
majority of this classification is on a global scale (WHO). Of course all I
have access to is this summary, but it seems like other work that I have
read it focused on the health center level. This is where the contradiction
lies, of course, but can it be resolved at this level. From both reading the
book (Star and Bowker) and lived experience in the world of HMO's I am
having difficulty seeing how the inner contradiction can be resolved on this
level. I am also wondering what the possible cultural-historical differences
were between his work and the states. Recently in my city one ambulance was
blocking another (free market) so they would be the one to take the patient
in.
First, with Star and Bowker, one tension was with the nurses knowledge not
being acknowledged and of course being the first thrown out. One response
to this was standards for the "ethic of caring" with one example being
humor. This of course had a lot to do with hospital reimbursement for
sevices rendered. We now have doctors joining unions and psycholgists in
many schoool districts joining teachers unions.
Engestrom was referenced in the ftp summary that culture or society becomes
too complicated or large for a unit of analysis, yet it seems the
contradictions are difficult to resolve on an activity setting level (health
center).
Of course Time Warner is on the back of my mind, I keep getting told
everything is being decentralized yet with all these mergers I'm beginning
to wonder. I recently got a letter from my congresswomen and she called me
customer. On our School of education webpage they told me of all these
changes because clients like me requested it. Now my daughter (4th grade)
tells me their hooking the hallways up with video cameras.
Nate
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