Abstract
Information and communication technologies are an important driver for network-based forms of governance. These technologies include computer decision support systems (CDSS) and software algorithms deployed to improve, optimise and manage health service delivery as in the case presented here, the NHS Pathways CDSS. This CDSS operates an algorithm, drawing on an extensive repository of clinical information to support NHS urgent and emergency care telephone triage services. Call handlers using the CDSS make decisions about whether the caller needs an immediate ambulance or can wait to see a general practitioner, and they can also provide advice about self-care. This chapter presents data from two large, comparative ethnographic studies of this CDSS which provide data from over 850 hours of observation, surveys of 700 staff, and interviews and focus group data from over 100 staff. Here I explore the interpretive gap between the promise of digital governance and the attempt to bring this computer technology into use as a way of managing demand for care. The chapter argues that, at its heart the CDSS maintains a model of ‘perfect governance’, premised upon the idea that triage is a rational, rule-governed, standardisable process. The reality, as we will see, is that this vision is thwarted, adapted, and resisted in the everyday situated practices and networks of care that involve human and non-human actors. The chapter presents a thematic analysis of a series of assumptive rules about disease presentation and decision-making to demonstrate how digital governance is resisted.
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Acknowledgements
Thanks are due to the research teams on the series of projects that provided the data used in this chapter. They include Joanne Turnbull, Jane Prichard, Susan Halford, Gemma McKenna, Alison Rowsell, Melania Calestani, Val Latimer, Carl May, Simon Brook, Jeremy Jones, Christine Barrett, Andrew Lennon, and Rob Crouch. The empirical work could not have been completed without them, or the willing participation of the many people involved in the case studies. The good parts of the thinking presented here are due to their input and that of the team involved with this book. Any errors or failings that remain, are mine to own.
The research reported here was funded by the National Institute for Health Research (NIHR) [Research grants SDO 08/1819/217; SDO 10/1008/10; HS&DR 14/19/16]. The views expressed are those of the author and not necessarily those of the NIHR or the Department of Health and Social Care.
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Pope, C. (2020). Situating Practices of Human and Non-human Networks in the Delivery of Emergency and Urgent Care Services. In: Bevir, M., Waring, J. (eds) Decentring Health and Care Networks. Organizational Behaviour in Healthcare. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-030-40889-3_6
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