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The health care system within the United States is in a state of transition. The industry, confronted with a variety of new technologies, new ways of organizing, spiraling costs, diminishing service quality and new actors, is changing, almost on a daily basis. Reports issued by the Institute of Medicine raise quality issues such as avoidable errors and underuse/overuse of services; other studies document regional variation in care. Improvement in the quality of care, according to health care experts is accomplished through measuring and comparing performance, but there are a number of disparate actors involved in this endeavor. Through a network of both public and private actors, collaboration on the development of a set of national performance measures is underway. Organizations such as the National Quality Forum (NQF), the Agency for Healthcare Research and Quality (AHRQ), the Centers for Medicare & Medicaid Services (CMS) and other have formed networks to develop and standardize performance measurement systems that can distinguish between quality services and substandard ones. While there is some available research about the processes involved in performance measurement system design, there is little known about the factors that influence the development and work of the network, particularly the selection of hospital performance measures. This dissertation explored the development of a national performance measurement system for hospitals, using an institutional rational choice perspective and actor-network theory as frameworks for discussion. Through qualitative research methods such as direct observation, interviews, participant observations and document review, a theoretically informed case study of the NQF's Hospital Steering Committee was performed, to address the following questions: How is a national performance measurement system developed and what is the role of federal agencies (e.g., AHRQ and CMS) in the process? / Ph. D.

Using a Systems Theory approach allows a person to analyze the intertwined elements of the drug development system and the potential influences of the environment. Thomas Hughes's Large Technological Systems (LTS) Theory is one that could be used for this purpose; however, it falls short in its ability to address the complexity of current day regulatory environments. This dissertation provides a critical analysis of Hughes's LTS Theory and his phases of evolution as they apply to the United States (U.S.) system for biologic drug research, development and labeling. It identifies and explains potential flaws with Hughes's LTS Theory and provides suggested improvements. As an alternative approach, this dissertation explores the concept of "techno-regulatory system" where government regulators play an integral part in system innovations and explains why such systems do not always follow Hughes's model. Finally, this dissertation proposes a hybrid version of Hughes's systems approach and uses it to explain the changes that occurred in the drug approval system in response to the push for, opposition, and inclusion of, pediatric research in drug development during the period 1950-2003. / Ph. D.

The Army-sponsored Institute for Soldier Nanotechnologies (ISN) was an entrepreneurial research institute established at the Massachusetts Institute of Technology (MIT) in 2002. Using Science and Technology Studies (STS) concepts from Actor-Network Theory, I study the founding era of this twenty-first century laboratory-based community, from 2002-2007. Actor-Network concepts of enrollment and translation, described by Bruno Latour, and heterogeneous engineering, described by John Law, are used as I 'follow the actors' founding this emergent institution. The operationalization of translation is traced through four case studies, structured around Defense funding constructs and Science and Technology communities: 6.0 Founding the Institute; 6.1 Building Basic Research Networks; 6.2 Shaping Applied Research for Cancer Research and Science Education to include non-users; and 6.3 Student Prototyping Teams Accelerating ISN Research for Traumatic Brain Injuries (TBI). Scientists, engineers, and transitioners partnered in new ways to transition innovative technologies to improve human protection, with soldiers as the first of many users. Using public information, I used qualitative and quantitative methodologies to assess the actor networks and research portfolio changes. These historical case studies extend STS with operationalization of translation and a new dynamic of bi-directional actor enrollment, as research teams transitioned nanotechnologies and prototypes. / Doctor of Philosophy / The Institute for Soldier Nanotechnologies (ISN) was an Army-sponsored entrepreneurial research institute established at the Massachusetts Institute of Technology (MIT) in 2002. This historical study examines the founding era, rarely described for start-up organizations. Science and Technology Studies (STS) concepts of Actor-Network Theory enrollment and translation are traced through four case studies: Founding the Institute; Building Basic Research Networks; Shaping Applied Research for Cancer Research and Science Education to include non-users; and Student Prototyping Teams Accelerating Research for Traumatic Brain Injuries (TBI). The scientists, engineers, and transitioners partnered in new ways to transition technologies to improve human protection, with soldiers as the first of many users. Using public information, I provide qualitative and quantitative methodologies to assess the social networks of actors, as well as the composition and changes in the research portfolio. These case studies show what the ISN members did and how the small teams innovated, operationalizing translation through enrollment, and transitioning nanotechnologies and other prototypes.

Syllabi are an integral part of any college experience and an understanding for how the genre functions on a rhetorical level is an under-researched area in the field of higher education. Using the tools of rhetorical analysis—looking at language and genre structures—I gathered a selection of 25 First-Year Writing syllabi within the Department of English at Virginia Tech to help address this concern of a lack of research. Using qualitative research methods—specifically those dealing with language and genre coding—I worked through my syllabi selection to ascertain how the genre functions rhetorically. Using Mary Louise Pratt's idea of the "contact zone" as well as Rhetorical Genre Theories and Actor-Network Theory, I argue that beginning with an understanding for how the genre of syllabi function rhetorically will also help us understand how the genre can be communicative, in the sense that it sends a message, as well as performative. / Master of Arts / Syllabi are an integral part of any college experience and an understanding for how the genre functions on a rhetorical level is an under-researched area in the field of higher education. Using the tools of rhetorical analysis—looking at language and genre structures—I gathered a selection of 25 First-Year Writing syllabi within the Department of English at Virginia Tech to help address this concern of a lack of research. Using qualitative research methods—specifically those dealing with language and genre coding—I worked through my syllabi selection to ascertain how the genre functions rhetorically. Using Mary Louise Pratt’s idea of the “contact zone” as well as Rhetorical Genre Theories and Actor-Network Theory, I argue that beginning with an understanding for how the genre of syllabi function rhetorically will also help us understand how the genre can be communicative, in the sense that it sends a message, as well as performative.

IT is often seen as a solution to many problems concerning effectiveness in organizations. Information systems within the healthcare sector is often viewed as medical devices rather than just systems or services. These medical devices are thoroughly regulated by laws, standards and certifications. In this study I participated in an innovative project that aimed to bring new life and use to the old fashioned patient journal by giving it a visual representation through the use of an avatar. I aimed to study the effects of regulators connected with the patient journal as a source of information for the innovative project. I drew upon Actor-network theory as a theoretical lens to trace the patient journal and connect it with regulatory aspects important to innovative projects such as the studied scenario. I also aimed to research the possibilities and obstacles provided with today’s IT-climate in Swedish healthcare. I found that regulatory aspects according to Actor-network theory proved to be an actor that stabilizes the network that is the innovative project. Certain regulatory aspects such as quality management standards provided support for unifying the vision concerning the innovation. Further the regulatory aspects proved to be an actor that can shift power between project developers and external actors. The regulatory aspects did not show any significant effect on the innovation or its original vision. These aspects did however show proof of being a heavy provider of project complexity and experience concerning these aspects was shown to be hard to find. I also found that there are two distinct ways for an innovator to realize a vision within Swedish healthcare, the healthcare way and the patient way, these two ways are represented in a model framework for future research. Last but not least I presented a framework for future IT-architecture based on modern technology and the results found in this study.

Samtidskonsten innebär att en mängd nya sätt att organisera presentationen av konst på har uppstått. Museet för glömska är en mindre samtidskonsthall med starkt idébaserad grund som kan sägas vara allt från ett kulturprojekt till ett idébaserat museum. Denna uppsats belyser vad Museet för glömska är och hur det görs i ett ANT-perspektiv. En del av uppsatsen är också att se hur en organisation som Museet för glömska låter sig studeras. Syftet med uppsatsen är att öka förståelsen för icke-traditionella museum och samtidskonsthallars organisation. Detta genom att synliggöra de förbindelser och relationer som bildar Museet för glömska. Tidigare studier av har visat att problematiken med samtidskonsten och dess organisering är att konsthallarna står i en beroendeställning till finansiärer varför det kritiska perspektiv som kännetecknar samtidskonsten kan vara svår att åstadkomma. Därför finns det anledning att studera alternativa organisationsformer. Museet för glömska undgår i viss mån denna problematik eftersom verksamheten sker på ideell grund. För att beskriva hur förbindelserna inom Museet för glömska hålls på plats använda begreppet obligatorisk passagepunkt, vilket kan sägas vara ett sätt att belysa hur makten fördelas i en organisation och vilka strategier som används för att bibehålla en maktposition. För att ytterligare beskriva vad Museet för glömska är och hur det görs används också begreppen objektskapande- och rumsligt nätverksperspektiv. Museet för glömska består, i ett ANT-perspektiv, av två kretslopp. Ett litet för varje utställningstillfälle och ett stort som beskriver Museet för glömskas identitet. Det lilla kretsloppet består av delarna utställningsidén, konstnärerna, konstverken, platsen och finansieringen. Det stora innehåller delarna utställningar, Medier utan minne och icke-platsen samt anti-grupperna museer, akademin, media och konstvärlden. Den sammanhållande faktorn för båda kretsloppen är en obligatorisk passagepunkt i form av talespersonerna och en obligatorisk icke-passagepunkt i form av artikeln Medier utan minne. Talespersonernas strategier för att bevara nätverket varierar beroende på vilken aktör i nätverket som ska intresseras. I ett objektskapande nätverksperspektiv är de små kretsloppen och det stora kretsloppet olika, men sammankopplade, objekt som skapar Museet för glömska. I ett rumsligt nätverksperspektiv existerar endast ett litet kretslopp, det som för tillfället är aktivt. När kretsloppet övergår till att inte länge vara aktivt så övergår det till att vara en del av det stora kretsloppets rumsliga nätverksform genom att det då endast existerar på Museet för glömskas webbsida. Jag hävdar genom uppsatsen att Museet för glömska kan ses på många olika sätt men att det i min uppsats ska förstås som en icke-organisation bestående av två kretslopp som hålls samman av en obligatorisk icke-passagepunkt i form av Medier utan minne och en obligatorisk passagepunkt i form av två talespersoner vars kommunikationer med kretsloppens olika delar och utpekandet av anti-grupper är essentiell för att Museet för glömska ska kunna bibehålla sin homeomorfism. Studien bidrar till att öka förståelsen för icke-traditionella konsthallar och museer genom att utvidga vad idébaserade museum kan vara och genom att visa på anti-gruppernas betydelse för icke-traditionella konsthallars identitetsskapande. Utöver detta visar också uppsatsen hur icke-organisationer kan studeras. / The emergence of contemporary art implied many new ways of organizing and presenting art. The Museum of Forgetting is a small and nomadic contemporary art gallery with a strong idea-based foundation. This thesis describes, what the Museum of Forgetting is and how it is made through an Actor Network Theory-perspective. Because of the complexity in what Museum of Forgetting is, it is also relevant to examine how an organization such as Museum of Forgetting can be studied. The purpose of this thesis is to increase the understanding of non-traditional museums and contemporary art galleries by displaying the associations with and within the Museum of Forgetting. Previous studies of contemporary art have shown that one problem of contemporary art and its organization is the dependence on external financiers. Therefore, the critical perspective, characterizing contemporary art, can be difficult to achieve. Because of this, there is reason to study alternative organizational forms of presenting and organizing art. This thesis increases the understanding of non-traditional art galleries and museums by expanding what idea-based museums can be and by showing the importance of anti-groups for the creation of the identities of non-traditional art galleries and museums. The empirical and analytical findings show, that the Museum of Forgetting, through an ANT perspective, consists of two cycles. A small one, that is actualized at each exhibition and a large one, describing the identity of the Museum of Forgetting. The small cycle consists of the following units: the exhibition-idea, the artists, the artworks, the place and the financing. The large cycle consists of: exhibitions, the article ”Media without memory” and non-location as well as anti-groups. The unifying factors for both cycles are one obligatory passage point manifested in two spokespersons and one obligatory non-passage point manifested in the article Media without memory. The spokespersons strategies to maintain their position as obligatory passage point varies, depending on which actor to enrol in the network. In essence, according to my findings, the Museum of Forgetting should be understood as two cycles which are coalesced by an obligatory non-passage point, manifested in Media without memory and an obligatory passage point, manifested in two spokespersons, whose communications with the different parts of the cycles and identification of anti-groups, are essential for maintaining the homeomorphism of the Museum of Forgetting.