There is a need for research to understand change processes and knowledge management in health service organisations, and indeed public sector organisations in general. This research seeks to explain how knowledge becomes formulated and thereby mobile, and also how practice has come to be established, visibilised and thereby sustained in a specific context. Exploring practice within a health service organisation, and in particular a public health service organisation, is a particular feature of this research. The research demonstrates how collaboration becomes necessitated under pressure of enacting increasingly complex work activities, an outcome being changing practices and extended accountability relationships which enacts discipline while realising expertise. Using an ethnographic approach, the research explores how the practice of early childhood nursing in the South Western Sydney Area Health Service became a specialised expert undertaking. The research examines how change has occurred, whereby early childhood nursing was refined from being one part of the generalist community nursing practice to being a specialised practice through the increasing technologisation of practice. The technologisation of practice refers to the artefacts, conduct and the processes through which the conceptualisation and enactment of early childhood nursing has become increasingly standardised. Through the technologisation of practice explicit knowledge becomes distributed within the artefacts for practice and tacit knowing becomes distributed across, and is continually enacted by, the collaboration of the practice community. There are four interrelated aspects to the technologisation of practice. Firstly, the technologisation of practice involves standardising the conceptualisation and enactment of practice through constructing a multi-dimensional practice resource within a community of practice. Secondly, the technologisation of practice involves the mobilisation and refinement of the multi-dimensional practice resource to realise a practice network involving extended relationships of accountability. These relationships of accountability are within a profession and also with other professionals. Thirdly, the technologisation of practice involves the ongoing enactment of accountability in a collaborative community of practice. The research shows that a team can become a collaborative community by constructing an accountability context, reorganising and facilitating the team, and then amalgamating the organising and service delivery activities through integrating formal meetings and informal interactions. Fourthly, the technologisation of practice involves the collaborative community assemblage and/or appropriation of further technologies into practice thereby strengthening the local and extended relationships of accountability and expanding the boundaries of practice. The research describes how the technologisation of practice is the enactment of a number of mutually enabling practice dualities, which together simultaneously discipline and realise expertise. The interrelated practice dualities are individual-community, subjective-objective, local-global, formal-informal and governmentality-communal self-governance. The situatedness of practice is shown to necessitate a subjectivity-objectivity duality, whereby individual and communal experience is drawn upon to see through the otherwise opaque nature of statistics and information. The alignment of practice with the broader organisation and professional colleagues realises a local-global duality, whereby the community's local understandings are informed and shaped by distant issues. The formal-informal duality is a mechanism by which practice is increasingly collaboratively conceptualised and enacted, and thereby standardised. Individual and communal 'expertise' becomes realised through the assemblage and appropriation of organising and transforming tools and artefacts, or alternatively technologies. At the same time, the community in defining the use of such technologies as competent practice is disciplining their own conduct. Through this action a governmentality-communal self-governance duality is realised as the nursing community pursues expertise while disciplining themselves; by engaging in collaborative interactions and using standardised technologies the community constructs and makes visible their knowing, practice and expertise.
| Identifer | oai:union.ndltd.org:ADTP/241096 |
| Date | January 2004 |
| Creators | Greenfield, David, Public Health & Community Medicine, Faculty of Medicine, UNSW |
| Publisher | Awarded by:University of New South Wales. School of Public Health and Community Medicine |
| Source Sets | Australiasian Digital Theses Program |
| Language | English |
| Detected Language | English |
| Rights | Copyright David Greenfield, http://unsworks.unsw.edu.au/copyright |
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