Benefit of using Actor-Network Theory

Many sociological theories can explain the causation of an event but are more concerned with human to human interaction. To understand the research question of this thesis, in a complex hospital environment, it is imperative to think beyond human factors to manage incidents. Particularly as the literature review identified a mix of human, technology and environment to interact in the events of violence and also identified the role of WHSMS and training in minimising the risk of OVAS. The proponents of ANT mention that at any point of time any of those, that is people, technology and natural phenomena, can compete to be a decisive actor to control the event (Asdal, 2007).

Actor-Network theory adopts an anti-essentialist position in which it rejects there being some difference between humans and nonhumans (Tatnall, 2003). In other words, ANT doesn’t consider there is a difference in the interaction of human, society or non-human factors (technology, system, idea, practice or others) to initiate or control an event. This is an important aspect in understanding the impact of a new thing or idea or practice in the service delivery process. Whenever new things are introduced people don’t adopt them in their life or in work practices just because of one attractive

74 aspect of the new one, but by a cumulative outcome that might bring to the individual and other members of the society, convenience and other factors (Keong, 2010). The WHSMS and the trainers need to consider this in introducing new approaches or practices or tools in workplace.

In healthcare, human actions do not only depend on human characteristics but also depend on non- human actors including the environment and climate. Compared to other social theories like diffusion of innovation theory (Rogers, 2003), behaviour changing models, social adaptation theory in customer behaviour, concept of adaptation in climate change, Actor-Network theory is better placed to explain why an act happens in a particular way and, the interaction of human and non-human factors in evolution of the behavioural change in innovation adoption (Young, 2010). So, the use of ANT would be effective in explaining how the actors are considered in training of OVAS risk minimisation.

The adoption of electronic records in hospitals as a part of the information communication technology (ICT) mass rollout across all healthcare facilities in Australia was possible due to support from all actors and the perception of benefit (like accuracy, completeness, easy sharing) by all users. This is an example of the adoption of an innovation due to perception of benefit by users and also influenced by the internal factors (Perez, 2016).

According to ANT all elements of an act or an innovation are primarily heterogeneous. “Unlike other approaches ANT maps the act or innovation process from genesis to implementation, with focus on relationship between the evidence and the networks employing the evidence” (Young, 2010). At a point of time the elements under the influence of some actors remain aligned in a network. But a new impulse (like a concept or idea or product) might play a major actor role and destabilise the existing subsystems or components of the network to encourage forming a new network to bring about the change. Such formation and reformation of networks depends on the influence of the actors which play two roles: intermediary and mediator (Bleakley, 2014; Muller, 2016). Organisations are a network of heterogeneous actors (social, technical, textual, naturally occurring and others) brought together into stable associations or alliances at different stages or periods of their lifecycle (Callon, 2007; Law, 1991b). Stability of this actor-network depends on the dominance of one or more actors also on the inclination or loyalty of the human and nonhuman to the network (Whittle, 2008).

Intermediaries make connections while mediators translate the connections into a form which builds the network into an object. Mediators are actors with the capacity to translate within the subsystems of a network what they transport, with agreement or disagreement. This helps the researcher to separate the actors into their role and then re-group them as needed. Interaction of intermediaries and then mediators to form the network is an important assertion of ANT. After several transformations a

75 network stabilisation occurs which might be long term or short term depending on interaction of actors (Bleakley, 2014).

Discussion on adoption of innovation also needs the inclusion of human and non-human actors as people do not only consider whether technology is better, but also consider how the technology is perceived by family members, peers, colleagues and even by the larger community (Keong, 2010). Adoption also depends on the convenience of use of the technology, its cost-effectiveness, social value or image, and availability of a network to support its operation (Wong, 2009).

To study the impact of training it is also necessary to observe the actors that influence the adoption of the ideas or technologies that are discussed in the training classroom. ANT is best suited to explain the interaction of the actors (particularly the non-human actors) within the hospital and beyond to help in developing a direction to find the best approach of implementing the message delivered through training. Suitability of ANT in the discussion of training in the health sector lies in the complex nature of the environment created by its position (at campuses or facilities) to deliver the service, the

dynamic nature of training with changes in mode of delivery from fixed classroom-based to learners’ convenience-based with the inclusion of technology, and also changes in its scope from group training to an individual focus.

This study wanted to identify the actors that are intermediaries or moderators to influence the OVAS situation and effectiveness of the MSVT in the research hospital (BN123 Health). This was a qualitative case study looking through the lenses of Actor-Network Theory to explain the interaction of factors in improving the performance with the scope of inclusion and adoption of innovation.

The specific objectives were to gain information about -

- The relevance of the MSVT programme to the existing WHS legislation of Victoria.

- An organisation’s goal in WHSMS in relation to occupational violence, during the study period - The incidence rate of hazard, that is the annual rate of Occupational Violence Related Injury

(OVAS).

- The relationship of the prevention programme (i.e. MSVT) to the hazard (i.e. occupational violence), in relation to updated hazard register and risk management plan for occupational violence.

- The existence of performance indicators (e.g. reducing the LTI per year from violence) - A review of MSVT aligned to the WHSMS goal

- The post training evaluation procedure and its coverage

76 - Perception difference between employer and employee, about the outcome of training (e.g. work

environment complying with the statements of the training, or resources available), and - Awareness/ acquaintance about the MSVT in the hospital (among stakeholders)