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CHAPTER 2 LITERATURE REVIEW

E- Health Vision – Health Service Delivery

2.5 Conceptual Background – Constructs for Analysis

2.5.1 PPT-construct – heuristic device

DEVELOPMENT OF THE CONSTRUCT

Kelder and Turner first used the vocabulary of ‘people, place and things’ in (2005b) in their discussion of “the utility of Dcog theory in sensitizing designers to the cognitive implications of changes to information systems and/or work processes and… how the use of Dcog can empower user centered design methodologies” (p. 79), aiming for a ‘human-centred’ approach in the sense of (Gasson, 2003). During the course of this research, the researcher reoriented and extended the conceptualisation of ‘PPT.’ PPT as a construct was initially reoriented to guide identifying socio-technical frameworks and approaches that aligned with human-centred perspectives and demonstrated capacity to investigate and understand rich complex social domains (Kelder & Turner, 2005c) and ‘wicked’ problem situations. PPT-frameworks were selected on the grounds of: “capacity to accommodate and deliver insight into the interactions and relations between the people, the place and the things (PPT) in the setting” (Kelder, 2007), noting that many socio-technical frameworks had been fruitfully used in medical/health informatics research projects (Bate & Robert, 2002; Nemeth, O'Connor, Klock, & Cook, 2006).

Generic attributes for these PPT-frameworks/ approaches were identified: 1) qualitative techniques to capture a rich data set; 2) constructs to represent spatio-temporal

interactions of people, place and things; 3) analysis for cultural and historical

contextualisation of data; 4) techniques for challenging assumptions and generating new insights by redrawing the boundaries of what is under observation or changing the unit of analysis and 5) constructs and theory for insights into structural relations in a setting with implications for design of technical information systems (Kelder & Turner, 2008). These attributes were built into and applied to the concept of PPT such that different PPT frameworks could be used as sensitising lenses to keep the research method open and a process of inquiry. Distributed Cognition theory (Hutchins, 1995a), Community of Practice theory (Wenger, 1998) and Activity Theory (Engeström, 1999) together provide useful sensitising concepts and lenses for data collection and analysis in a socio-technical setting, differently focusing on cognition, community and activity (see Table 2-2).

Theoretical framework used as a sensitising lens

Attend to …

Distributed Cognition (Hutchins, 1995a)

Cognition: cognition stretched over mediating artefacts and people-artefact interactions; development of both practice and practitioners over time

Communities of Practice (Wenger, 1998)

Community: mechanisms for sharing and distributing knowledge and information (membership, brokers, boundary objects)

Activity theory (Engeström, 1999)

Activity: interactions mediated by tools, rules and division of labour for an activity

Table 2-2 PPT-theoretical frameworks sensitising lenses

The unit of analysis employed by different socio-technical theoretical frameworks varies. It can range from connected organisation groups (Bowker & Star, 2000; Brown & Duguid, 2000; Gasson, 2006), human activity systems (Engeström, 2000), functional systems of cognitive activity and artefacts used in cognitive activity (Hutchins, 1995a), connected people groups (Brown & Duguid, 2000; Wenger, 1998), individual users interacting with an information technology artefact (Johnson, Johnson, & Zhang, 2005) and trajectories of an organisation’s clients interacting with the staff and information artefacts (Wales et al., 2002).

Wicked problem contexts are best studied as a process of inquiry, without a presumptive problem definition, perspective or boundary (Rittel & Weber, 1973). Kelder and Turner (Kelder, 2007; Kelder & Turner, 2005a, 2005b, 2005c, 2008) have explored and

identified that it is useful to initially frame an organisation setting in terms of a flexible understanding of a setting as:

PPT: configurations of people, place and things (PPT) on trajectories of interaction over time

Table 2-3 synthesises a range of people, place and thing elements and PPT- configurations and different units of analysis that can be observed in a setting.

PEOPLE Individuals as actors (organisation staff members, clients, workers external to the organisation), social groupings (teams, alliances, networks, communities of practice), social system.

PLACE Physical environment, digital environment, geographical locations, work place physical layout.

THING Physical and cognitive artefacts, information technologies, reified practice, tools, rules (policies, procedures, protocols, standards, etc), technical system.

PPT

configurations

Trajectory of PPT interactions involving an individual client with: individual staff member, clinic team or the organisation via client information system.

Trajectory of PPT interactions involving a single client record, aggregated client record data (reports).

Units of analysis for PPT – configurations

Individual-level, Team-level, Organisation-level, Enterprise-level, community of practice, functional units of distributed cognition, human activity system, ‘technological frame’ (Bijker, 1987).

Boundaries are identifiable by social, political, technical, cultural distinctions as well as physical or geographical barriers. Table 2-3 People, Place, Thing, PPT- configurations and units of analysis

PPT is similar to the OAT-construct (interacting elements: ‘organisation’, ‘agents’ and ‘technology’) referred to by Checkland in his discussion of sense-making in IS

(Checkland & Holwell, 1998). Checkland placed the OAT-construct and OAT-

relationships in a sense-making framework: “COAT.” The “C, for conceptualising” (p. 232) was a reminder that OAT was part of a conceptual model for thinking about an organisation and its information systems.

In this sense, PPT-construct is useful as a heuristic device for connecting approaches which perceive the real world as comprised of mutually constituted social and technical systems of interaction between people, their environment, history and technologies (Bijker et al., 1987; Bijker & Law, 1992). As such, it is aligned with actor network theory concepts of trajectory and interactions between networks of human and artefact actors (Latour, 2005).

The PPT-construct is a tool to operationalise the GTM principle of using a range of theories of analysis (Strauss & Corbin, 1994). It is useful to identify frameworks that provide suitable lenses and constructs for analysing and structuring data from a setting. It may also indicate alternative units of analysis and additional data sources (Kelder, 2007; Kelder & Turner, 2008).

The PPT-construct heuristic device can be used in conjunction with Table 2-2 and Table 2-3 to generate options for data collection and analysis and facilitate the research method as an open process of inquiry sensitive to emergence.