158
possible with the individual theoretical approaches. The Anticipation Cycle allows for a broader spectrum of analysis then what is possible if only applying the individual theories. Sensemaking offers retrospective insights into and ways of describing certain aspects of organizational life, and positioning theory and the concept of scripting others insights into other aspects of organizational life. In combination the three concepts constitute what I call the Anticipation Cycle which is a framework for the analysis of the anticipatory phase preceding the implementation of Sundhedsplatformen.
159
It is as if the clinical staff tries to fit the new technology into the play in a way that allows them to continue playing the role as previously – and why? Why not change? Because the role of being nurse, doctor of secretary is so deeply rooted and the identity it gives such an engrained part of the actors own identity. Perhaps the two are inseparable.
Being a doctor is not something that one simply put on like a uniform or costume. It is not just a mask that covers the real face of the real person. It is a mask / role but there is nothing behind. One can put on another mask, but that does not cover something more real (Goffman, 1959). The role is real. The role of the doctor is the real doctor.
The looming introduction of Sundhedsplatformen can be seen to create a frame
(Goffman, 1986) within which activities, roles and responsibilities are being interpreted.
It is within this new frame we should understand the reactions of the interviewees.
Inherent in the frame of Sundhedsplatformen is also the notion of technology per definition representing progress. We find this view well represented in the numerous Health IT strategies published over the years, and Sundhedsplatformen makes the same promise of a better future. Using the Anticipation Cycle it can be argued that a new dominant storyline is emerging, not just in the views presented in the official
documents, but also amongst interviewees who agree to a storyline essentially stating that Sundhedsplatformen represents progress.
An essential function of anticipatory actions is the defense of current and future organizational positions. The actors are employing various strategies to defend their position in the organization or in Goffmanian terms they perceive to be the defining characteristics of their current role. What are the things that makes them what they are and how are they defended?
Doctors defend their position refereeing to the uniqueness of the tasks they perform.
“The acts that I perform are so important that a new stage prop/technology does not really change anything”
Nurses find ways to circumvent the new technology and thus to evade the intrusive character of the new technology. “If it does not fit with how we do things, we will find ways around it.”
160
Secretaries seem to know that their role is undergoing more fundamental changes and are searching for new roles or to redefine the performance of their current role to stay in the play. “Well, we might have to pick up some of the acts of the other players”.
In all three cases we are seeing various strategies for coping with changes.
What in the past may have seemed like set in stone – institutionalized ways of acting in the context of the hospital – is now up for renegotiation, simply because it is required in order to realize the potential of Sundhedsplatformen. If on the contrary rights, duties and obligations do not change according to the demands of the new Health IT,
Sundhedsplatformen is likely to fail in realizing its potential. The clinical staff members are trying to inscribe themselves into possible and desired futures.
From an overall point of view Sundhedsplatformen results in pushing activities which up till now have been seen to require the insight and experience of a clinical specialist, into the domain of standardized processes and thus essentially reducing the professional
‘value’ of the task. In positioning terms, the value or prestige of the rights and
responsibilities associated with certain tasks is reduced because of the move from the domain of the individual specialist to the domain of the standardized process. For the doctors of the study this does, perhaps surprisingly, not represent a problem. The
standardization and moving of activities to the process end of the spectrum is welcomed because it is seen to free up resources to perform the tasks, and in positioning terms exercise the rights and responsibilities that constitutes the essence of being a doctor.
In contrast to this we find the nurses whom are expressing concerns about the consequences of standardization. An important argument is e.g. that standardized charts are not able to capture the variations in conditions from one patient to the next.
“We cannot put our patients into boxes”. This direct interaction with the patient and the ability to sense and capturing subtle changes in conditions constitutes are core of the nurse self-understanding, which is seen to be reducing the professional value because the standardization transfers it from the professional domain to the process domain.
Amongst the secretaries the pending changes – the push towards increased
standardization – is hardly mentioned. It is as it they are saying ‘Yes, it will be fine not having to document so much’, and as such it is not seen to affect the essence of being a secretary. Their work is still about controlling, coordinating and following the processes
161
to ensure availability of accurate data and a smooth flow of the day-to-day operations of the department.