The concept of boundary work is also important to collaboration, as it relates to concepts or objects that facilitate cooperation between social worlds: “Boundary objects are objects which are both plastic enough to adapt to local need and the constraints of the several parties employing them, yet robust enough to maintain a common identity across sites” (ibid., 393). Star and Griesemer (1989) use their concept of boundary objects to address the problem of how people from different social worlds, perhaps with conflicting interests, are able to cooperate and succeed in the performance of work (Star
& Griesemer 1989, 388). Using boundary objects enables people from different social worlds to collaborate by sharing the use of certain objects or concepts, while maintaining their differences. Boundary objects may be concrete or abstract (ibid., 393), but more importantly, the concept generates an analytical focus on how people are able to collaborate, despite great differences (Bossen & Lauritsen 2007, 147).
According to Fujimura, the strength of the concept of boundary objects also constitutes an analytical disadvantage. Boundary objects are eminently suitable for providing a lens for understanding collaboration across social worlds in which actors maintain their different perspectives and agendas. This flexibility makes the boundary object an inadequate tool for examining cases where a stabilization of fact occurs (Fujimura 1992, 169; Bossen & Lauritsen 2007, 148). Therefore, Fujimura proposes the concept of standardized packages, which address interactions and cooperative work between social worlds, as well as the stabilization of fact (Fujimura 1992, 169). Standardized packages define a conceptual workspace, which is “less abstract, less ill-structured, less ambiguous, and less amorphous” than that described by boundary objects. “It is a gray box which combines several boundary objects […] with standardized methods […] in ways which
further restrict and define each” (ibid., 169). In Fujimura’s field studies, the standardized packages of an abstract theory and specific standardized technologies and work practices enabled collaboration among researchers from different disciplines engaged in cancer-related research. Moreover, as the theory was accompanied by specific, standardized technologies and procedures, work was reorganized in the different social worlds engaged in the cancer research, and their construction of problems was framed by the scope of the general theory, thereby strengthening and stabilizing the theory itself (Bossen & Lauritsen 2007, 149).
Conceptualization of healthcare technology benefits from drawing on both standardized packages that push procedures from the hospital into the home, and boundary objects that are still recognizable, but may be interpreted differently when moved from the hospital to the home. The two concepts are useful for describing different ways in which transformations take shape when new healthcare technology is introduced.
Summing up
In this chapter, I briefly introduced ideas from the field of symbolic interactionism, to conceptualize emergent themes that have their bases in analyses of the ElderTech and Healthy Home projects: The continuous negotiations of work arrangements and order, the transformations of distribution of work, and the role of healthcare technology serving as a boundary object and standardized package mediating between the two social worlds. In particular, the notion of social worlds and memberships is useful for understanding the tensions that may occur when healthcare technology is moved into the home.
Chapter 4: The social world of the home
An ongoing discussion throughout the PhD project, which crystallizes the tensions between, and contrasting characters of the social worlds of the professional and the popular sectors, addressed how to describe persons suffering from disease who is being treated at home. When admitted to a hospital for treatment, a person suffering from a disease acquires the status of a patient, which involves certain working arrangements and divisions of labor between patient and healthcare professionals. When hospital care is shifted to the home, the person becomes a home patient. This requires re-organization of working arrangements and divisions of labor. Furthermore, a home patient remains a family member, giving rise to discussions of how to define the person. Should the person be called a patient, parent, spouse, child, or perhaps resident? The dilemma arises because the person stands between two social worlds, and has memberships in both the social world of the home, and that of the hospital. Embedded in the discussion are negotiations of the balance between memberships and divisions of labor, as the person suffering from the disease, and his or her family, become responsible for much of the monitoring and treatment. Moreover, underlying the discussion of the prevailing definition are potential tensions, as the activities and concerns of the two social worlds may conflict with each other.
The tensions inherent in defining the person with a disease who is being treated at home have been central to the PhD project. The various cases and my approaches to an analysis of the tensions have resulted in persons being identified as “elderly”, “pregnant women with diabetes”13, “citizens”, “participants”, and “patients”. In the following two chapters, however, I have chosen to use the term home patient to explore and highlight the ambiguous position of the person receiving or performing treatment in the home, as the person has memberships in both the social world of the home, and that of the hospital. I hope to emphasize the multiple and perhaps conflicting memberships and obligations that a home patient may experience, and draw attention to the contrasting characters of the two social worlds and thus problematize what it implies to be a patient in the home.
13 Regrettably, these women are called “pregnant, diabetic women” in paper 2, as the definition focuses on the women’s health conditions. The paper therefore holds a paradox, as the main argument in the paper is that developing technology should include a broader perspective on the everyday lives of the women, as their lives revolve around more than disease management.
In the following section I will address the work in which home patients engage, in order to domesticate, utilize, and interpret healthcare technology. Furthermore, I will discuss the implications of the new distribution of work, where home patients are given more work and responsibility in their interaction with healthcare technology, and the role of healthcare technology as a boundary object, bridging the two social worlds. I base these discussions on cases from existing literature and on my analysis in paper 1, which explores how the elderly manage their medication, and paper 5, which analyzes the boundary work in which home patients engage, in their efforts to domesticate healthcare technology.