Jeanne Mengis - room A23 - 13.30-15.00
Institute of Marketing and Communication Management
Start date: 19.04.2012
End date: 20.04.2012
Configuring (Time in) Incident Investigations
The paper enquires into the interactoriality of a particular organizational text, namely the timeline, by analysing how it is both communicatively constructed and acts as a constructor (Cooren, 1999: 181). It aims to add to the ideas of tele-action and dislocation (texts acting from a distance) (Putnam & Cooren, 2004) by showing empirically how the timeline shapes conversations not only across institutional distances, but also temporal ones. By tracing the multiple, local enactments of the timeline, we ask what provides “restance” (Derrida, 1988) to a text and, in this attempt, develop on the timeline’s specific physical configuration of time and its material entanglements with other texts and conversations.
The analysis builds on an 18-months ethnographic study on the investigation of clinical incidents in two university hospitals in England. Part of a nationwide initiative to increase patient safety, the two trusts have adopted an approach called Root Cause Analysis (RCA), which aims to foster organizational learning from adverse events by identifying not the human, but the latent or system factors responsible for the incident. One of the striking empirical observations of the study was that from all the analytical tools proposed by RCA, such as barrier analysis, five whys, narrative chronology, tabular timeline, or time person grid (NPSA, 2004), the only one that the healthcare professionals and management staff of the hospitals used in practice was the tabular timeline. In their attempts to collectively and conversationally make sense of the events leading up to the incident, they used the timeline both to label the multiple pieces of information they bracketed from medical notes, written statements, interviews and policy documents, and as the object of reference during the RCA meeting when all parties involved in the incident deliberated about possible causes and necessary actions.
The question why the timeline is so popular when investigation teams retrospectively make sense of clinical incidents (to the contrary of the other tools suggested by RCA) has so far only been answered generally by the current literature on sensemaking referring to the centrality of time, for example in relation to narration and emplotment (Patriotta, 2003; Weick, 1995). Little we know how specific configurations of time act in sensemaking activities (Gomes da Silva & Wetzel, 2007). By zooming in on the timeline and its physical and material configurations, our analysis inevitably needs to open up to the larger network of texts and conversational practices, which construct and are constructed by the timeline (Latour, Jensen, & Venturini, forthcoming).
In particular, we address questions of institutional tele-action and trace how the timeline, as it is put forward by the National Patient Safety Agency, is locally enacted in conversation by the central governance unit and local clinical directorates. Our analysis suggests that despite the multiple and diverse enactments of translocal agency, the timeline as a text remains astonishingly stable (in terms of ‘restance’) (Cooren, 2004; Derrida, 1988). For example, we will show that while the timeline’s tele-agencies of accountability and control are locally enacted differently in the investigation practice as professional independence, the timeline as text remains relatively unaltered and continues to be used by investigation teams.
We argue that this capacity of the timeline to resist, that is its materiality (Callon & Muniesa, 2005), can partially be explained by further trans-local entanglements with other texts of the medical practice (Barad, 2007), which favour a particular configuration of time. In fact, the timeline interacts with texts such as the medical records, which privilege an ordering of events in a monotemporal sequence and reflect a standardized and context-free understanding of time (Nandhakumar & Jones, 2001; Yakura, 2002). Entangled in these relations, the timeline’s ordering of events allows for establishing the “facts” of the incident beyond the boundaries of the professional groups or clinical departments involved in a particular incident. The timeline thereby not only provides epistemological closure on the sequence of events (Patriotta, 2003), but also closes down possibilities on causalities as the established sequence suggests that what happened earlier caused what happened later on.
Next to institutional tele-action, our analysis suggests that the timeline also transcends temporal distances. The paper outlines how the texts and the conversations that precede the construction of a specific timeline, such as on the interviews or written statements provided by the members of the clinical team involved in the clinical adverse event, are shaped by the interactoriality of the timeline. For example, being able to consult medical notes and anticipating the timeline and its tele-actions, in the statements, clinical staff recall events in their exact monotemporal occurrence (e.g. “At 03:42 I spoke to Mr X”; “I saw Miss X at 23:19 on that day in Accident & Emergency”). This suggests further temporal tele-actions in as much as future events are not only conversationally enacted as “future-in-the-present” (Cooren, Fox, Robichaud, & Talih, 2005), but particular configurations of texts are retroacting from the future.
Overall, our close up analysis of the conversational and textual practices involved in incident investigation adds to an empirically grounded understanding of the hybridity of agency that transcends micro-macro dichotomies. ‘Restance’ is thereby provided not only by the physicality of text that can linger around, but also by its material entanglements.
