This research is about the organisation of technology in work. It focuses specifically on new technologies that are reconfiguring the relationship between organisations and society.
The two publications on acute kidney injury (AKI) consider how diagnostic algorithms can shift the attention of medical practitioners from patient care, or 'caregiving', to maintaining algorithms and their outputs, or what we call organisational 'caretaking'. Whereas caregiving is directed toward the health and wellbeing of people, organisational caretaking is directed toward the survival of the organisation. In a financialised organisation, survival depends on the production of economic value measured using numbers. We show exactly how care is counted to feed financial decision-making processes and consequently how caregiving ends up being reduced to caretaking.
When this goes too far, algorithms can end up wholly displacing caregiving with caretaking. This can be dangerous when it prevents experts from introducing necessary human checks and balances to automation. By studying two hospitals implementing the same AKI diagnostic algorithm in two different ways, we are able to show how one hospital sends the algorithms' output straight to the wards, whereas the other sends its output to a team of specialist nurses who have the expertise to spot diagnostic errors. In the absence of these checks and if an algorithm fails for whatever reason, many patients would have to die before a hospital would notice the anomaly. The organisation of technology in work can be a life and death matter.
Our study of AKI diagnostic algorithms underscores the argument that these new technologies can speedily upturn the relationship between actors that would previous be identifiable in fixed social positions. It undermines many of our existing social theories because they lack an equivalent dynamism. We propose that these technologies are better understood to exist in parasitic universes in which shifts in the positions and relations between organisational actors (people, technologies, profit, etc.), can be analysed as they happen.
In our analysis of a UK non‐profit social care organisation, we show that relations of care were fundamentally disrupted by disorderly, dysfunctional forms of agency, whereas in our analysis of UK retail banking, we show how management used disorder to strategically obscure their own agency. Ultimately, technological innovation and ‘future of work’ narratives appear in our analysis to feed each other, in service to interests that benefit from the repurposing of technologies, people and organisations.
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