Disabling and Enabling Technologies for Learning in Higher Education for All : Issues and Challenges for Whom?

Integration, inclusion, and equity constitute fundamental dimensions of democracy in post-World War II societies and their institutions. The study presented here reports upon the ways in which individuals and institutions both use and account for the roles that technologies, including ICT, play in disabling and enabling access for learning in higher education for all. Technological innovations during the 20th and 21st centuries, including ICT, have been heralded as holding significant promise for revolutionizing issues of access in societal institutions like schools, healthcare services, etc. (at least in the global North). Taking a socially oriented perspective, the study presented in this paper focuses on an ethnographically framed analysis of two datasets that critically explores the role that technologies, including ICT, play in higher education for individuals who are “differently abled” and who constitute a variation on a continuum of capabilities. Functionality as a dimension of everyday life in higher education in the 21st century is explored through the analysis of (i) case studies of two “differently abled” students in Sweden and (ii) current support services at universities in Sweden. The findings make visible the work that institutions and their members do through analyses of the organization of time and space and the use of technologies in institutional settings against the backdrop of individuals’ accountings and life trajectories. This study also highlights the relevance of multi-scale data analyses for revisiting the ways in which identity positions become framed or understood within higher education.

Talking about quality: exploring how ‘quality’ is conceptualized in European hospitals and healthcare systems

BACKGROUND: Conceptualization of quality of care - in terms of what individuals, groups and organizations include in their meaning of quality, is an unexplored research area. It is important to understand how quality is conceptualised as a means to successfully implement improvement efforts and bridge potential disconnect in language about quality between system levels, professions, and clinical services. The aim is therefore to explore and compare conceptualization of quality among national bodies (macro level), senior hospital managers (meso level), and professional groups within clinical micro systems (micro level) in a cross-national study. METHODS: This cross-national multi-level case study combines analysis of national policy documents and regulations at the macro level with semi-structured interviews (383) and non-participant observation (803 hours) of key meetings and shadowing of staff at the meso and micro levels in ten purposively sampled European hospitals (England, the Netherlands, Portugal, Sweden, and Norway). Fieldwork at the meso and micro levels was undertaken over a 12-month period (2011-2012) and different types of micro systems were included (maternity, oncology, orthopaedics, elderly care, intensive care, and geriatrics). RESULTS: The three quality dimensions clinical effectiveness, patient safety, and patient experience were incorporated in macro level policies in all countries. Senior hospital managers adopted a similar conceptualization, but also included efficiency and costs in their conceptualization of quality. 'Quality' in the forms of measuring indicators and performance management were dominant among senior hospital managers (with clinical and non-clinical background). The differential emphasis on the three quality dimensions was strongly linked to professional roles, personal ideas, and beliefs at the micro level. Clinical effectiveness was dominant among physicians (evidence-based approach), while patient experience was dominant among nurses (patient-centered care, enough time to talk with patients). Conceptualization varied between micro systems depending on the type of services provided. CONCLUSION: The quality conceptualization differed across system levels (macro-meso-micro), among professional groups (nurses, doctors, managers), and between the studied micro systems in our ten sampled European hospitals. This entails a managerial alignment challenge translating macro level quality definitions into different local contexts.