Rules and resources: a structuration approach to understanding the coordination of childrens`s inpatient health care

Aim. This paper presents findings from a multi-method study exploring the process of care coordination in children's inpatient health care.

Background. Existing work on care coordination is typified by 'black-box' type studies that measure inputs to and outcomes of care coordination roles and practices, without addressing the process of coordination.

Method. Using questionnaires, interviews and observation to collect data in multiple sites in the United Kingdom and Denmark between 1999 and 2005, the study gathered the perceptions of staff and compared these with observed practice. Giddens' structuration theory was used to provide an analytical and explanatory framework.

Findings. Current care coordination practice is diverse and inconsistent. It involves a wide range of clinical and non-clinical staff, many of whom perceive a lack of clarity about who should perform specific coordination activities. Staff draw upon a wide range of different material and non-material resources in coordinating care, the use of which is governed by largely tacit and informal rules.

Conclusions. Care coordination can be usefully conceptualized as a 'structurated' process – one that is continually produced and reproduced by staff using rules and resources to 'instantiate' or bring about care coordination through action. Potentially negative implications of this are manifested in diversity and inconsistency in care coordination practice. However, positive aspects such as the opportunity this provides to tailor care to the needs of the individual patient can be realized.

Structuration theory and information systems development - frameworks for practice

Giddens’ structuration theory (ST) offers an account of social life in terms of social practices developing and changing over time and space, which makes no attempt to directly theorize the Information Systems (IS) domain. IS researchers have long been interested in it as a way of deepening understanding; a common application is the analysis of empirical situations using Giddens’ ‘dimensions of the duality of structure’ model. Other writers, most notably Orlikowski, have used it help theorize the field. Often the mode of research employed has been the interpretative case study. However, direct attempts to influence practice (an important component of working in an applied field), perhaps through the vehicle of action research, have yet to be undertaken. There are at least three serious problems with attempting this. The first is the inaccessibility of the theory to IS researchers and practitioners. The second is the absence of specific theories of technology. The third is Giddens’ own disinterest in practical uses of his work – which leaves no obvious path to follow. This paper explores that path, in the context of information system development (ISD). Some frameworks for practice are suggested which are translated into forms of discourse that are more accessible to the IS community. In particular, we include an empirical illustration to demonstrate the potential of ISD tools based on structuration theory.

Judith Butler's postmodern existentialism : a critical analysis

Bucher ascertains that Butler's description of the temporalized process of structuration, which seeks to avoid recourse to political voluntarism, or the sovereign intentionality of the autonomous individual, yields powerful insights into social identity. He asserts further that Butler's description of the dominant heterosexual culture in terms of melancholia, and her insights into the structures of repetition and difference that make up the social conventions that produce cultural norms, represent important resources in thinking about contemporary cultural conflicts.

Social justice in education in 'new times'

This thesis considers social justice in education in ‘new times’. To facilitate the investigation a number of research questions were pursued. These questions were: • What is meant by the label ‘social justice’? • How is social justice to be understood in contemporary terms? • Are there tensions between traditional and contemporary views of social justice? • How effective are policy developments in delivering social justice via education? • What difference do such policies make at the local level? To answer these questions a critical case analysis of a country community and one of its primary schools was carried out. Data were gathered using a variety of methods. As a researcher who was also a teacher in the school I kept a personal professional journal during 1993 and 1994. During this period I was the teacher in the school with responsibility for curriculum development related to issues of social justice. In 1994 I conducted interviews with twenty students, parents and teachers at the school in relation to social justice issues. I also interviewed the CEO of the town’s Council. A number of relevant Federal and State Government and school policy documents were consulted and an archival search of the local newspaper from 1956 to 1994 was undertaken. Statistical information from the Australian Bureau of Statistics as well as from school records was used. A number of local history books were consulted as well as the minutes of relevant school committee meetings. Contemporary social theory, more specifically the work of Anthony Giddens, provided the major methodological tool. Giddens structuration theory was selected as it provided a way of interpreting society from both macro and micro perspectives, it provided a way of studying the interconnectedness of the individual and society. In addition to this, a metaphor was used as a way of developing an understanding of the data. The river was chosen as the metaphor as it has significance to the case study community and it also provides a way of understanding interconnectedness. At an interpretive level, both social theory and moral philosophy were drawn on, including the work of Geoffrey Sharp, Anthony Giddens and Alisdair MacIntyre. A review of selected literature indicated three main areas of concern in relation to this thesis. We live in a time of constant and ongoing change, understanding how this change impacts on the lives of individuals and society is important. Such an understanding relates directly to issues of ontology. In addition it was necessary to consider schools in these ‘new times’. The literature revealed that the changes occurring in the wider society were related to the changes currently being seen in schools. Specifically this related to the increasing emphasis on economics and on individualism, emphases also reflected in the findings of this thesis. Finally the literature related to social justice was discussed, the focus here was on distributive theories of justice and the way these are reflected in programs such as the DSP. The data, as expressed in the metaphor of the flowing river, revealed dominant and marginal currents in social justice in education in ‘new times’. The dominant social group are the intellectually trained and the dominant issues were related to technology, globalisation and economic and bureaucratic rationalism. In the marginal currents we find the under-employed and the unemployed and marginal issues relating to housing, the black economy, poverty and the survival of rural communities. The data also revealed a marginal tributary running into the river. This tributary shows that social cohesion is still a part of life in ‘new times’, albeit a marginalised part. The dominant and marginal currents in social justice in ‘new times’ reveal changes at a deep cultural level. Social justice in ‘new times’ is set within the limits provided by economic rationalism. Such a position is closely linked to the rise of liberal democracy as a political ideology. A rise which has been on a global scale. This valorizes the individual as compared with the group, and the family as compared to the social whole, within the context of expanded economic groupings and markets. Such an ideological position sees the role of the state as providing the ‘legitimising muscle’ to advance the cause of individuals and their families as compared to larger social groupings. These perceptions were applied in Australia, even under a Labor Government. In this sense social justice policies in ‘new times’ are ideological, they act as a political lever to legitimate economic restructuring. They are policies designed to carry disparate groups forward and together on a common wave of economic reform. They are used to ‘sell’ economic reform as being ‘good’ for all of society. Against the backdrop of economic rationalism and liberal democratic ideals there emerges a language geared to the production of an economically viable self, self image, self identity, self esteem and self confidence. As a result, the sense of identity as ‘social’ is lost from view. This thesis argues that what is needed is a new way of looking at social justice in education. A way that reaches beyond the solutions forwarded by the political Left and the Right. It is about the development of an understanding of the way in which an assimilation of the hyper individual and the social group can result in the emergence of the socially responsible individual. This is a cultural shift that sees the individual/society dualism presented in a new way. The categories enter into a new relationship where the balance shifts away from the individual towards society. A shift to a culture where the individual’s rights and responsibilities are respected within a social whole. Such a cultural shift would result in a curriculum which would build social identity, promoted socially responsible independent thought and make space for creativity and the aesthetic. A ‘curriculum for social responsibility’ would be a socially just curriculum.

Knowledge, identities and dilemmas of the self in physical education teacher education

The purpose of this study was to understand how becoming a physical education teacher is shaped by personally and socially constructed knowledge and is affected by the rules and resources of the structural systems in which physical education teacher education (PETE) takes place. The study was influenced by the traditions of Personal Construct Theory (Kelly 1955), the theoretical tenets of social constructionism (Gergen 1991), and Giddens’s work on structuration (1984) and self-identity (1991). Ten PETE students participated in the study over almost three years. They undertook repertory grid sessions periodically through their study, followed by ‘learning conversations’, in which the grid itself was discussed, reworked and collaboratively analysed. All conversations were audio taped and were fully transcribed. The data were analysed in three ways, all of which were used to construct a story of the study. First, the grids were analysed for patterns, consistencies across students and for consistencies within students. These grids provided the first level story that related to constructions of knowledge. These constructions were then content analysed using analysis categories developed from Gergen’s notion of the saturated self and Giddens’ ideas of identity in late modernity. These analyses represented what Giddens calls a double hermeneutic since to all intents and purposes, the story of the study was constructed from the participants’ constructions of what it is to be a physical education teacher. The data suggests that during the process of constructing professional knowledge the student experienced a series of dilemmas of professional self-identity. It seems that to become a PE teacher, the dilemmas must be worked through until a position of what Giddens calls ontologist security has been achieved. Some students in this study had not managed to reach such a point before they left university and entered the teaching profession. In spite of this, the methods of the study allowed the participants to begin to articulate their theories and visions of teaching physical education. The therapeutic qualities of Kelly’s theory encouraged a number of the students to ‘see it differently’ (Rossi, 1997) and to begin to develop a rationale for physical education based on educational practice that considers the needs of individuals and the promotion of a socially just community. I have argued however that this ‘critical’ approach to physical education pedagogy was considered risky and as such students who were prepared to engage in such risk strategies also had other strategic relational selves (Gergen, 1991) to minimise risk at key times during their teacher education.

Investigating the pedagogical process in physical education teacher education

The study investigated two main questions: the first focused on the factors that enabled and constrained student teachers' engagement of a socially critical pedagogy in physical education teacher education (PETE); the second centered on gaining insight into the usefulness of knowledgeability as a concept for analysing student teachers engagement of a socially critical pedagogy. At the time of writing this thesis empirical analyses of socially critical pedagogies in physical education were rare in the educational literature. The study provided an alternative way of analysing student teachers’ engagement of a socially critical pedagogy in PETE. Alternative in that it avoided recycling and reproducing the dualism between agency and structure (Aronowitz and Giroux, 1985) that is prevalent in much of the physical education literature. Conversational interviews were conducted with four student teachers and their teacher educators throughout the duration of a one-semester PETE unit in an Australian university. Observations were made of the lecture and practical sessions and a document analysis was conducted of all unit learning resources. The analytical frame used in the study was structuration theory (Giddens, 1979, 1984). This framework was useful because it gave primacy to the duality of structure which recognised ‘the structural properties of social systems are both the medium and outcome of practices that constitute those systems’ (Giddens, 1979, p.69). The pedagogical intentions of the teacher educator co-ordinating the PETE unit were to change the orientations of the student teachers towards primary school physical education by encouraging them to adopt different ‘lenses’ through which to examine pedagogical practices. These ‘lenses’ highlighted the questions central to those with socio-critical intentions, eg. power, social injustice and diversity. Data generated from conversations with, and observations of, the student teachers, indicated that the actualisation of the teacher educator's intentions were somewhat limited. Despite this, adopting structuration theory as the explanatory framework for the study proved generative at a number of levels. Broadly, structuration theory was useful because it highlighted the way that student teachers' engagement with a socially critical pedagogy is contingent upon particular (idiosyncratic) dialectics of agency and structure. Using the duality of structure as an analytical tool illustrated the way student teachers' were influenced by structural factors as well as the way these structural factors were in turn constituted by the action of the student teachers. Also, by utilising structuration theory as an explanatory framework, the concept of knowledgeability was identified as a useful concept for analysing student teachers' engagement with a socially critical pedagogy in PETE. What is more, the study highlighted the reflexivity of the self and social knowledge, both characteristics of late modernity, as being integral to the way the student teachers engaged with the socially critical pedagogy of EAE400. Not only did the study highlight the reflexivity of the self but it also provided insight into the reflexivity of social knowledge. Much of the socially critical work in physical education implicitly adopts a linear approach to change. Given the findings of the study it might be useful for future developments to consider change as circular. The thesis concludes by suggesting that given the reflexivity of social knowledge, socially critical perspectives might be more readily engaged if the PETE content was incorporated into student teachers existing knowledge frameworks rather than viewed as a replacement for such frameworks.

Changing spaces

Using Gidden's structuration theory to explore marginalised young people's perceptions of a six-week outdoor experiential program, this study uncovers the processes involved in increasing the agency and control the young people have over their future health and wellbeing to enable them to make significant changes in their life styles.

Using internet technology within the organization : a structurational analysis of intranets

Many organizations are implementing Internet technology, specifically Word Wide Web technology, inside the organization in the form of an “organizational Internet” or irttrunet. Intranet technology can unify dispersed computer based information systems in the organization into one rich “system”. Thus, intranets can have a major impact on organizational processes, for example cross-functional information sharing and collaboration. We focus on the social aspects surrounding intranet implementation. We seek to answer how intranet implementations shape and how they are shaped by ‘social structures employed by organizational agents. We adapt structuration theory into an explanatory device to analyze inhanet implementation and we apply it to four cases. We conclude that, intranets are initially more shaped by, rather than shaping social structures, but that this may change over time. The following learning points are condensed: Firstly, intranets are socially constructed and implementers need to be cautious when seeking to transplanting Web technology into an organizational context. Secondly, intranets typically evolve in sophistication over time. Finally, institutionalization is isolated as the key challenge in intranet implementation.

What drives the end user to build a feral information system?

A Feral Information Systems (FIS) is any technological artefact (e.g. spreadsheets) that end users employ instead of the mandated Enterprise System (ES). ES proponents suggest that the installation of an ES will boost productivity. However, Production Possibility Frontier theory provides insights as to why the introduction of an ES may instead suppress an end user's productivity. Structuration Theory offers insights that explain how certain end users may have access to powerful resources. Rather than submitting to the ES, the end user can employ FIS to block or circumvent aspects of the ES. Further, the concept of life chances helps explain why individuals may or may not develop the core skills required to construct an alternate to the ES, the FIS. In relation to the ES usage, an end user may adopt one of four Modes of Operation, namely: Submit, Dismiss, Hidden, or Defiant.

‘Global’ is not just ‘out there’ but also ‘right here’

This paper reports on a study into how the cultural expectations of the roles of students and teachers impact on the lived experience of higher education students. Specifically, the paper discusses ways in which academics and students perceive the theoretical and practical sides of the front-end loading programs in which they are involved. The paper takes an interdisciplinary and cross-cultural approach in drawing from data sets collected from students and staff in both a UK medicine program and also an Australian teacher education program. As such, it responds to the aim of the AARE-APERA conference to enrich global cooperation in educational research. Giddens’ (2003) sociological theory of “structuration” was selected as a framework for the study because it enables insight into how individuals make meaning and identity through their circumstances and endeavours. The theory provided useful in demonstrating how we understand, and thus educate for, the roles of professionals, including doctors and teachers, in society. The discussion and findings of the paper contribute to the international literature on professional culture and identity, work-integrated learning and the enactment of theory and practice in university front-end loading programs.

Enriching interdisciplinary connections : student engagement in theory and practice in higher education programs in Australia and the UK

This paper provides insight into how postgraduate students in two pre-service disciplines, namely medicine and education, identify and make meaning of their circumstances in the globalised era of tertiary education.
Drawing on elements of Giddens’ theory of structuration, we discuss some of the tensions students have reported encountering in an era which is characterised by greater internationalisation of the student body and more globalised curricula.