BackgroundOver the past decade, acute kidney injury (AKI) has become a global priority for improving patient safety and health outcomes. In the UK, a confidential inquiry into AKI led to the publication of clinical guidance and a range of policy initiatives. National patient safety directives have focused on the mandatory establishment of clinical decision support systems (CDSSs) within all acute National Health Service (NHS) trusts to improve the detection, alerting and response to AKI. We studied the organisational work of implementing AKI CDSSs within routine hospital care.MethodsAn ethnographic study comprising non-participant observation and interviews was conducted in two NHS hospitals, delivering AKI quality improvement programmes, located in one region of England. Three researchers conducted a total of 49 interviews and 150 hours of observation over an 18-month period. Analysis was conducted collaboratively and iteratively around emergent themes, relating to the organisational work of technology adoption.ResultsThe two hospitals developed and implemented AKI CDSSs using very different approaches. Nevertheless, both resulted in adaptive work and trade-offs relating to the technology, the users, the organisation and the wider system of care. A common tension was associated with attempts to maximise benefit while minimise additional burden. In both hospitals, resource pressures exacerbated the tensions of translating AKI recommendations into routine practice.ConclusionsOur analysis highlights a conflicted relationship between external context (policy and resources), and organisational structure and culture (eg, digital capability, attitudes to quality improvement). Greater consideration is required to the long-term effectiveness of the approaches taken, particularly in light of the ongoing need for adaptation to incorporate new practices into routine work.

Algorithms are increasingly being adopted in healthcare settings, promising increased safety, productivity and efficiency. The growing sociological literature on algorithms in healthcare shares an assumption that algorithms are introduced to ‘support’ decisions within an interactive order that is predominantly human-oriented. This article presents a different argument, calling attention to the manner in which organisations can end up introducing a non-negotiable disjuncture between human-initiated care work and work that supports algorithms, which the authors call algorithmic work. Drawing on an ethnographic study, the authors describe how two hospitals in England implemented an Acute Kidney Injury (AKI) algorithm and analyse ‘interruptions’ to the algorithm’s expected performance. When the coordination of algorithmic work occludes care work, the study finds a ‘dismembered’ organisation that is algorithmically-oriented rather than human-oriented. In the discussion, the authors examine the consequences of coordinating human and non-human work in each hospital and conclude by urging sociologists of organisation to attend to the importance of the formal in algorithmic work. As the use of algorithms becomes widespread, the analysis provides insight into how organisations outside of healthcare can also end up severing tasks from human experience when algorithmic automation is introduced.

Although sociological studies of quality and safety have identified competing epistemologies in the attempt to measure and improve care, there are gaps in our understanding of how finance and accounting practices are being used to organise this field. This analysis draws on what others have elsewhere called ‘financialisation’ in order to explore the quantification of qualitatively complex care practices. We make our argument using ethnographic data of a quality improvement programme for acute kidney injury (AKI) in a publicly funded hospital in England. Our study is thus concerned with tracing the effects of financialisation in the emergence and assembly of AKI as an object of concern within the hospital. We describe three linked mechanisms through which this occurs: (1) representing and intervening in kidney care; (2) making caring practices count and (3) decision‐making using kidney numbers. Together these stages transform care practices first into risks and then from risks into costs. We argue that this calculative process reinforces a separation between practice and organisational decision‐making made on the basis of numbers. This elevates the status of numbers while diminishing the work of practitioners and managers. We conclude by signalling possible future avenues of research that can take up these processes.

Gangs have been described as an episodic phenomenon comparable across diverse geographical sites, with the US gang stereotype often acting as the archetype. Mirroring this trend, academic researchers have increasingly sought to survey the global topography of gangs through positivist methodologies that seek out universal characteristics of gangs in different cultural contexts. So, research about youth street groups requires an innovative methodological approach to develop a renewed approach for the twenty-first century’s youth street groups, different from the local, coetaneous, male and face-to-face model, used to understand the twentieth century’s gangs. How can complex social forms such as street gangs be researched in the twenty-first century? Can a single ethnographic approach be shared by researchers working in entirely different cultural contexts? What novel methodological and ethical challenges emerge from such a task and how might they be resolved? This article examines the methodological perspectives of the TRANSGANG project.

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A Correction to this paper has been published: 10.1007/s43151-020-00028-y

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