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In this paper we make a case for the use of multiple theoretical perspectives -theory on boundary objects, epistemic objects, cultural historical activity theory and objects as infrastructure -to understand the role of objects in cross-disciplinary collaboration. A pluralist approach highlights that objects perform at least three types of work in this context: they motivate collaboration; they allow participants to work across different types of boundaries; and they constitute the fundamental infrastructure of the activity. Building on the results of an empirical study we illustrate the insights that each theoretical lens affords into practices of collaboration and develop a novel analytical framework that organizes objects according to the active work they perform.Our framework can help shed new light on the phenomenon, especially with regards the shifting status of objects and sources of conflict (and change) in collaboration. After discussing these novel insights, we outline directions for future research stemming from a pluralist approach. We conclude by noting the managerial implications of our findings -3 -

Publisher statement: NOTICE: this is the author's version of a work that was accepted for publication in Social Science and Medicine. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Social Science and Medicine, 73(2), (2011) POLICY AND PRACTICE IN THE USE OF ROOT CAUSE ANALYSIS TO INVESTIGATE CLINICAL ADVERSE EVENTS: MIND THE GAP AbstractThis paper examines the challenges of investigating clinical incidents through the use of Root Cause Analysis. We conducted an 18-months ethnographic study in two large acute NHS hospitals in the UK and documented the process of incident investigation, reporting, and translation of the results into practice. We found that the approach has both strengths and problems. The latter stem, in part, from contradictions between potentially incompatible organizational agendas and social logics that drive the use of this approach. While Root Cause Analysis was originally conceived as an organisational learning technique, it is also used as a governance tool and a way to re-establish organisational legitimacy in the aftermath of incidents. The presence of such diverse and partially contradictory aims creates tensions with the result that efforts are at times diverted from the aim of producing sustainable change and improvement. We suggest that a failure to understand these inner contradictions, together with unreflective policy interventions, may produce counterintuitive negative effects which hamper, instead of further, the cause of patient safety.3

Health services leaders need to provide open endorsement of root cause analysis and of the staff carrying it out; enhance staff participation within learning activities and new analytic tools; and develop capabilities in change management.