Dismembering organisation: The coordination of algorithmic work in healthcare

Abstract

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.

Ambiguous workarounds in policy piloting in the NHS: Tensions, trade‐offs and legacies of organisational change projects

“…The NHS' uniquely multi‐professional make‐up intensifies these politics through competing agendas. We might also acknowledge that in the act of making some practices formal and visible, for example in standards and protocols, other practices, such as articulation work, are rendered invisible (Star and Bowker, 2007; Bailey et al ., 2020). This implies that workarounds are both necessary to the rules and protocols that define them and also necessarily invisible.…”

Artificial intelligence, algorithms, and social inequality: Sociological contributions to contemporary debates

“…Sociologists of work, occupations, and organizations have examined how new algorithmic systems reconfigure human labor, in ways that are often detrimental to workers (Bailey et al., 2020; Griesbach et al., 2019; Kellogg et al., 2020; Newlands, 2021; Shestakofsky, 2017). Utopian and dystopian predictions of robots taking and transforming human jobs have been the subject of discourse analysis (see James & Whelan, 2021; Ossewaarde & Gulenc, 2020; Vicsek, 2020), but sociological scholarship has been skeptical or critical of these claims, and more attentive to questions of power relations (Boyd & Holton, 2018).…”

“…While macro‐level social theories provide analytic tools for global transformations, sociologists can attend to the production of power and knowledge through genealogies (Denton et al., 2021) and ethnographies of AI research (Hoffman, 2021; Jaton, 2021). There will also be continuing value in producing ethnographies (and institutional ethnographies, James & Whelan, 2021) of organizations implementing algorithmic systems (Bailey et al., 2020; Brayne & Christin, 2021; Cruz, 2020; Shestakofsky & Kelkar, 2020), as well as studies into the experiences of people who are further ‘downstream’, interacting with algorithmic systems (Christin, 2020; Noble, 2018). Roberge and Castelle (2021) argue that we need an ‘end‐to‐end sociology’ of AI, investigating how these ‘upstream’ and ‘downstream’ processes are entangled, and tracing these sociotechnical systems ‘from genesis to impact and back again’ (Roberge & Castelle, 2021, p. 3).…”

Parasitic universes: Organisational and technological meddling in the social

“…Digital payments, for example, have not only cut costs from transactions (or at least have the capacity to do so in future) but also fundamentally altered work processes. Work previously done in branches shapeshifts into digital protocols and algorithms doing 'work', with the occasional human doing 'algorithmic work' that acknowledges these processes (Bailey et al, 2020). Work is digitalised through technology, but technology, whilst facilitating much of this, is by no means in total charge.…”