Taking data seriously: the value of actor-network theory in rethinking patient experience data

Abstract

Hospitals are awash with patient experience data, much of it collected with the ostensible purpose of improving the quality of patient care. However, there has been comparatively little consideration of the nature and capacities of data itself. Using insights from actor-network theory, we propose that paying attention to patient experience data as having agency in particular hospital interactions allows us to better trace how and in what circumstances data lead (or fail to lead) to quality improvement.

Organisational strategies and practices to improve care using patient experience data in acute NHS hospital trusts: an ethnographic study

“…. Desai et al 25 In parallel with more interventionist research studies (see Developing and testing interventions), there has also been a recent interest in making greater theoretical contributions to 'patient experience' as an important aspect of health-care QI work. For example, Ziewitz 21 undertook an ethnographic study that is particularly relevant to our own research, as it asked 'what does it take to mobilise experiences of care and make them useful for improving services?'…”

“…[34][35][36][37][38][39][40][41][42] Although not a unitary theory, ANT provides a framework and tools that allowed us to pay attention to the 'materiality' of organisational activity and the inseparability of the technical and the social aspects in organisational practices. [43][44][45] In a recent paper, 25 we have argued that research approaches to the study of patient experience data informed by ANT have the potential to make at least two contributions to current debates on health-care improvement. First, ANT perspectives and sensibilities emphasise the enacted nature of patient experience data and quality improvement:…”

“…bringing to the fore the ways in which quality improvement emerges, or fails to emerge, as a result of a contingent series of interactions between various human (individual, institutional) and non-human actors (bureaucratic documents, policies, technologies, targets, etc.). Desai et al 25 Second, ANT sheds light on useful dimensions of organisational structure and functioning that might otherwise be overshadowed by more traditional perspectives that see data 'as inert, open to infinite technical refinement in the service of quality improvement' 25 (see Contemporary studies of the collection and use of patient experience data). When data travel in an organisation, transforming and translating as they travel (into reports, narratives, interventions, etc.…”

“…), 'it makes and reveals alternative organizational relations to those which are officially recognized'. 25 In the case of hospitals, which are formally hierarchical institutions with specific configurations of roles and responsibilities, paying attention to the interactions in which data become embedded: 25,46,47 . .…”

“…may reveal alternative decision-making processes and may bring to the fore the role of certain actors (such as health care assistants or receptionists) who are conventionally marginal, but who nevertheless often come to play an unexpectedly central role in ensuring the quality of care. Desai et al 25 The flattened perspective afforded by ANT approaches, 'which treats actors as equally important regardless of their assumed place in an institution,' at the same time requires and ensures 'that better attention is paid to alternative organizational arrangements as well as to forms of agency which would otherwise go undetected, including non-human agency'. 25 A widely recognised discrepancy exists between the proliferation of forms of patient experience data collection and the limited ways in which such data are used to inform QI.…”