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A Calculative Infrastructure in the Making: The Emergence of a Multi-Layered Complex for Governing Healthcare 正在形成的计算基础设施:管理医疗保健的多层综合体的出现
Pub Date : 2019-08-07 DOI: 10.1108/S0733-558X20190000062004
J. Reilley, Tobias Scheytt
This study sets out to shed light on those infrastructures underlying the ubiquitous, yet contested nature of governing by numbers. Investigating the 30-year long emergence of Germany’s “external quality assurance system” for hospitals, the authors show how methods for quantifying quality align with broader institutional and ideational shifts to form a calculative infrastructure for governance. Our study focuses on three phases of infrastructural development wherein methods for calculating quality, institutions for coordinating data and reform ideals converge with one another. The authors argue that the succession of these phases represents a gradual layering process, whereby old ways of enacting quality governance are not replaced, but augmented by new sets of calculative practices, institutions and ideas. Thinking about infrastructures as multi-layered complexes allows us to explore how they construct possibilities for control, remain stable over time and transform the fields in which they are embedded. Rather than governance being enacted according to a singular goal or value, we see an infrastructure that is flexible enough to support multiple modalities of control, including selective intervention, quality-based competition and automatized budgeting. Infrastructural change, instead of revolving around crises in measurement, is shaped by incubation periods – times of relative calm when political actors, medical practitioners, mathematicians, and many others explore and reflect past experiences, rather than follow erratic reforms fads. Finally, analysing infrastructures as multi-layered constructs underlines how they produce multiple images of care quality, which not only shift existing power relations, but also change the ways we understand and make sense of public services.
这项研究旨在揭示那些无处不在、但存在争议的数字治理本质背后的基础设施。研究了30年来德国医院“外部质量保证体系”的出现,作者展示了量化质量的方法如何与更广泛的制度和观念转变相结合,形成了一个可计算的治理基础设施。我们的研究集中在基础设施发展的三个阶段,其中计算质量的方法、协调数据的机构和改革理想相互融合。作者认为,这些阶段的继承代表了一个渐进的分层过程,据此,制定质量治理的旧方法没有被取代,而是被新的计算实践、制度和思想所增强。将基础设施视为多层综合体,可以让我们探索它们如何构建控制的可能性,如何随着时间的推移保持稳定,以及如何改变它们所嵌入的领域。我们看到的不是根据单一目标或价值制定的治理,而是一个足够灵活的基础设施,以支持多种控制方式,包括选择性干预、基于质量的竞争和自动化预算。基础设施的变化不是围绕测量中的危机,而是由潜伏期形成的——在相对平静的时期,政治行为者、医疗从业者、数学家和许多其他人探索和反思过去的经验,而不是追随不稳定的改革潮流。最后,将基础设施作为多层结构进行分析,强调了它们如何产生护理质量的多重形象,这不仅改变了现有的权力关系,而且改变了我们理解和理解公共服务的方式。
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引用次数: 4
Index 指数
Pub Date : 2019-08-07 DOI: 10.1108/s0733-558x20190000062024
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引用次数: 0
Prospective Sensemaking and Thinking Infrastructures in a Large-Scale Humanitarian Crisis 大规模人道主义危机中的前瞻性意义和思维基础设施
Pub Date : 2019-08-07 DOI: 10.1108/S0733-558X20190000062006
M. Gatzweiler, Matteo Ronzani
This study explores how thinking infrastructures can orchestrate collective sensemaking in unstable and socially contested environments, such as large-scale humanitarian crises. In particular, drawing from recent interest in the role of artifacts and infrastructures in sensemaking processes, the study examines the evaluative underpinnings of prospective sensemaking as groups attempt to develop novel understandings about a desired but ambiguous set of future conditions. To explore these theoretical concerns, a detailed case study of the unfolding challenges of managing a large-scale humanitarian crisis response was conducted. This study offers two contributions. Firstly, it develops a theorization of the process through which performance evaluation systems can serve as thinking infrastructures in the collaborative development of new understandings in unstable environments. Secondly, this study sheds light on the practices that support prospective sensemaking through specific features of thinking infrastructures, and unpacks how prospective and retrospective forms of sensemaking may interact in such processes.
本研究探讨了思维基础设施如何在不稳定和社会竞争环境(如大规模人道主义危机)中协调集体意义构建。特别是,根据最近对人工制品和基础设施在语义构建过程中的作用的兴趣,该研究考察了前瞻性语义构建的评估基础,因为群体试图对一组期望但模糊的未来条件形成新的理解。为了探讨这些理论问题,对管理大规模人道主义危机应对所面临的挑战进行了详细的案例研究。这项研究提供了两个贡献。首先,它发展了一个过程的理论化,通过这个过程,绩效评估系统可以作为在不稳定环境中协作开发新理解的思维基础设施。其次,本研究通过思维基础结构的特定特征揭示了支持前瞻性语义构建的实践,并揭示了前瞻性和回顾性语义构建形式在这些过程中如何相互作用。
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引用次数: 5
Indexal Thinking – Reconfiguring Global Topologies for Market-Based Intervention 索引思维——为市场干预重新配置全球拓扑
Pub Date : 2019-08-07 DOI: 10.1108/S0733-558X20190000062009
Afshin Mehrpouya, Rita Samiolo
Through the example of a “regulatory ranking” – an index produced with the aim to regulate the pharmaceutical market by pushing companies in the direction of providing greater access to medicine in developing countries – this chapter focuses on indexing and ranking as infrastructural processes which inscribe global problem spaces as unfolding actionable territories for market intervention. It foregrounds the “Indexal thinking” which structures and informs regulatory rankings – their aspiration to align the interests of different stakeholders and to entice competition among the ranked companies. The authors detail the infrastructural work through which such ambitions are enacted, detailing processes of infrastructural layering/collage and patchwork through which analysts naturalize/denaturalize various contested categories in the ranking’s territory. They reflect on the consequences of such attempts at reconfiguring global topologies for the problems these governance initiatives seek to address.
通过“监管排名”的例子——一种旨在通过推动公司向发展中国家提供更多药物获取途径的方向来监管制药市场的指数——本章重点关注作为基础设施过程的索引和排名,这些基础设施过程将全球问题空间作为展开市场干预的可操作领域。它强调了构建和指导监管机构排名的“指数思维”——它们的愿望是协调不同利益相关者的利益,并吸引排名公司之间的竞争。作者详细介绍了实现这些目标的基础设施工作,详细介绍了基础设施分层/拼贴和拼凑的过程,分析人员通过这些过程将排名领域内各种有争议的类别归化/非归化。它们反映了为这些治理计划寻求解决的问题重新配置全局拓扑的这种尝试的后果。
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引用次数: 1
Thinking Transparency in European Securitization: Repurposing the Market’s Information Infrastructures 思考欧洲证券化的透明度:重新定位市场的信息基础设施
Pub Date : 2019-08-07 DOI: 10.1108/S0733-558X20190000062011
Antonios Kaniadakis, Amany R. Elbanna
In the aftermath of the global financial crisis, transparency became a rhetorical token used to provide a solution to financial problems. This study examines how transparency materialized in the context of the European securitization industry, which was largely blamed for the credit crunch. The authors show that although transparency was broadly associated with a political call for financial system reform, in the European securitization industry it provided the basis on which to repurpose its market infrastructure. The authors introduce the concept of transparency work to show that transparency is a market achievement organized as a standardization network of heterogeneous actors aiming at establishing a new calculative infrastructure for managing credit risk. Combining insights from information infrastructure research and Economic Sociology, the authors contribute to a distributed and networked understanding of information infrastructure development.
在全球金融危机之后,透明度成为了一种用来提供金融问题解决方案的修辞符号。本研究考察了透明度是如何在欧洲证券化行业的背景下实现的,该行业在很大程度上被指责为信贷紧缩的罪魁祸首。作者表明,尽管透明度广泛地与金融体系改革的政治呼吁联系在一起,但在欧洲证券化行业,它为重新调整其市场基础设施提供了基础。作者引入了透明度工作的概念,表明透明度是一种市场成果,组织为异构行为者的标准化网络,旨在建立一种新的管理信用风险的计算基础设施。结合信息基础设施研究和经济社会学的见解,作者对信息基础设施发展的分布式和网络化理解做出了贡献。
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引用次数: 1
Designing Infrastructure for the Poor: Transactions Within Unstable Ecologies* 为穷人设计基础设施:不稳定生态中的交易*
Pub Date : 2019-08-07 DOI: 10.1108/S0733-558X20190000062021
C. Cholez, P. Trompette
This chapter investigates these failures by exploring the ecology of such infrastructures, designed for “the poor.” It discusses “thinking infrastructures” in terms of longevity by focusing on economic failures risks. The authors argue that the ecology of the infrastructure integrates various economic conversions and exchanges chains expected to participate in the infrastructure’s functioning. By following energy access solutions for rural Africa in sub-regions of Senegal and Madagascar, from their political and technical design to their ordinary life, the authors examine the tensions and contradictions embedded within the scripts of balance supposed to guarantee their success.
本章通过探索这些为“穷人”设计的基础设施的生态来调查这些失败。它通过关注经济失败风险,从长寿的角度讨论了“思考基础设施”。作者认为,基础设施生态整合了参与基础设施功能的各种经济转换和交换链。通过跟踪塞内加尔和马达加斯加分地区非洲农村地区的能源获取解决方案,从其政治和技术设计到日常生活,作者研究了本应保证其成功的平衡脚本中嵌入的紧张和矛盾。
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引用次数: 4
A Communication Perspective on the Fabric of Thinking Infrastructure: the Case of Social Media Analytics 思维基础结构结构的传播视角:以社交媒体分析为例
Pub Date : 2019-08-07 DOI: 10.1108/S0733-558X20190000062019
F. Lambotte
The digital and material traceability of our interactions in organizations are nowadays the subject of very advanced analyses through tools known as social media analytics (SMA). As thinking (infrastructure), SMA tools constitute objects to think of our digitally mediated interactions with. It produces a substratum (a new meaning) that would not exist otherwise, and enacts different types of reasoning that hypothetically influence community managers’ or members’ sensemaking of digitally mediated interactions. This chapter proposes to look behind the curtain of charts and graphs, in order to highlight the performativity of the interactions between the different machines and the traces of our digitally mediated interactions. Drawing on a detailed analysis of the fabric of SMA, this chapter highlights the explanatory power of a communication perspective on types of reasoning enacted by thinking infrastructures. First, considering the SMA tool as an editorial enunciation allows us to see it as a process implying several beings (e.g. machines, humans and logs) that are not without consequences. Second, we show that these beings have different modalities of interactions with each other, and that these modalities of interactions influence the materiality of the digital traces of past interactions. Third, throughout the process, we demonstrate the fragility and variability of their materiality. Finally, faced with the rise of a technological deterministic discourse, which tends to portray the exploitation of our digital traces as an objective way of representing the collaborative practices that make up the organization, our research aims, on the contrary, to demonstrate their relativity.
如今,我们在组织中互动的数字和材料可追溯性是通过社交媒体分析(SMA)工具进行非常高级分析的主题。作为思维(基础设施),SMA工具构成了思考我们与数字媒介互动的对象。它产生了一种原本不存在的基础(一种新的意义),并制定了不同类型的推理,假设影响社区管理者或成员对数字媒介互动的理解。本章建议通过图表和图形来揭示不同机器之间交互的表现力,以及我们以数字媒介进行交互的痕迹。通过对SMA结构的详细分析,本章强调了沟通视角对思维基础设施制定的推理类型的解释力。首先,将SMA工具视为一种编辑性的表达,可以让我们将其视为一个过程,它暗示着几个存在(例如机器、人类和日志)并非没有后果。其次,我们展示了这些生物彼此之间有不同的互动方式,这些互动方式影响了过去互动的数字痕迹的实质性。第三,在整个过程中,我们展示了其材料的脆弱性和可变性。最后,面对一种技术决定论话语的兴起,这种话语倾向于将我们对数字痕迹的利用描述为代表构成组织的协作实践的客观方式,相反,我们的研究目标是证明它们的相对性。
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引用次数: 0
Social Media and the Infrastructuring of Sociality 社会媒体和社会的基础设施
Pub Date : 2019-08-07 DOI: 10.1108/S0733-558X20190000062018
C. Alaimo, J. Kallinikos
Social media stage online patterns of social interaction that differ remarkably from ordinary forms of acting, talking and relating. To unravel these differences, we review the literature on micro-sociology and social psychology and derive a shorthand version of socially-embedded forms of interaction. We use that version as a yardstick for reconstructing and assessing the patterns of sociality social media promote. Our analysis shows that social media platforms stage highly stylized forms of social interaction such as liking, following, tagging, etc. that essentially serve the purpose of generating a calculable and machine-readable data footprint out of user platform participation. This online stylization of social interaction and the data it procures are, however, only the first steps of what we call the infrastructuring of social media. Social media use the data footprint that results from the stylization of social interaction to derive larger (and commercially relevant) social entities such as audiences, networks and groups that are constantly fed back to individuals and groups of users as personalized recommendations of one form or another. Social media infrastructure sociality as they provide the backstage operations and technological facilities out of which new habits and modes of social relatedness emerge and diffuse across the social fabric.
社交媒体展现了一种在线的社交互动模式,这种模式与普通的表演、交谈和联系有着显著的不同。为了揭示这些差异,我们回顾了微观社会学和社会心理学的文献,并得出了社会嵌入互动形式的简写版本。我们用这个版本作为衡量标准,来重建和评估社交媒体所促进的社交模式。我们的分析表明,社交媒体平台呈现出高度程式化的社交互动形式,如点赞、关注、标记等,其本质上是为了从用户平台参与中生成可计算的、机器可读的数据足迹。然而,这种社交互动的在线风格化及其获取的数据只是我们所说的社交媒体基础设施的第一步。社交媒体利用社交互动风格化产生的数据足迹来获得更大的(和商业上相关的)社交实体,如受众、网络和群体,这些实体不断以一种或另一种形式的个性化推荐反馈给个人和用户群体。社交媒体基础设施社会性,因为它们提供了后台操作和技术设施,从中产生了新的社会关系习惯和模式,并在整个社会结构中扩散。
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引用次数: 15
Infrastructuration: On Habits, Norms and Routines as Elements of Infrastructure* 基础设施:作为基础设施要素的习惯、规范和惯例*
Pub Date : 2019-08-07 DOI: 10.1108/S0733-558X20190000062022
P. N. Edwards
This chapter explores examples from several different nations that show how infrastructures depend on habits, norms and routines, and how the persistence of automaticity in social systems and individuals creates its own forms of path dependence and structural inertia. My title plays on Anthony Giddens’s notion of “structuration” to evoke the mutually constructive character of agency and structure.
本章探讨了来自几个不同国家的例子,展示了基础设施如何依赖于习惯、规范和惯例,以及社会系统和个人的自动性如何持续产生其自身形式的路径依赖和结构惯性。我的书名借用了安东尼·吉登斯(Anthony Giddens)的“结构”概念,以唤起代理和结构相互建构的特征。
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引用次数: 5
Calculative Infrastructure for Hospitals: Governing Medical Practices and Health Expenditures Through a Pricing Payment System 医院的计算基础设施:通过定价支付系统管理医疗实践和卫生支出
Pub Date : 2019-08-07 DOI: 10.1108/s0733-558x20190000062005
Pierre-André Juven
Whereas many researchers have examined the way in which health institutions have been transformed through funding modalities, and particularly through prospective payment systems (PPS), few have investigated the architecture of these systems, that is, costs and cost variance. Focusing on the study of costs and on the production of hospital rates, this chapter shows that the French PPS, called “rate per activity” made possible what we call a policy of variance. For health policymakers, the aim was to make the different accounting figures between hospitals, and between ways of practising healthcare, visible, in order to reduce these variances. This policy was attended by uncertainty in the processes of quantification, which led to metrological controversies. As a consequence of the issues around the way of calculating costs, some accounts and calculations were redone. In this chapter, we consider the case of metrological controversy over the remuneration of costs for cystic fibrosis patients’ hospital stays, and over the action of a patient organization that criticized the costs calculated officially. It leads to the analysis of the way calculative infrastructures, as cost accounting and rates, are challenged, and how some actors try to stabilize them.
尽管许多研究人员已经研究了卫生机构通过资助方式,特别是通过预期支付系统(PPS)进行转变的方式,但很少有人调查这些系统的架构,即成本和成本差异。本章着重研究成本和医院费率的产生,表明法国PPS(称为“每活动费率”)使我们所说的方差政策成为可能。对于卫生政策制定者来说,其目的是使不同医院之间以及不同医疗保健实践方式之间的不同会计数据可见,以减少这些差异。这一政策伴随着量化过程中的不确定性,导致了计量学上的争议。由于计算成本的方法存在问题,一些账目和计算被重新做了。在本章中,我们考虑了关于囊性纤维化患者住院费用报酬的计量争议案例,以及一个患者组织批评官方计算的费用的行动。它会导致分析计算基础设施的方式,如成本会计和费率,受到挑战,以及一些参与者如何试图稳定它们。
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引用次数: 2
期刊
Thinking Infrastructures
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