Ephemera conference.ae,mk.june2017
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How a set of actors in Swedish healthcare work to ignore information that they themselves keep producing.
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Ephemera conference.ae,mk.june2017
- 1. Differences making no difference – on numbers and self-inflicted ignorance Anna Essén anna.essen@hhs.se Morten Knudsen mk.ioa@cbs.dk Ephemera Stockholm, June 2017
- 2. Background
- 3. From the use of ignorance to strategies of ignoring Data produced – and ignored The non-use of self-produced data Theories of ignorance, agnotology, stupidity, (McGoey, Gross, Proctor…) Dominant theme: the function or use of ignorance, strategic ignorance (of others or of the ignorant) We: HOW is ignorance produced? That is: strategies of ignoring
- 4. Strategies of ignoring • Observers have structures creating expectation of actions in relation to certain information • Information has a normative dimension relative to the observer (observers are complex and not only cynical optimizers of self-interest) • How do organisations ignore potentially relevant information to which they are sensitive? • Ignoring: the simultaneous presence of knowledge and non-knowledge • It takes work to be ignorant • Strategies of ignoring: ways in which potentially relevant information is kept un-actualized
- 5. How the comparisons were produced and ignored
- 8. Rheumatologists We have nothing to hide! We protect the registry! Better than new documentation requirements We simply try to identify variables that can be compared Creating legitimacy The comparisons are not that relevant Avoiding more damaging interventions We secure registry funding !
- 10. National health agency Our job is not no interpret the results The comparisons will be relevant for X We are not the intended users I think the comparisons are useful for county councils We have created a democratic system for transparency & e-surveillance Better than creating new e- surveillance systems Creating legitimacy Avoiding more damaging interventionsOtherization Futurization
- 12. Relatively high prescription of expensive drugs in the county content challengeing the accuracy of prescription patterns Relatively small share of patients with good health outcomes X X
- 13. County councils As measures will be improved… When the search- function gets better… WE dont interpret the results. We don’t want to threaten the professionals’ autonomy! learning rather than blaming The comparisons are great! We are responsible Creating legitimacy Futurization Otherization
- 15. Medical specialist I expected a lot of reactions but I have heard…zero! I noticed it but I did not suggest any changes in the action plan
- 16. EXPLICIT IGNORIG STRATEGIES 1. Creating a legitimate image 2. Avoiding damaging interventions The comparisons are useful for reasons other than those officially announced. Content of the comparisons ignored Actors produce the comparisons . IMPLICIT IGNORIG STRATEGIES 1. Otherization 1. Futurization The comparisons does/will fulfill its officially announced purpose. Actors keep producing the comparisons
- 17. Contributions to the literature • Irrational organisations/Information as symbol • Rational parts/irrational whole • On ignorance/functional stupidity • Accountability • Evidence-based management
Editor's Notes
- So our work builds on empirical data that I generated in a larger study concerning the development and use of the rheumatology registry in Sweden, that is, an IT-based documentation system in Swdish rheumatology setting in sweden. I was interested in how rheumatologists experienced the increasing pressure to share the registry data with external actors because since 2008 some of the data in the registry was aggregated and used to compare clinics and regions in Sweden in the so called open comparisons/publicly disclosed online and available to the general public, county councils, patients etc. My plan was to study the disciplinary power of the comparisons, resistance, conflicts, but found that everyone seemed happy, too happy with the comparisons. But, at the same time, noone seemed to use the content in the officially announced way. To understand this paradox and the non-use of the data, I contacted Morten, who had written about non-use, ignorance of information, to learn how this empirical phenomena could build on and contribute to the literature in this field.
- Morten talks about gap in theory
- So let me talk about how the comparisons were produced and ignored. A set of actors were involved in producing, maintaining and ignoring the comparisons
- A set of actors were involved in producing the comparisons
- Wether or not the content of the comparisons is relevant or not does not bother them too much. The comparisons however fulfil other purposes for rheumatologists. The comparisons however help rheumatologists and the registry admin to appear open, pro-innovation, pro new external uses , the comparisons help rheumatologiss to create a legitimate image of themselves and the registry. To satisfy external expectations (in fact, funding is contingent on the registry sharing data to some extent).
- A set of actors were involved in producing the comparisons
- Given their responsibiity to monitor the provision of healthcare, the content of the comparisons could be relevant for them. Differences across men and women, differences among county councils. However, they are not the intended users. They however express that the comparisons are are very valuable. Or rather, that they will become valuaable in the future.
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- Figure 1-2. Diagrams in the Comparisons suggesting problematic relationship between drugs and outcomes in County A.
- Clueless, Not very capable management wise, so Being friends with medical professionals, ”heroes” who created the registry.
- A set of actors were involved in producing the comparisons
- A tentative conceptual of how the system can ignore self-produced data.