Learning in clinical practice: findings from CT, MRI and PACS
This thesis explores learning in clinical practice in the cases of CT, MRI and PACS in\ud UK hospitals. It asks the questions of how and why certain evolutionary features of\ud technology condition learning and change in medical contexts.\ud Using an evolutionary perspective of cognitive and social aspects of technological\ud change, this thesis explores the relationships between technology and organisational\ud learning processes of intuition, interpretation, integration and institutionalisation.\ud Technological regimes are manifested in routines, skills and artefacts, and dynamically\ud evolve with knowledge accumulation processes at the individual, group and\ud organisational levels. Technological change increases the uncertainty and complexity of\ud organisational learning, making organisational outcomes partially unpredictable.\ud Systemic and emergent properties of medical devices such as CT and MRI make\ud learning context-specific and experimental. Negotiation processes between different\ud social groups shape the role and function of an artefact in an organisational context.\ud Technological systems connect artefacts to other parts of society, mediating values,\ud velocity and directionality of change. Practice communities affect how organisations\ud deal with this complexity and learn. These views are used to explore the accumulation\ud of knowledge in clinical practices in CT, MRI and PACS.\ud This thesis develops contextualised theory using a case-study approach to gather novel\ud empirical data from over 40 interviews with clinical, technical, managerial and\ud administrative staff in five NHS hospitals. It uses clinical practice (such as processes,\ud procedures, tasks, rules, interpretations and routines) as a unit of analysis and CT, MRI\ud and PACS technology areas as cases. Results are generalised to evolutionary aspects of\ud technological learning and change provided by the framework, using processes for\ud qualitative analysis such as ordering and coding.\ud When analysed using an evolutionary perspective of technology, the findings in this\ud thesis suggest that learning in clinical practice is diverse, cumulative and incremental,\ud and shaped by complex processes of mediation, by issues such as disease complexity,\ud values, external rules and choice restrictions from different regimes, and by interdisciplinary\ud problem-solving in operational routines.
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