Context in Action

This chapter brings together the findings of the various research experiences outlined throughout the book, and it presents ways for furthering contextual research in organization and management. It also discussed the implications this research may have on practice, and the challenges faced by academics, practitioners, and policy makers going forward. The important point is that it is wise for researchers to reflect on and explicitly state how they understand the construct of context applied in their work and whether or not “context” refers to a shared/common context or an idiosyncratic/individual context or both. For both theoretical and methodological reflections, the crucial question is not what context is, as a stable phenomenon “out there,” rather it is how we theorize, operationalize, study, and analyze context in action, and the consequences of these choices for the research we can produce.

Tracing Context as Relational, Discursive Accomplishment

This chapter problematizes traditional approaches to understanding context as an analytical category, and, instead, it suggests engaging it differently, as members’ concern continually made present through particular kinds of attention and action. The authors elaborate on this via illustrative empirical exemplars from shadowing-based study of chief executives in the UK’s National Health Service. These examples demonstrate the ways in which context was actively made to matter by CEOs making connections and giving particular meaning in district work situations. Building on these examples, it offers a number of analytical and methodological contributions, as well as outlines implications, including those for the literature on managerial work, power, and relational prospective sensemaking.

Methodological Challenges in Studying Context in Action

This chapter develops the methodological aspects of the Framework for Studying Context and Action presented and discussed in the first two chapters of the book. The chapter offers two vignettes as examples of how context can be operationalized and studied (Genetics Knowledge Park and Comparing across Contexts in Action), and it reflects on the lessons these vignettes offer. Next it explores why the links between an understanding of context, the unit of analysis, and methods have such an impact on a given research project and its results. It discussed the methodological aspects of the Framework for Studying Context and Action, specifically in relation to the three main questions we address in the book. Then it presents and discusses the methodological challenges of studying context raised by the contributors.

How Context Shapes the Experience of Staff and Residents in Residential Long-Term Care Settings

This chapter describes 10 years of research into organizational context in residential long-term care (LTC) settings. It focuses on this book’s first and third questions: What constitutes context for an event, situation, or phenomenon? And how do contexts change, and what is the role of actors in such processes? Although with respect to change, it does not focus as much on secular trends as it does on strategies to improve local context. We explore how context influences use of research by staff, quality-of-life indicators for staff, and ability to improve quality of care and quality of life for LTC residents. First, it describes the development and ongoing use of the Alberta Context Tool. Second, it describes the Translating Research in Elder Care (TREC) program of research, and the LTC setting in which the authors study context to bring about quality improvements. Third, it presents selected empirical findings as evidence that context matters in LTC. Finally, it proposes future directions to understand and modify context for improved quality in LTC.

Analyzing Context in Health Care Organizations

This chapter reprises and reflects on Pettigrew, Ferlie, and McKee’s Shaping Strategic Change (1992), which analyzed processes of strategic change in the health care sector in England, based on a set of eight comparative and longitudinal case studies of management teams in English District Health Authorities attempting to accomplish large-scale service-level change. Further, it derived a more general and inductive model of receptive and nonreceptive contexts for change. The strengths and the limitations of this text are considered, along with a possible contemporary research agenda. Present day conditions for such research projects may not be as favorable as they were then.

Technology in Context

The phrase “technology in context” contains a paradox, because much technology is assumed “context-free.” Information and communication technology (ICT) in health care, including telemedicine, electronic patient records, and other forms of ICT are often presented as virtual—free of time and space. This chapter argues that technology development and implementation, as drivers of modernity, make attention to context more relevant than ever in both practice and research. High-tech and information technologies transcend the traditional understanding of context to become something multilayered and relational, with the risk of blurring borderlines of tasks, roles, and responsibilities. Research into disrupted and decontextualized spaces of action offers insights into the dependencies and vulnerabilities of ICT-mediated health care practices. Here, surgery is chosen as a learning aid to understand the mediated character of context, its dependencies and vulnerabilities, and how it must be continuously reproduced at different levels of understanding and organization.

Context of Health Policies and the Impact on Implementation of Health Care and Health Interventions

This chapter will discuss the interface between context, health and health care policy, and health care delivery, using examples primarily from the experience of cancer control and mental health care within the US health care system, although drawing on the more general trends in the influence of policy on health care. Primarily, the chapter will describe policy as existing as two distinct spheres of activity. First, it will describe the set of legislative and regulatory actions that governments and organizations use to influence the provision and receipt of health care, which form the context upon which health care is delivered. Second, it will describe policy as a set of interventions that may support or impede the implementation of health and health care innovations. Finally, the chapter discusses how research can be advanced in this space.

Context and Work Organization in an Acute Health Care Setting

This chapter explores the influence of context in shaping the health care support worker in a hospital setting. Viewing context as constraining or facilitating the exercise of discretion or choice, the chapter examines such influences at different levels of a health care system: the national, the organizational, and the workplace. Drawing on material from four case study hospitals in National Health Service England, the chapter highlights the sensitivity of the support worker role to national and organizational policies and practices. However, the role is presented as particularly affected by workplace contingencies linked to clinical setting, work organization, and interpersonal relations on the ward. The result is a role that shares a job title but assumes a very different form, in terms of tasks performed between and especially within different hospitals.

Patients, Families, and Care Settings

Involving patients and family members as “experts by experience” in health care research and delivery has become accepted practice. There is a growing reliance on patients to manage their own care, and on families to provide support and informal care in wider settings. It is perhaps surprising, therefore, that patients, families, and informal care settings are absent in most discussions of context in health care. In part, this is because “context” in health service research has traditionally been explored through cross-sectional, “structural” studies at the macro- or mesosystem level, as opposed to taking a longitudinal and/or microlevel psychological perspective concerned with social dynamics or individual staff and patient interactions. The observations in this derive from collective experience in studying both health care organizations and the experiences of patients. Drawing on this corpus of research, this chapter explores the often-neglected role of patients and families in discussions of health care context.

Bringing the Hospital Back In

The aim of this chapter is to include buildings in studies of context. It foregrounds what is usually considered contextual background—the building—and focuses on the hospital building and the ways in which it matters for the organization and performance of health care. Our approach to the question of context is processual, socio-technical, and inspired by actor-network theory. The actor-network theory lens allows the researcher to consider the building as both background and foreground, as object, context, and process. As an object, and as a matter of fact, the building resides in the background, yet it can always become foregrounded as a matter of concern. This can happens for a multitude of reasons, including that the “object” itself might create unwelcome surprises and obstacles for its human users and, in turn, spur further attempts by specialists in building construction to contain these through mitigating projects and redesign.