Editorial introduction. The emergence of a growing corpus of sociological studies with work, technology, and interaction in organizational environments

Informed consent at stake? Language barriers in medical interactions with immigrant anaesthetists: a conversation analytical study

Background

Language barriers in doctor-patient interactions are still an understudied phenomenon. This is particularly true concerning interactions with immigrant physicians who are learners of the patient’s language; there is a lack of research even though labour migration is increasing internationally. This conversation analytical study focusses on language errors in one specific type of doctor-patient interaction, namely pre-anaesthesia evaluations with immigrant anaesthetists.

Methods

The study combines the research field of language acquisition with that of medical interaction. It is a qualitative study with an ethnomethodological framework which addresses the following research question: How do language errors, produced by immigrant anaesthetists, impact pre-anaesthesia evaluations? The primary data comes from naturally occurring pre-anaesthesia evaluations carried out by immigrant anaesthetists. The analysis method is a combination of conversation and error analysis.

Results

The study shows that the anaesthetists produced a considerable number of unintelligible utterances, due to various language errors. Despite the lack of understanding, hardly any negotiation of meaning occurred and both sides (anaesthetists and patients) claimed to be satisfied.

Conclusions

The findings appear to be contradictory. An explanation for this can be found in the effect of the roles and scripts that are given in pre-anaesthesia evaluations. Since no negotiation of meaning is initiated during the interactions, the anaesthetists’ insufficient language competence leads to a considerable impairment of informed consent, which is the main goal of the pre-anaesthesia evaluations. Based on these findings, the study reveals an urgent need for action regarding immigrant anaesthetists’ language skills.

To start practice theorizing anew: The contribution of the concepts of agencement and formativeness

The journal Organization was a precursor of the turn to practice with its 2000 Special Issue, and the burgeoning number of special issues between 2000 and 2011 testifies to the vitality of a field under construction. Nowadays, the consolidation of the field makes it possible to start to understand and spell out differences and, in so doing, to promote lines of practice theorizing with a greater internal consistency. This article contributes to the articulation of differences among various practice theories and within a practice-based theorizing inspired by the sociology of translation. It proposes two concepts—agencement and formativeness—that address two ‘blind spots’ in the conversation on the turn to practice. The first blind spot concerns how we can talk of practices as having agency and the second concerns how we can articulate knowing in practice as a ‘doing while inventing the way of doing’, that is, the creative entanglement of knowing and doing. I shall address these two ‘blind spots’ by saying that one difficulty in addressing them is created by language. Hence, if we want to turn to practice anew, we need to invent/discover/reconfigure a new vocabulary with which to shape new concepts or to circulate existing ones better.

Egg dates sperm: a tale of a practice change and its stabilization

The aim of this article is to enlarge practice-based studies to the consideration of institutional environment and institutional work, opening a dialogue with neo-institutionalism and, in so doing, advance the growing field of sociology of practice. This study attempts to do this by answering the question: how does a change in a practice become stabilized and what does the new practice do, once stabilized? Within practice-based studies, most studies have considered mainly endogenous changes, emergent from the community of practitioners under study. By contrast, this study discusses an exogenous change (a recent Italian law limits medically assisted reproduction practices) and the emergent relations that stabilize a provisional new practice through negotiation within the institutional context. Stabilization of a new practice is achieved by limitation, by rhetorical closure and by anchoring in technology. The aim of the article is to show the unintended power effects that a new practice generates once stabilized.

Knowledge Practices in Design: The Role of Visual Representations as `Epistemic Objects'

We use a detailed study of the knowledge work around visual representations to draw attention to the multidimensional nature of `objects'. Objects are variously described in the literatures as relatively stable or in flux; as abstract or concrete; and as used within or across practices. We clarify these dimensions, drawing on and extending the literature on boundary objects, and connecting it with work on epistemic and technical objects. In particular, we highlight the epistemic role of objects, using our observations of knowledge work on an architectural design project to show how, in this setting, visual representations are characterized by a `lack' or incompleteness that precipitates unfolding. The conceptual design of a building involves a wide range of technical, social and aesthetic forms of knowledge that need to be developed and aligned. We explore how visual representations are used, and how these are meaningful to different stakeholders, eliciting their distinct contributions. As the project evolves and the drawings change, new issues and needs for knowledge work arise. These objects have an `unfolding ontology' and are constantly in flux, rather than fully formed. We discuss the implications for wider understandings of objects in organizations and for how knowledge work is achieved in practice.

`That Miracle of Familiar Organizational Things': Social and Moral Order in the MBA Classroom

Garfinkel's work over the last five decades has created an alternate view of organizational phenomena which has been understood only at the margins of organization studies. His approach is profoundly empirical yet it is not positivist. He does not deny the reality of things but argues that their appearance as objects on any particular occasion is socially constructed. He shows us familiar organizational things in an unfamiliar way: organized phenomena of order in practical detail. This paper specifically examines the moral dimension of Garfinkel's approach. When Garfinkel says that members make settings accountable, i.e. `observable and reportable', he means accountable rationally and morally. To explicate this point, the paper examines data from a study of an executive MBA classroom in a way that builds on Macbeth's (2003) ethnomethodological study and examines the way in which the social organization of vernacular talk and interaction in the classroom is simultaneously moral organization. Moral order and social order are shown to be inseparably intertwined in and as the practical details of classroom interaction. Endogenously organized sequences of interaction and vernacular discourse accomplish the emergent socio-moral order of the class; a background texture of relevances which becomes a resource within which members' shared understandings progress.

Organization in Actual Episodes of Work: Harvey Sacks and Organization Studies

This paper explores the relevance of Harvey Sacks' work for contemporary organization studies. Sacks encourages analysts to tether their studies to real-time workplace activities; ordinary scenes of work are recorded, slowed down and made the central object of study. Something of Sacks' analytic mentality and style are illustrated through the analysis of two data extracts: an emergency 999 call and a face-to-face sales encounter. A distinctive way of doing organizational analysis is discussed that foregrounds knowledgeability and agency via the examination of sequence and method. Sacks raises the possibility that organization might be recoverable from the fine-grained detail of actual episodes. The idea that order, intelligibility and the constitution of social scenes might have a basis aside from the more general notion of discourse is discussed.