#2 TransLAtional Mobilisation Theory

Development of the theory

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The Empirical Foundations of
Translational Mobilisation Theory

 
 
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The immediate origins of Translational Mobilisation Theory lie in ethnographic research on the ‘organising work’ of hospital nurses (Allen, 2015b).   

  • The study showed that the organising work of nurses arises from the need to manage and organise patient ‘care trajectories’ as these evolve. 

  • A care trajectory refers to the ‘unfolding of a patient’s health, welfare and social care needs, the total organisation of work associated with meeting those needs, plus the impact on those involved with that work and its organisation’ (Allen et al, 2004).

  • The care trajectory concept is proposed as an alternative to the notion of a patient pathway in order to underline the unpredictable and uncertain qualities of much healthcare organisation and delivery (Allen, 2015b).  Whereas pathways are founded on an organisational logic which presupposes predictability, standardisation and rational planning, a care trajectory points to the requirement for on-going and flexible management in response to changing patient and family needs and organisational capacity, and is informed by an alternative organisational logic, that is characterised as ‘emergent organisation’. 

  • Nurses have a central role in care trajectory management, and function as ‘obligatory passage points’ in healthcare systems to funnel, refract and shape the activities and materials supporting patient care needs.  

  • ‘Translational mobilisation’ is the term coined to refer to the mechanisms (object formation, reflexive monitoring, translation, articulation and sensemaking) and resources (organisational and clinical knowledge, material and immaterial artefacts) through which nurses fulfil their care trajectory management function.

 
 
 
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Translational Mobilisation Theory also draws on insights from Normalisation Process Theory (NPT). Grounded in a substantial body of empirical research on implementation, NPT identifies, characterises, and explains mechanisms that motivate and shape the ways that situated interventions – changed professional roles, practices of care, new technologies and techniques, and organisational innovations – are implemented, embedded, and integrated in practice settings (May and Finch, 2009; May, 2013).

 
 

References

Allen, D. (2015b)
The Invisible Work of Nurses: Hospitals, Organisation and Healthcare, London: Routledge

https://www.amazon.co.uk/Invisible-Work-Nurses-Organisation-Healthcare/dp/0415723256

Allen, D., Griffiths, L. and Lyne, P. (2004)
Understanding complex trajectories in health and social care provision Sociology of Health and Illness 26 (7): 1008-1030.

https://onlinelibrary.wiley.com/doi/full/10.1111/j.0141-9889.2004.00426.x

May C, Finch T.  (2009) Implementing, Embedding, and Integrating Practices: An Outline of Normalization Process Theory. Sociology, 43 (3): 535-54.

http://journals.sagepub.com/doi/abs/10.1177/0038038509103208

May C. (2013)
Agency and implementation: Understanding the embedding of healthcare innovations in practice, Social Science and Medicine, 78: 26-33.

https://implementationscience.biomedcentral.com/articles/10.1186/1748-5908-8-18

 
 

The Theoretical Foundations of Translational Mobilisation Theory

Translational Mobilisation Theory belongs to a family of approaches known as practice theories (Nicolini, 2013) and directs attention to the socio-material practices through which social life is accomplished.  It draws on and reworks a number of theoretical resources:

 
 
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Negotiated Order Perspective (Strauss et al., 1964) 

A sociological perspective which conceptualises the social order as a process, reconstituted continually through everyday interactions among individuals within a changing structural environment.  Negotiated order theorists show how social interaction (negotiation) contributes to the constitution of social orders (structures) and how social orders give form to interaction processes. 

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Cultural Historical Activity Theory (Engeström, 2000)

Cultural Historical Activity Theory draws attention to the mediated relationship between cognitive processes and practical action. 

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Ecological approaches to the division of labour (Hughes, 1984) 

Ecological approaches to the division of labour attend to the inter-relationships in systems of work and how these are shaped by the wider social, technological and political context.  

 
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Actor Network Theory (Latour, 2005)

Actor Network Theory is a theory and methodological orientation which focuses on the shifting networks of social-material relationships through which the social world is assembled and maintained; human and non-human actors are conceptualised as equal actors in a network, with Actor Network Theory providing a language with which to describe these relationships. 

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Sensemaking (Weick, 1979, 1995) 

Sensemaking refers to how people interpret and give meaning to their circumstances in order to be able to act and account for their actions.  The concept was introduced to organisation studies and was intended to encourage a shift away from the traditional focus on decision-making towards the processes that constitute the meaning of the decisions that are enacted in behaviour.

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Strategic Action Fields (Fligstein and MacAdam, 2011) 

A Strategic Action Field defines the context for collective action and is formed on a situational basis when social actors (individual or collective) with knowledge of one another, interact around a salient concern under a common set of understandings about the purposes of the field, its relationships and its social norms and maxims.

References

Engeström Y. (2000)
Activity Theory as a framework for analysing and redesigning work, Ergonomics 43 (7): 960-72.

Fligstein N, McAdam D. (2011)
Toward a General Theory of Strategic Action Fields, Sociological Theory 29 (1): 1-26.

Hughes EC. (1984)
The Sociological Eye, New Brunswick & London: Transaction Books.

Latour B. (2005)
Reassembling the Social: An Introduction to Actor-Network-Theory, Oxford: Oxford University Press.

 

Nicolini, D. (2013)
Practice Theory, Work and Organization: An Introduction, Oxford: Oxford University Press.

Strauss A, Fagerhaugh S, Suczet B. (1985)
The Social Organisation of Medical Work. Chicago: University of Chicago Press.

Weick K.E. (1995)
Sensemaking in Organizations. Sage: Thousand Oaks, London, New Dehli.

Weick K.E. (1979)
The Social Psychology of Organizing. London: Random House.