#4 TransLAtional Mobilisation Theory

Using Translational Mobilisation Theory

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Research

Empirical research

Translational Mobilisation Theory, like any theory, has value in framing the design, data generation and analysis for research purposes.  

  • Translational Mobilisation Theory has particular value in observational studies where it can be difficult to systematically focus data generation in complex organisational environments.  

  • As a generic sociological theory Translational Mobilisation Theory explains and describes the mobilisation of emergent projects of collective action wherever these are found, enabling studies of all kinds to be linked together, not by methodology, but by theoretical constructs.  This opens up the very real possibility of cross sector learning which is attentive to context.

 
 
 

Example 1:
The EDARA Study

EDARA was a mixed methods study designed to evaluate the effectiveness of Alcohol Intoxication Management Services in diverting attendances at Accident and Emergency Departments (https://www.cardiff.ac.uk/crime-security-research-institute/research/projects/evaluating-the-diversion-of-alcohol-related-attendances-edara).   

The study included three ethnographic case studies of city centres – two with an Alcohol Intoxication Management Service and one without.  The aim of this work-stream was to explore the impact of an Alcohol Intoxication Management Service on referral pathways and the working lives and professional identities of participants in the night-time environment: ambulance services, police, street pastors, door workers, and healthcare staff.   

Translational Mobilisation Theory was used in the EDARA study to inform the data generation strategy to ensure a consistent focus across all case studies, and analyse the processes, practices, organisational logics and materials through which the different actors in the night-time economy managed individuals with acute alcohol intoxication and how this was shaped by the different contexts (Strategic Action Fields) in which they worked.

 
 

Example 2:
Illustrative cross-case comparison of patient care and a research study (Allen and May, 2017).

Allen and May (2017) used Translational Mobilisation Theory to compare the mobilisation of collective action in caring for patients with a research project.

Whereas health care trajectories commence swiftly through parallel projects of object formation in which actors working within a clear division of labour deploy established routines and practices inscribed in a range of sensemaking artefacts, research projects depend on significant initial investment in agreeing to study aims, structures and standards, and roles and responsibilities. 

Whereas the exercise of professional judgment in health care enables standards and protocols to be interpreted flexibly in individual cases, in research projects, standards and operating procedures must be revised to bring them in line with amendments to the study design, and is an acknowledged bureaucratic burden that can inhibit progress. 

In both cases, mechanisms enable the parallel mobilization of project elements. In health care, where trajectories of care exhibit high degrees of fragmentation and fluidity, mobilization is made possible because of the work of nurses in mediating these interrelationships. Whereas in research, the relationship between project elements is more typically embedded in the research design and mediated through adherence to study protocols.

 

Want more information?

Read more in these case studies.

#1

A health care
trajectory

#2

A multidisciplinary research project

 
 

References

Allen, D., & May, C. (2017)
Organising Practice and Practising Organisation: Towards an outline of Translational Mobilisation Theory, Sage Open, April-June 2017 1-14, http://journals.sagepub.com/doi/abs/10.1177/2158244017707993

 
 

Literature reviews and evidence syntheses

  • Translational Mobilisation Theory can also be used to inform literature reviews and syntheses.  

  • Translational Mobilisation Theory provides a template to guide data extraction but also concepts to support the interpretation and synthesis of evidence.   

  • The use of theory in literature syntheses can be particularly valuable in making progress in fields characterised by a heterogeneous literature which do not lend themselves to aggregation as is typical in conventional effectiveness reviews. 

 
 
 

Example:
The PUMA Study

Translational Mobilisation Theory was used alongside Normalisation Process Theory in a theory-driven systematic hermeneutic literature review that examined the socio-material and contextual factors consequential for the effectiveness of early warning systems in paediatric hospitals. An early warning system refers to the elements that need to be in place in an organisation to ensure that signs of clinical deterioration are detected and acted upon at the earliest opportunity. Failure to recognise and act upon signs of clinical deterioration is an acknowledged safety concern and there is a developing professional consensus on the importance of wider system factors on the effectiveness of responses to deterioration but no evidence-based framework exists to support a whole systems approach. The review addressed the following question:  

What socio-material and contextual factors are associated with successful or unsuccessful Paediatric Early Warning Systems?

Because Translational Mobilisation Theory explains how collaborative activity is mobilised in turbulent and unpredictable contexts it is well suited for understanding the literature on early warning systems. Detecting and acting in response to deterioration requires the organisation of action in evolving conditions, which are emergent and uncertain, and takes place in a variety of clinical environments, with different teams, skill mixes, resources, structures, and technologies. Translational Mobilisation Theory allows us to attend to these socio-material relationships focusing on how their capabilities, opportunities and constraints condition action. Normalisation Process Theory shares the same domain assumptions as TMT and is concerned with ‘how and why things become, or do not become, routine and normal components of everyday work’.

The literature in this field is heterogeneous and stronger on the socio-material barriers to successful paediatric early warning systems than on solutions. While a number of different interventions have been proposed and some have been evaluated, there is limited evidence to recommend their use beyond the specific clinical-contexts described in the papers. While the evidence did not lend itself to empirical generalisations, by using Translational Mobilisation Theory and Normalisation Process Theory it was possible to identify common principles for improving paediatric early warning systems to inform local improvement projects.  These were used to develop a propositional model to specify the core components of paediatric early warning systems.

 
 

Improving organisational processes

Mobilising collective action in conditions of organisational turbulence is a practical concern in contemporary society.

Translational Mobilisation Theory has value in offering a systematic framework through which to assess service processes for improvement purposes.

 
 
 
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Understanding the work

  • Any quality improvement initiative should be founded on an understanding of the processes it is designed to improve. 

  • Translational Mobilisation Theory can facilitate understanding of service processes.   

  • Many practices targeted by quality improvement interventions are poorly understood; workers themselves may not be aware of their contribution to an overall activity (Nardi and Engeström, 1999) and/or feel obliged to offer official rather than realist accounts of how the work is done (Dourish, 2001).  

  • Translational Mobilisation Theory offers a framework to think systematically about the goals of a project of action, how activity is shaped by the Strategic Action Field and highlight areas where improvements are required.   

 
 
 
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Developing programme theory

  • Translational Mobilisation Theory is a middle-range theory like that described by Robert Merton (1949).  

  • Middle range-theories can be used for improvement purposes or combined with informal theories derived from the practice setting to develop programme theories to inform an improvement project.  

  • Programme theories have particular value for improvement purposes, typically combining formal and informal theories to frame problem diagnosis, and the design, implementation and evaluation of interventions (Davidoff et al., 2014). 

  • Translational Mobilisation Theory offers a useful starting point for programme theory development because it focuses on the material and cognitive processes through which collective activity is accomplished in context and with which participants are familiar, and provides a language to describe these relationships.  

 
 
 
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Developing and implementing improvement initiatives

  • Translational mobilisation theory provides a framework for the systematic consideration of improvement projects directing attention to the ecology of socio-material relationships in a service process and the relationship between project goals, and how the local Strategic Action Field conditions these.  

  • Translational Mobilisation Theory invites improvers to take seriously the role of artefacts in organisational processes and the local socio-material infrastructures in which they are located (Allen, 2017), directing attention to the  ‘affordances’ of artefacts (Hutchins, 1995; Gibson, 1979), that is the possibilities they offer for action, the assumptions they embody about the world in which they are used (Latour, 1998) and the preconditions for their use. 

  • Translational Mobilisation Theory connects the domains of projects, practice and organisation and provides a framework to facilitate understanding of the inter-relationships between content, context and implementation in improvement. 

  • Translational Mobilisation Theory has particular value in informing functions-focused improvement (Hawe et al., 2009).  Here designers of an intervention give practitioners maximal information on the goal to be achieved, but minimal specifications of how to get there.  

  • Because Translational Mobilisation Theory is concerned with analysing the relationships between project elements and their mechanisms of action in the local context, it supports the design of bottom up improvement initiatives. 

  • Translational Mobilisation Theory enables teams systematically to consider barriers and facilitators to change and potential sources of drift (Berg, 1997) arising from the practical activity of the workplace.  

  • By bringing to the fore the wider ecology of projects of action – sub-projects, intersecting projects and lines of work - Translational Mobilisation Theory helps to identify and plan for the potential impact of other changes in the system.  

  • As a practice-based approach, Translational Mobilisation Theory shares the domain assumptions and action orientation of Normalisation Process Theory (May & Finch, 2009; May et al., 2016), which opens up the potential for these theories to be combined in improvement efforts from problem diagnosis, through intervention development, implementation, sustainability and spread.  

 

Operationalising Translational Mobilisation Theory - Table

This table offers prompts and questions as a starting point for operationalising Translational Mobilisation Theory although the precise questions will need to be tailored for the particular purpose.  

View the table using the button below - or visit our Additional Resources page to see all tables.

 

References

 

Allen, D. (2017)
From polyformacy to formacology (editorial), BMJ Quality and Safety https://qualitysafety.bmj.com/content/early/2017/03/31/bmjqs-2017-006677


Gibson, JJ. (1979)

The Ecological Approach to Perception. Houghton Mifflin: London.


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


Nardi, B. & Engeström, R. (1999)
A web on the wind: the structure of invisible work, Computer Support Cooperative Work 8: 1-8.

Berg M. (1997)
On Distribution, Drift and the Electronic Medical Record. In: Proceedings of the Fifth European Conference on Computer Supported Cooperative Work. Springer, Dordrecht


Hutchins, E. (1995)

Cognition in the Wild, MIT Press: MA.



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


Davidoff, F., Dixon-Woods, M., Leviton, L. and Michie, S. (2014)
Demystifing theory and its use in improvement, BMJ Qual Saf,. 24: 228-238.


Hawe, P., Shiell, A. and Riley, T. (2009)
Theorising interventions as events in systems, Am J Community Psychol, 43: 267-276.


Merton, R. (1949)
On sociological theories of the middle range, In: Merton, R. (Ed.) Social Theory and Social Stucture. The Free Press: New York: Sion and Schuster, pp. 448-459.


Dourish, P. (2001)
Process descriptions as organizational accounting devices: the dual use of workflow technologies, International ACM SIGGROUP Conference on Supporting Group Work, September 30 - October 03, 2001 2001 Boulder, Colorado, USA


Latour, B. (1998).
Mixing humans and nonhumans together: the sociology of a door-closer. In S. L. Star Ecologies of knowledge: Work and politics in science and technology. (pp. 257-277).  New York: State University of New York Press.

 

Translational Mobilisation Theory references

 

Allen, D., & May, C. (2017)
Organising Practice and Practising Organisation: Towards an outline of Translational Mobilisation Theory, Sage Open, April-June 2017 1-14, http://journals.sagepub.com/doi/abs/10.1177/2158244017707993

Allen, D. (2018a)
Translational Mobilization Theory: A new paradigm from understanding the organisational components of nursing work, International Journal of Nursing Studies, 79 (February 2018): 36-42 https://www.journalofnursingstudies.com/article/S0020-7489(17)30242-0/fulltext


Allen, D. (2018b)
Analysing healthcare coordination using translational mobilization theory Journal of Health Organization and Management, 32 (30): 358-373, https://www.emeraldinsight.com/doi/full/10.1108/JHOM-05-2017-0116

Allen, D. (2018c)
Care Trajectory Management: A conceptual framework for formalising emergent organisation in nursing practice, Journal of Nursing Management, 1-6. DOI: 10.1111/jonm.12645 https://onlinelibrary.wiley.com/doi/abs/10.1111/jonm.12645