Implementacija novih tehnologija u zdravstvenim organizacijama: Kulturno-povijesna teorija aktivnosti
DOI:
https://doi.org/10.15291/oec.4406Ključne riječi:
tehnološke promjene, implementacija novih tehnologija, zdravstvene organizacije, interdisciplinarni rad, kulturno-povijesna teorija aktivnosti, studije prakseSažetak
Implementacijom novih tehnologija u zdravstvu stvaraju se nove prakse, različite od tradicionalnih medicinskih postupaka. Znanstvena literatura smatra da su nove tehnologije često u suprotnosti s uobičajenim načinima liječenja te postaju prijetnja postojećim podjelama rada i odgovornosti između zdravstvenih djelatnika i njihovih medicinskih domena. Nadalje, smatra da tenzije i sukobi koji proizlaze iz tih kontradikcija usporavaju implementaciju novih tehnologija i procedura u zdravstvenim organizacijama. Ovaj članak, međutim, dovodi u pitanje takve pretpostavke, tvrdeći da su sukobi starih i novih praksi ili između praksi različitih medicinskih domena zapravo pokretači inovacija. Kulturno-povijesna teorija aktivnosti (Engeström, 1987; 2001; Blackler, 2009) promiče dijalektički pristup istraživanjima implementacije novih tehnologija u organizacije te tvrdi da nije nužan konsenzus između starih i novih, kao ni između domenski specifičnih praksi kako bi se uspješno implementirale nove tehnologije, uz uvjet zajedničkog cilja aktivnosti. Naprotiv, kontradikcije i napetosti između različitih načina rada smatraju se redovitim karakteristikama sustava aktivnosti pri uvođenju novih tehnologija u organizacije. U ovom članku predstavljaju se rezultati dugogodišnje studije slučaja bolnice koja je uvela novu tehnologiju imena TAVI (transkateterska ugradnja aortnog zaliska) u svoje kardiokirurške postupke. Novonastalom procedurom omogućeno je liječenje dotad inoperabilnih pacijenata koji boluju od stenoze aorte srčanog zaliska. Tijekom petogodišnjega etnografskog istraživanja njezine implementacije zabilježene su mnogobrojne kontradikcije i poteškoće u napretku ove inovacije. Primjenom kulturno-povijesne teorije aktivnosti na slučaj, uočene su različite kontradikcije za koje se isprva činilo da usporavaju njezin napredak. Međutim, ispostavlja se da je upravo iz njih nastala ekspanzija aktivnosti liječnika i transformacija liječenja stenoze aorte. Iako se iz studija slučaja ne mogu postavljati generalizacije, ovim se primjerom pokazuje korisnost upotrebe kulturno-povijesne teorije aktivnosti u istraživanjima modernizacije zdravstvenih organizacija. Stoga ovaj članak pridonosi razvoju novih teorijskih pristupa i metoda, pozivajući istražitelje i teoretičare implementacija novih tehnologija da preispitaju postojeća razumijevanja tih procesa.
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