Learning in clinical practice: findings from CT, MRI and PACS

Sinozic, Tanja (2014) Learning in clinical practice: findings from CT, MRI and PACS. Doctoral thesis (PhD), University of Sussex.

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This thesis explores learning in clinical practice in the cases of CT, MRI and PACS in
UK hospitals. It asks the questions of how and why certain evolutionary features of
technology condition learning and change in medical contexts.
Using an evolutionary perspective of cognitive and social aspects of technological
change, this thesis explores the relationships between technology and organisational
learning processes of intuition, interpretation, integration and institutionalisation.
Technological regimes are manifested in routines, skills and artefacts, and dynamically
evolve with knowledge accumulation processes at the individual, group and
organisational levels. Technological change increases the uncertainty and complexity of
organisational learning, making organisational outcomes partially unpredictable.
Systemic and emergent properties of medical devices such as CT and MRI make
learning context-specific and experimental. Negotiation processes between different
social groups shape the role and function of an artefact in an organisational context.
Technological systems connect artefacts to other parts of society, mediating values,
velocity and directionality of change. Practice communities affect how organisations
deal with this complexity and learn. These views are used to explore the accumulation
of knowledge in clinical practices in CT, MRI and PACS.
This thesis develops contextualised theory using a case-study approach to gather novel
empirical data from over 40 interviews with clinical, technical, managerial and
administrative staff in five NHS hospitals. It uses clinical practice (such as processes,
procedures, tasks, rules, interpretations and routines) as a unit of analysis and CT, MRI
and PACS technology areas as cases. Results are generalised to evolutionary aspects of
technological learning and change provided by the framework, using processes for
qualitative analysis such as ordering and coding.
When analysed using an evolutionary perspective of technology, the findings in this
thesis suggest that learning in clinical practice is diverse, cumulative and incremental,
and shaped by complex processes of mediation, by issues such as disease complexity,
values, external rules and choice restrictions from different regimes, and by interdisciplinary
problem-solving in operational routines.

Item Type: Thesis (Doctoral)
Schools and Departments: School of Business, Management and Economics > SPRU - Science Policy Research Unit
Subjects: R Medicine > R Medicine (General) > R895 Medical physics. Medical radiology. Nuclear medicine
R Medicine > RC Internal medicine > RC0071 Examination. Diagnosis Including radiography
Depositing User: Library Cataloguing
Date Deposited: 28 Jul 2014 08:11
Last Modified: 24 Sep 2015 14:35
URI: http://srodev.sussex.ac.uk/id/eprint/49367

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