Conceptualising Health Care Change: Regimes, Implements, Boundaries
The aim of putting knowledge and an understanding of its productive powers at the core of a sociological investigation of health care change presents a variety of challenges. How are we to acknowledge that health care systems are institutionally and economically embedded and yet suggest that knowledge plays a decisive role in articulating and maintaining these contexts? How are we to develop sensitive conceptual instruments to capture the dynamics of health care change without assuming the existence of an integrated, overarching or epochal transformation in the forms of reasoning that underpin practices and policies? How are we to account for conﬂ ict and divergence within those processes? As I argued in the previous chapter, a possible answer to this question would be to follow an analytical policy whereby the multiple reasons given to support or contest health care reforms or change become the very object of sociological enquiry. But the consequence of this foregrounding is that instead of looking at health care change as a coherent phenomenon that somehow could be captured by one single overarching concept or theory, we should instead attempt to build concepts that, as much as possible, capture the complexity and multiplicity of our object of enquiry. I suggested that this should be done by attending to the two interrelated analytical policies of developing concepts that capture the moral and cognitive dimension actors and groups mobilise, and exploring the socio-technical worlds that are assembled in processes of health care change.