Realism, Causality and the Problem of Social Structure

Lewis, Paul A.

doi:10.1111/1468-5914.00129

Cited by 91 publications

(56 citation statements)

References 20 publications

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Section: Transcendental Realism and Social Naturalismmentioning

confidence: 97%

“…Social structure does not initiate activity and cause things to happen in the same way that people do (Lewis, 2000). This is not a standard ''efficient'' notion of causality (like billiard balls) as described by Aristotle (Groff, 2004;Lewis, 2000). This view replaces the overly deterministic notion of social structures as strings controlling a marionette with the metaphor of the rules of chess or the blueprint of a house (Groff, 2004, p. 110).…”

Section: Transcendental Realism and Social Naturalismmentioning

confidence: 99%

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Overcoming theory-practice inconsistencies: Critical realism and information systems research

Smith

2006

Information and Organization

134

104

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Section: Transcendental Realism and Social Naturalismmentioning

confidence: 97%

Section: Transcendental Realism and Social Naturalismmentioning

confidence: 99%

Overcoming theory-practice inconsistencies: Critical realism and information systems research

Smith

2006

Information and Organization

134

104

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“…Such social structure, understood as the internal and necessary relations between social positions and positioned-practices, gave rise to emergent causal powers as the material cause of social activity. [733][734][735] Perceived through our non-reductionist critical realist ontological stance, patient safety is, therefore, an emergent property of the micro-level organisation of health care. In examining the bureaucratisation and normalisation of the 1000 Lives + programme, together with the local implementation of the three focal interventions selected, the underpinning role of the MI-PDSA approach, depicted in Figures 2-11, was revealed.…”

Section: Mediation and Reflexive Theorisationmentioning

confidence: 99%

A realist analysis of hospital patient safety in Wales: applied learning for alternative contexts from a multisite case study

Herepath

Kitchener

Waring

2015

Health Serv Deliv Res

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BackgroundHospital patient safety is a major social problem. In the UK, policy responses focus on the introduction of improvement programmes that seek to implement evidence-based clinical practices using the Model for Improvement, Plan-Do-Study-Act cycle. Empirical evidence that the outcomes of such programmes vary across hospitals demonstrates that the context of their implementation matters. However, the relationships between features of context and the implementation of safety programmes are both undertheorised and poorly understood in empirical terms.ObjectivesThis study is designed to address gaps in conceptual, methodological and empirical knowledge about the influence of context on the local implementation of patient safety programmes.DesignWe used concepts from critical realism and institutional analysis to conduct a qualitative comparative-intensive case study involving 21 hospitals across all seven Welsh health boards. We focused on the local implementation of three focal interventions from the 1000 Lives+patient safety programme: Improving Leadership for Quality Improvement, Reducing Surgical Complications and Reducing Health-care Associated Infection. Our main sources of data were 160 semistructured interviews, observation and 1700 health policy and organisational documents. These data were analysed using the realist approaches of abstraction, abduction and retroduction.SettingWelsh Government and NHS Wales.ParticipantsInterviews were conducted with 160 participants including government policy leads, health managers and professionals, partner agencies with strategic oversight of patient safety, advocacy groups and academics with expertise in patient safety.Main outcome measuresIdentification of the contextual factors pertinent to the local implementation of the 1000 Lives+patient safety programme in Welsh NHS hospitals.ResultsAn innovative conceptual framework harnessing realist social theory and institutional theory was produced to address challenges identified within previous applications of realist inquiry in patient safety research. This involved the development and use of an explanatory intervention–context–mechanism–agency–outcome (I-CMAO) configuration to illustrate the processes behind implementation of a change programme. Our findings, illustrated by multiple nested I-CMAO configurations, show how local implementation of patient safety interventions are impacted and modified by particular aspects of context: specifically, isomorphism, by which an intervention becomes adapted to the environment in which it is implemented; institutional logics, the beliefs and values underpinning the intervention and its source, and their perceived legitimacy among different groups of health-care professionals; and the relational structure and power dynamics of the functional group, that is, those tasked with implementing the initiative. This dynamic interplay shapes and guides actions leading to the normalisation or the rejection of the patient safety programme.ConclusionsHeightened awareness of the influence of context on the local implementation of patient safety programmes is required to inform the design of such interventions and to ensure their effective implementation and operationalisation in the day-to-day practice of health-care teams. Future work is required to elaborate our conceptual model and findings in similar settings where different interventions are introduced, and in different settings where similar innovations are implemented.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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“…Examples of causal powers include water's capacity to extinguish fires and the capacity of a society where production is organised under the division of labour to produce higher levels of output than one not so characterised. For more on the notion of causal powers, see Sayer (1992: 104-116), Lawson (1997: 21-23) and Lewis (2000). 2 A 'mechanism' can be defined as a way of acting or working of a structured entity.…”

Section: Emergencementioning

confidence: 99%