Patient experience data as enacted: Sociomaterial perspectives and 'singular-multiples' in health care quality improvement research.

Over the last three decades, sociomaterial approaches to the study of health care practices have made an important contribution to the sociology of health care. Significant attention has been paid to the role of technology and artefacts in health care and the operation of actor-networks but less space has been given to questions of ontological multiplicity in health care practices. In this paper, we draw upon our study of patient experience data in five acute hospitals in England to illustrate how treating patient experience data as 'singular-multiples' can enable useful insights into patient experience data work in health care organisations. Our data was generated during 12 months of fieldwork at five participating hospitals and included organisational documents, field notes, informal and formal interviews with frontline and managerial staff and patient representatives at the study sites. We use the examples of the Friends and Family Test (FFT) and the National Cancer Patient Experience Survey (NCPES) in England to consider the multiple nature of data as it is enacted in practice and the work data does when coordinated as an entity in the singular. We argue that, and discuss how, the sociomaterial insights we discuss here are relevant to health care quality and improvement research and practice.

Enabling 'citizen voice' in the English health and social care system: A national survey of the organizational structures, relationships and impacts of local Healthwatch in England.

BACKGROUND: Local Healthwatch have been operating since 2013 as 'consumer champions' in health and social care in England. There is little evidence about how they operate and the daily practices through which they seek to represent citizen views and influence others. OBJECTIVE: To explore (a) the current organizational arrangements, relationships and impact of local Healthwatch in England, and (b) to what extent do these vary across local Healthwatch organizations. DESIGN: An online survey of all 150 local Healthwatch in England between December 2018 and January 2019. The survey comprised 47 questions and used a combination of closed- and open-response questions. RESULTS: We received responses from 96 local Healthwatch (68% response rate). Most local Healthwatch reported that they are 'independent' organizations that only do Healthwatch-related work (58.3%) and are funded through a contract (79.2%). Budget cuts have affected four-fifths of local Healthwatch (79.3%) since 2013. Three-quarters (74%) of local Healthwatch currently receive funding external to that provided by their local authority for their Healthwatch functions. Most Healthwatch engage with only one CCG (56.3%), one mental health trust (82.3%) and one community health trust (62.5%), though 59.4% engage with more than one hospital trust. Healthwatch respondents overwhelmingly reported impacts that were local in nature. CONCLUSIONS: Geographical and historical factors, the quality and quantity of their relationships with stakeholders, and different funding arrangements all contribute to high variability in the structure and activities of local Healthwatch and to shaping the nature of their work and impact across England.

Taking data seriously: the value of actor-network theory in rethinking patient experience data.

Hospitals are awash with patient experience data, much of it collected with the ostensible purpose of improving the quality of patient care. However, there has been comparatively little consideration of the nature and capacities of data itself. Using insights from actor-network theory, we propose that paying attention to patient experience data as having agency in particular hospital interactions allows us to better trace how and in what circumstances data lead (or fail to lead) to quality improvement.

"It was fun, it was dangerous": Heroin, young urbanities and opening reforms in China's borderlands.

BACKGROUND: An unprecedented flow of opiates flooded China's southern regions in the wake of the country's opening reforms in the 1980s. After the Maoist war on drugs had turned the People's Republic of China into an almost entirely drug-free area for three decades, heroin reappeared to become the most widely used illicit substance in the country. As the number of users rose by 1200% between 1988 and 1998, a generation of young people found themselves facing the consequences of addiction. METHODS: Based on ethnographic data collected during 13 months of field research among a community of heroin users in the county-level city of Qilin in Yunnan Province, this paper explores the interplay of historical and social factors that led southern China's young urbanities to turn to heroin in the 1980s and 1990s. Towards this end, it draws on a broad array of research methods including the collection of life histories, extensive participant observation, and focus groups among the members of Qilin's local community of heroin users. RESULTS: I argue that the spread of heroin among southern China's young urbanities should be read as the aggregate outcome of such seemingly disparate factors as the opening of new global routes for the trafficking of opiates, the almost complete lack of Chinese public discourse around drugs in the immediate post-Mao period, the increased individualization of young people's ambitions, desires and forms of socialization, and the rise of a consumerist market economy in the country. CONCLUSIONS: Based on the data collected, I claim that the boom in the diffusion of heroin use in post-reform China cannot be described exclusively as a matter of deviant individual behaviours. Rather, it has to be interpreted as a complex social act, which is only understandable when framed within the social and historical context in which it was performed.