Dismembering Organisation: How Medical Algorithms Are Remaking the Human in Healthcare

Algorithms are increasingly being adopted and implemented within the English National Health Service, promising increased safety, productivity and efficiency in the delivery of health care. Following Berg (1997), medical sociological literature on algorithms often conceptualises these technologies as ‘decision support’ (e.g. Peiris et al., 2011). More recent work makes a corresponding move in analysing the meaning-making practices of algorithmic data users (e.g. Maiers, 2017). Both kinds of analyses involve a coupling of the algorithmic world with the social world of medical practices, and proceed according to the negotiations involved in making this coupling ‘work’ (Turnbull et al., 2017). By building upon analyses of financial algorithms, we present a slightly different argument, calling attention to the essential and non-negotiable disjuncture between the algorithmic and the social, and the consequent need for a reconsideration of the forms of human agency available within health care organisations.

We build our argument with ethnographic data from a study across two hospitals of the implementation of an algorithm that aims to identify cases of acute kidney injury (AKI). By analysing the differences between the approach taken in each hospital to implement the algorithm, we juxtapose two problematisations of the concept of ‘algorithmic work’, in which the technological and social worlds are coupled. We then draw upon ‘interruptions’ in the smooth flow of the algorithm within each setting in order to highlight the ‘dismembered’ (Lenglet, 2013) organisational state that constitutes the ideal expression of this technology. In discussion, we draw lessons from our data for rethinking extant conceptions of the technological and social, which, we argue, are remaking both the caring and the cared-for human. As the use of algorithms becomes widespread, sociologists of organisation may find our analysis helpful for understanding how organisations split tasks from human experience in the automation of work.