Dismembering organisation: The coordination of algorithmic work in healthcare

Abstract

Algorithms are increasingly being adopted in healthcare settings, promising increased safety, productivity and efficiency. The growing sociological literature on algorithms in healthcare shares an assumption that algorithms are introduced to ‘support’ decisions within an interactive order that is predominantly human-oriented. We present a different argument, calling attention to the manner in which organisations can end up introducing a nonnegotiable disjuncture between human initiated care work and work that supports algorithms, which we call algorithmic work. Drawing on an ethnographic study, we describe how two hospitals in England implemented an Acute Kidney Injury (AKI) algorithm and we analyse ‘interruptions’ to the algorithm’s expected performance. When the coordination of algorithmic work occludes care work, we find a ‘dismembered’ organisation that is algorithmically-oriented rather than human-oriented. In our discussion, we examine the consequences of coordinating human and non-human work in each hospital and conclude by urging sociologists of organisation to attend to the importance of the formal in algorithmic work. As the use of algorithms becomes widespread, our analysis provides insight into how organisations outside of healthcare can also end up severing tasks from human experience when algorithmic automation is introduced.