The Duality of Articulation Work in Large Heterogenous Settings - a Study in Health Care

Based on an empirical study of articulation work in a health care setting this paper discusses core characteristics of articulation work in large settings. We argue that articulation work in large-scale settings is characterized by a dual nature, especially by a duality between articulation handled internally in a local work arrangement and articulation activities undertaken across boundaries of local work arrangements appears. We suggest that our understanding of articulation activities is related to a distinction between local and global work arrangements. We illustrate how cooperating actors involved in any given trajectory (e.g., a patient trajectory) have to articulate their activities in accordance with both a local and a global dimension. The distinction between local and global is important when aiming at understanding articulation work in large-scale heterogenous settings. The differences and their consequences are discussed. The paper conclude in some reflections on the challenges implied by the local/global variations, both for the analysis of large heterogeneous work settings and for design of IT support.