An Information Ecology Structured by a Nexus between Accreditation and Practice: Boundary Objects, Brokers and Translation across the Boundaries of Standards Compliance and Practice-Oriented Work

BreastScreen Tasmania (BST) is a health service organisation with a complex information ecology dominated by information integration and work practice standardization embodied in the client record. The client record is oriented to provide evidence of organization-level standards compliance. Client record data is also used to support professional practice specific communication, the coordination of multidisciplinary breast screening practices and client-specific decision-making. The paper illustrates how the client record is a boundary object structured by a nexus between accreditation and practice. This nexus is the impetus for broker roles and boundary object design efforts to manage the different requirements and meanings of information in BST. The findings highlight how despite the full integration of the information systems design to support accreditation and practice, disjunctions occur that require considerable human activity to coordinate, explain, align and prioritize meanings. These meanings have significant ethical and moral implications for the nature of breast screening services.