Modelling of the Patient Care Process: a Two-Way Journey from a Hospital Case Study to Ontological, Epistemological and Methodological Challenges

At the start of an empirical study into the patient care process (PCP) a number of ontological, epistemological and methodological challenges were identified. The PCP appeared to be an “objective”, manageable, reality which is carried out by individuals with their own “subjective” understanding of the process, its purposes, organisational constraints and their roles. The dual perception of the PCP has called for establishing and defending a philosophical foundation for cross-paradigmatic research, i.e. the research that can combine analytic techniques such as modelling, with non-positivist methods suitable for describing the dynamics and complexities of the social world from the perspective of human actors. “Subtle realism” offers an alternative to the ontological and epistemological dichotomy of positivist and non-positivist frameworks and allows the researcher to apply methods of ethnographic research without abandoning the commitment to arrive at a plausible account of objective reality. Cross-paradigmatic methods, though not entirely new in IS research, are still considered contradictive. In this article we argue that methodology based on the philosophical assumptions of “subtle realism” justifies the use of a mix-method approach, where ethnography is combined with highly structured modelling techniques. Resolving ontological and epistemological challenges is the first step towards developing a research method that will potentially bridge the gap between the formal, context-insensitive language used by systems analysts, and the informal, textual representation of socially situated data.