Modes of Orderings and Standardisation: Enacting medical and social conditions through care planning and record keeping within acute inpatient care and community care settings

This thesis investigates the relationship between objects and organisational forms, with particular reference to the transformation and enactment of clinical and administrative objects, practices and relations within NHS inpatient and community care settings. Through the use of an ethnographic style of enquiry this thesis investigates inpatient admission and discharge processes in the light of various health and social care practices, service commissioning issues, the Department of Health's initiative of the Care Planning Approach and other local electronic-based initiatives, and how this relates to the notions of “good” and “bad” practices, changing regimes of trust from practitioners to administrators, and from experts to documentary evidence. In particular, a range of narratives associated with mental health care which seek to provide a coordinating frame for different relations are reviewed. This involves exploring the attempts to link different information practices and ontologically distinct objects, and how this process relies on both multiplicity and singularity (e.g. both a sense of stability and heterogenous relations). Finally, this research examines how these mediating objects and processes in acute inpatient care settings seek to contribute to the creation of composite conditions and multiple bodies that fractionally relate to one another, but also the many problems experienced by those involved in the process of mental health care. In conclusion, this thesis explores several issues relating to specific organisational practices of care planning and record keeping, as well as broader questions of how objects are both enacted and enact practices in relation to complex modes of orderings and standardisation.