organizational forgetting and the production of knowledge

8/10/2019 Organizational Forgetting and the Production of Knowledge

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Lest we remember: organizational forgetting and the production of knowledge

Geoffrey C. Bowker

Graduate School of Library and Information Science

University of Illinois at Urbana-Champain

Introduction - Well do I remember...

!I remember that I had a typical "nlish rammar school education from aes ##-#$% afterwhich time the family emirated to &ustralia!. 'his is a kind of reminiscence we can all relateto% but it is clearly problematic% in my case% with respect to the issue of the truth about the

past. It is a memory laden with my present understandin of the cateory ("nlish education)%which feeds partly at least off the filmIf about "nlish private schoolin% and so which(should) not be relevant. *urthermore% I saw the film some years after I left "nland and

school both. So the framework that contains% in some sense% my memories of what it was likein those years could not possibly have e+isted at the time that I e+perienced them. It may still

be a valid and useful framework, however it almost certainly helps me to remember someparts of my life which make me like alcolm ac/owell in the film0 and foret others lessheroic and less nihilistic0.

1ecall is in eneral a problematic concept% even when we can assume that people are tryin totell the truth about the past. Studies of people)s intensely remembered (flashbulb memories)what were you doin at the time that 2ennedy was assassinated0 have proved them to beoften false Brown and 2ulik% #3450. 6ohn /ean claimed fairly total recall at the time of7aterate - but as Ulric 8eisser points out throuh analysis of the tapes made in the 9val9ffice he remembered neither conversations% nor even ists of conversations - but rather anideal set of possible conversations which encoded his perceived truth of the situation and hisfantasies about his own role therein 8eisser% #345, but see the e+cellent criti:ue in "dwardsand ;otter% #335#0. ;eople cannot remember accurately how they felt in the past< they take the

present as a benchmark and then work from a currently held belief about chane or stability intheir attitudes< thus when asked how you felt si+ months ao about% say% a '= series% yourmemory will necessarily be colored by what has happened since in that series Linton% #3450.If all history is history of the present% then one miht surely think of memory as ineluctably aconstruction of the present. 'hese studies from conitive science suest that truth or falsity isnot a simple concept when it comes to analy>in orani>ational memory in science or

elsewhere cf ?ackin% #33@% Chapter #A - on the indeterminacy of the past0. 'hus Bannonand 2uutti% #33 stress that if (orani>ational memory) is at all a useful concept% it is so to thee+tent that it refers to active rememberin which carries with it its own conte+t - so that itcomes in the form not of true or false facts but of multifaceted stories open to interpretation.

8eisser #3450% buildin on 'ulvin)s famous distinction between episodic and semanticmemory rememberin what vs rememberin how0 introduces a third kind of memory -(repisodic memory) rememberin what was really happenin0. &ainst this increasindifferentiation and speciali>ation in the concept of memory% we find a sinle andundifferentiated definition of (forettin) - it is (not rememberin). *urther% forettin in all itsuises has fre:uently been seen as necessarily a problem. *reud encouraed the recall of

suppressed memories see ?ackin% #33@ for a discussion of memory and veracity in *reud0.?istorians insist that we must learn the lessons of the past. DrEo "nestrom% in his memorable
http://weber.ucsd.edu/~gbowker/forget_fn.html#fn0http://weber.ucsd.edu/~gbowker/forget_fn.html#fn0


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paper on (orani>ational forettin) #3440 discusses problems raised by the ways in whichdoctors foret, thouh his activity theoretical perspective on the oranic links betweeninternal and e+ternal memory traces is particularly fruitful in that it provides a model forethnoraphic studies of collective memory. Bitner and Garfinkel #3A0 are amon the few toobserve and describe an ecoloy of forettin% in their account of (ood) orani>ational

reasons for (bad) clinical records).

'otal recall% in individuals or orani>ations% is neither desirable nor possible. 1ecent work inorani>ational theory has suested that perhaps it is ood on occasion to foret everythinabout the past% in order to start over without bein trapped in old routines 7ackers% #33@0.'here are indeed several ood reasons for orani>ations to foret thins about their own past.*irst% it miht be the case that rediscovery is easier than rememberin% especially where theoverhead of constructin a sufficiently precise archive so that a fine-rained situation can beremembered is hih. 'hus in order to remember down to the level of detail that the "nlishemployees miht not understand (>) when pronounced (>ee) one would need an immensearchive surely unnecessary for a telephone company but perhaps vital for a nuclear power

plant where :uick interpretation of a loudspeaker broadcast of (F-&lpha-9ne) miht havesafety conse:uences. Secondly% e+tendin Chandler #3AA0% one can see the development ofstatistics as a filterin mechanism that allows a central office not to have to remembereverythin about a company)s day to day runnin in order to make thins run smoothly< thefilterin works as proactive forettin. & third positive mode of forettin is when anorani>ation wants to chane its identity. In such a case the arument that (we have alwaysdone thins this way) stands in the way of breakin new round. ?uhes #343 #44H0described the chane at 1uby school under &rnold in this liht% showin &rnoldimperceptibly chanin the way thins were done in such a way that roup memory wasnever mobili>ed aainst the chanes. In eneral% if memory is bein used as a tool ofreification or proEection then it can have harmful conse:uences.

'his paper is about how orani>ations foret thins selectively about the past in the process ofproducin knowlede. I shall arue that there are two maEor kinds of orani>ational forettinin the process of producin and then maintainin classification systems in the workplaceation to

move from heteroeneous forms of memory operatin within multiple frameworks to theprivilein of a form of memory potential memory0 operatin within a well-definedinformation infrastructure subtended by classification systems. I shall demonstrate that in this

process% the decision of whether to opt in to an infrastructure% with its attendant memoryframes and modes of forettin% or to stay out of it% is of reat political and ethical import . Ishall firstly follow this set of aruments throuh with respect to a case study of thedevelopment of a classification of nursin work% and will then broaden the discussion out tomore eneral considerations of classification and memory.

Part 1 - Nursing classifications and organizational forgetting

'he common thread for this part will be an analysis of the ways in which a nursin roup inIowa city is classifyin nursin work. 8ursin is particularly interestin with respect to


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forettin% since nursin work has traditionally been invisible and removed at the earliestopportunity from the medical record. In the #344% a roup was formed in the Collee of

8ursin at the University of Iowa to create what they call a 8ursin InterventionsClassification - henceforth 8IC cCloskey and Bulechek% #330% see /iaram # and/iaram 5. 'here was already in place a somewhat badly maintained classification system for

nursin dianoses which is to say what specific nursin needs a iven patient had0, but therewas no standardi>ed lanuae for describin what it was that nurses did. 'he roup publisheda first edition of their system in #335% and a revised and e+panded version came out in #33.

In eneral% nursin has not been able as an institution to draw on an active memory. 1ather%nursin has been seen as an intermediary profession that does not need to leave a trace. &snursin informatician Castles notes% citin ?uffman on medical records manaement< &thenursin records are the first to be pured from the patient records, there is thus no lastindocumentation of nursin dianoses or nursin interventions and no method of storae andretrieval of nursin data. Castles% #34#% p.$50

8IC itself is a fascinatin system. 'hose of us studyin it see it as an ethnomethodoloicalnirvana. Some cateories% like bleedin reduction - nasal% are on the surface relatively obviousand codable into discrete units of work practice to be carried out on specific occasions. Butwhat about the e:ually important cateories of hope installation and humor see /iaram H0?ope installation includes the subcateory of (&void maskin the truth). 'his is not so muchsomethin that nurses do on a reular basis% as somethin that they should not do constantly.It also includes< (?elp the patient e+pand spiritual self). ?ere the contribution that the nurse ismakin is to an implicit lifelon proram of spiritual development. 7ith respect to humor% thevery definition of the cateory suests the operation of a paradim shift< !*acilitatin the

patient to perceive% appreciate% and e+press what is funny% amusin% or ludicrous in order toestablish relationships!, and it is unclear how this could ever be attached to a time line< it issomethin the nurse should always do while doin other thins. *urther% contained within thenursin classification is an anatomy of what it is to be humorous% and a theory of what humordoes. 'he recommended procedures break humor down into subelements. 9ne shoulddetermine the types of humor appreciated by the patient, determine the patient)s typicalresponse to humor e.. lauhter or smiles0, select humorous materials that create moderatearousal for the individual for e+ample (picture a forbiddin authority fiure dressed only inunderwear)0, encourae silliness and playfulness and so on to make a total of fifteen sub-activities< any one of which miht be scientifically relevant. & feature traditionally attached tothe personality of the nurse bein a cheerful and supportive person0 is now attached throuhthe classification to the Eob description as an intervention which can be accounted for.

'he Iowa roup% the kernel of whom were teachers of nursin administration% madeessentially three aruments for the creation of a nursin classification. *irst% it was arued thatwithout a standard lanuae to describe nursin interventions% there would be no way of

producin a scientific body of knowlede about nursin. 8IC in theory would be articulatedwith two other classification systems< 89C the nursin sensitive patient outcomesclassification scheme0 and 8&8/& the nursin dianosis scheme0. 'he three could worktoether thusly. 9ne could perform studies over a set of hospitals employin the threeschemes in order to check if a iven cateory of patient responded well to a iven cateory ofnursin intervention. 1ather than this comparative work bein done anecdotally as in the pastthrouh the accumulation of e+perience% it could be done scientifically throuh the conduct of

e+periments. 'he Iowa Intervention proEect made up a Einle< 8&8/&% 8IC and 89C to thetune of ?ickory% /ickory% /ock to stress this interrelationship of the three schemes. 'he


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second arument for classifyin nursin interventions was that it was a key stratey fordefendin the professional autonomy of nursin. 'he Iowa nurses are very aware of theliterature on professionali>ation - notably Schon #34H0 - and are aware of the force of havinan accepted body of scientific knowlede as their domain. Indeed &ndrew &bbott% takin ashis central case the professionali>ation of medicine% makes this one of his key attributes of a

profession.0 'he third arument was that nursin% alonside other medical professions% wasmovin into the new world of computers. &s the representational medium chaned% it wasimportant to be able to talk about nursin in a lanuae that computers could understand see/iaram $0 - else nursin work would not be represented at all in the future% and would risk

bein even further marinali>ed than it was at present.

Forgetting 1 - Clearance

Grand Historiograper! "ima #in $1%%& 'ca 1(()C*+! ,riting of te burning of te boos in

1/)C! notes tat te Cief 0inister adised te emperor tat2 3all ,o possess literature

suc as te "ongs! te 4ocuments! and te sayings of te undred scools sould get rid of it

,itout penalty. If tey ae not got rid of it a full tirty days after te order as reacedtem! tey sould be branded and sent to do forced labor on te ,alls. tere sould be

e5emption for boos concerned ,it medicine! parmacy! diination by tortoise-sell and

milfoil! te so,ing of crops! and te planting of trees $/1+. In response to tis! te 6mperor

ordered te famous burning of te boos - to cite #in2 3te First 6mperor collected up and

got rid of te "ongs! te 4ocuments! and te sayings of te undred scools in order to mae

te people stupid and ensure tat in all under Heaen tere sould be no re7ection of te

present by using te past. 8e clarification of la,s and regulations and te settling of statutes

and ordinances all stared ,it te First 6mperor. He standardized documents. $/1+.

'here was a primitive act of clearance in the establishment of 8IC. By clearance% I mean acomplete wipin away of the past of nursin theory in order to start with a clean slate - muchas the first cultivators burned the forest to create land suitable for tillin in ordered rows I amdrawin here on Serres) #33H0 work on clearance and oriins in eometry0. 'he nurses saidthat until now there had been no nursin science and therefore there was no nursinknowlede to preserve. 'here is% one nursin informatician ruefully noted< &It is reconi>edthat in nursin% overshadowed as it is by the rubrics of medicine and reliion% no nurse since

8ihtinale has had the reconi>ed authority to establish nomenclature or procedure by fiat.'here are no universally accepted theories in nursin on which to base dianoses% and% in fact%independent nursin functions have not yet ained universal acceptance by nurses or bymembers of other health professions!. Castles% #34#% $J0 8ursin% it was arued% had until

now been a profession without form, nothin could be preserved. 'here was no way of codinpast knowlede and linkin it to current practice - it was noted at a conference to establish astandardi>ed nursin minimum data set information about nursin practice that would becollected from every care facility0 that< !'he lists of interventions for any one condition arelon partially because nursin has a brief history as a profession in the choosin ofinterventions and lacks information for decision-makin. &s a profession% nursin has failedto set priorities amon interventions, nurses are tauht and believe they should do everythin

possible!. cCloskey and Bulechek% #335% A30

In the face of this view of the nurse as the inlorious other - doin everythin that nobody elsedoes - should all previous nursin knowlede be abandoned 7illiam Cody% in an open letter

to the Iowa Intervention 'eam published in 8ursin 9utlook in #33@ chared that this wasprecisely what would follow from widespread adoption of 8IC< &It would appear that the


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nursin theorists who ave nursin its first academic le to stand on% as it were% aredeliberately bein fro>en out. I would like to ask /rs cCloskey and Bulechek% 7hy is thereno substantive discussion of nursin theory in your article ?ow can you advocatestandardi>in )the lanuae of nursin) by adoptin the lanuae of only one paradim ?owdo you envision the relationship between the )standardi>ed) masses and those nurse scholars

with differin views Cody% #33@% 3H0. 'he ;roEect team responded that indeed clearance wasan issue< &the Iowa roup contends that ta+onomic development represents a radical shift intheory construction in which the rand conceptual models are not debated% but transcended.7e believe that% as a scientific community% nursin has moved to the point of abandonin theconceptual models of nursin theorists as formin the science base of the disciplinecCloskey% Bulechek and 'ripp-1eimer% #33@% 3@0.

It is not Eust at the level of nursin theory that this act of clearance is seen as unsettlin.;racticin nurses implementin 8IC at one of four test bed sites have complained thatlearnin to use 8IC toether with the new computer system it is embedded in is like oin toa forein country where you have to speak the lanuae, and to make matters worse you have

to o to a new country every day. ore prosaically% they say that they feel they are oin frombein e+perts to novices5'he arument was made that :uite simply there has been no workdone in the past< &'he discipline of nursin has not yet constructed a cohesive body ofscientific knowlede 'ripp-1eimer et al% #33% p.50. ?owever% there is a comple+ity here thatoften arises in connection with the stratey of clearance. 9ne wants to be able to say thatnurses no,do somethin which is valuable and adaptable to scientific principles, while at thesame time maintain that nurses have not yet until the development of the classificationsystem0 been able to develop any nursin theory and thence any systematic% scientificimprovement in practice. 'his same article% on the dimensional structure of nursininterventions% tackles this problem directly. 'ripp-1eimer arues that there must be a cycle offorettin in the development of the new classification scheme. 'he article beins with a:uote from Chun '>uations that characteri>e information statistics% it was asserted% in a book onne+t-eneration nursin information systems% that 5$ percent of total hospital operatin costswere devoted to information handlin. 8ursin% it is stated% & accounted for most of theinformation handlin costs 54 percent to H$ percent of nurses) time0, and what is worse% &inrecent years% e+ternal reulatory factors% plus increasin orani>ational and health carecomple+ity% have aumented the central position of information in the health care

environment.! Fielstorff et al.% #33H% @0 'he nursin profession acts as a distributed memorysystem for doctors and hospital administrators but in so doin is denied its own officialmemory.

"ven when the erasure is not mandated% it has been voluntary. 9ne te+t on a nursinclassification system cites as a motif of the profession an observation that< &)'he subEect ofrecord-keepin has probably never been discussed at a convention without some aitatednurse arisin to ask if she is e+pected to nelect her patients in order to write downinformation about them. ....) artin and Scheet% #335% 5# - echoin a #3#A source0. &nd6oanne cCloskey% one of the two principal architects of 8IC notes that< &...the mostconvincin arument aainst nursin service or 2arde+ care plans is the absence of them.&lthouh written care plans are a re:uirement by the 6oint Commission for ?ospital&ccreditation and a condition for participation in edicare% few plans are% in fact% written.cCloskey% #34#% #5J0. In her maisterial study of the International Classification of/iseases% &nn *aot-Lareault #3430 notes the same reluctance on the part of doctors tospend time accurately fillin in a death certificate itself a central tool for epidemioloists0when they miht be helpin live patients. 'hus there is% in "nestrom)s #3440 terms% a block

between internal memory and e+ternal memory< because representational work takes time% theform fillers systematically erase comple+ representations that they hold in their heads in favorof summary ones - in the case of the IC/ there are many complaints because of the overuse ofeneral disease terms or (other) cateories, in the case of a computeri>ed 8IC% nurses are

suspected by the 8IC implementation team of usin the choices that appear before them on ascreen which they can elect with a liht pen0 rather than searchin throuh the system for theapt descriptor.

9ne of the main problems that the nurses have is that they are tryin to situate their activityvisibly within an informational world which has both factored them out of the e:uation andmaintained that they should be so factored - since what nurses do can be defined precisely asthat which is not measurable% finite% packaed% accountable. In nursin theorist 6enkins) termsational aents compare here7oolar% #33@% #H0. It is difficult to e+press the fact that the representation can have differentmeanins at different times and places in the orani>ation in a lanuae which has been usedrather to demonstrate the conEurin of a sinle articulation of (fact). 'he act of rememberin afact orani>ationally involves not only mobili>in a set of black-bo+ed allies in Latour)sterms0 but also translatin from the conte+t of storae to the present situation one miht storea fact for reason + but recall it for reason y0. *urther% within an orani>ational conte+t it iseasier to e+plore the distribution of memory and forettin than the distribution ofrepresentation. *inally% there it is always a temptation when talkin of representation to fallinto a conitivist trap of assumin the primacy of the conitive act. By concentratin on(followin the actors)% socioloists of science have as a rule produced a lanuae which

privilees the scientific (fact) and its circulation and which puts the infrastructure supportinthat fact relatively into the backround what oes on inside the black bo+% or indeed what

black bo+es look like% is seen as irrelevant0. *rom the perspective of orani>ational memory% amodality can be deleted in a number of different ways< it miht be distributed held in another

part of the orani>ation than in that which produces the te+t0, built into the infrastructure thework environment is chaned such that the modality is never encountered0, or simplydismissed. Lookin at ways of distributin memory and operatin forettin we can%therefore% look in more fine-rained detail at what happens as the representation moves intoand out of circulation.

Clearance is a stratey employed internally within the profession of nursin as a tool forprovidin an oriin for the science of nursin, erasure is employed e+ternally on theprofession of nursin as a tool for renderin nursin a transparent distributed memory system.'he loic of the relationship between clearance and erasure has been that the nurses areoperatin the clearance of their own past in order to combat the erasure of their present in therecords of medical orani>ations. edical information systems% they arue% should representthe profession of nursin as if it Eust bean yesterday - for otherwise they will copy thetransparency of nursin activity from one representational space the hospital floor and paperarchives0 to another the electronic record0. 'his poses% then% the :uestion of what happenswhen a new ecoloy of attention what can be forotten and what should be remembered0 is

inauurated with the development of a new information infrastructure.


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Forgetting! classification and potential memory

>ames Fentress and Cris Wicam $1%%! 1/+! in a ,or reminiscent of Frances ?ates:

$1%@@+! argue tat artificial memory systems ,ent on te ,ane after 4escartes2 3Instead of a

searc for te perfectly proportioned image containing te :soul: of te no,ledge to be

remembered! te empasis ,as on te discoery of te rigt logical category. 8e memory oftis system of logical categories and scientific causes ,ould e5empt te indiidual from te

necessity of remembering eeryting in detail. ... 8e problem of memorizing te ,orld!

caracteristic of te si5teent century! eoled into te problem of classifying it scientifically.

emory - individual and orani>ational - is in eneral filtered throuh a classification system%which permits encodin of multiple bits of information about the environment into a sinlecoherent framework see Schachter% #33< 34-#HH0. "douard ClarapKde who performed theinitial notorious e+periment of havin a straner rush into the classroom% do somethinoutraeous% and then have students describe what happened0 noted as early as #3JA that< !thatthe past - even of a simple event - was less a record than a sort of ta+onomy. 8ot perceptions%

but cateori>ation of familiar types was the maEor function of memory! cited in atsuda%#33< #J30.

&ny information infrastructure to an orani>ation - paper or electronic, formal or informal -claims by its nature to contain all and only the information that is needed for the smoothrunnin of the orani>ation. 9rani>ations fre:uently want to know everythin relevant aboutsome past action. *or e+ample if there is a black-out alon in the 7est due to a tree fallin inIdaho% an awful amount of information needs to be recalled in order for the connection to bemade. *re:uently% a prime function of record keepin in the orani>ation is to keep track ofwhat is oin on such that% should anyone ever want to know auditors% a commission ofin:uiry and so forth0 a complete reconstruction of the state of the orani>ation at a particularmoment can be made. *or e+ample ?utchins #33@< 5J0 talks about the role of the los kept

by navy ships of all their movements< !&board naval vessels records are always kept -primarily for reasons of safety% but also for purposes of accountability. Should there be aproblem% the crew will be able to show e+actly where the ship was and what it was doin atthe time of the mishap!. ?owever% in order for somethin to be remembered officially by anorani>ation it must be recorded on a form, and forms necessarily impose classificationsystems Ber and Bowker% forthcomin0. 'he reconstruction will not cover literallyeverythin that was oin on at a particular moment% but only thins that fit into theorani>ation)s accepted classification scheme of relevant events. I shall refer to the kind ofmemory that is encoded in an orani>ation)s files for the purposes of a possible future

reconstruction as (potential memory). I am usin the word (potential) to draw attention to thedistributed% mediated nature of the record< no one person remembers everythin about amedical intervention, and enerally it can be processed throuh an orani>ation without everhavin been recalled. ?owever% there is a possible need to recall any one intervention in huedetail< and the only way that the possible need can be met is throuh the construction of aclassification system which allows for the efficient pieon-holin of facts.

7ithin the hospital% nursin work has been deemed irrelevant to any possible futurereconstruction, it has been canonically invisible% in Star)s #33#0 term. 'he loic of 8IC)sadvocators is that what has been e+cluded from the representational space of medical practiceshould be included.


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nursin practice reconi>ed by 8IC can be coded on the forms fed into a hospital)s computersor stored in a file cabinet.

8ursin informaticians aree as a body that in order for proper healthcare to be iven and fornurses to be reconi>ed as a profession% hospitals as orani>ations should code for nursin

within the framework of their memory systems< nursin work should be classified and formsshould be enerated which utili>e these classifications. ?owever% there has been disareementwith respect to stratey.

'o understand the difference that has emered% recall one of those forms you have filled inwe have all e+perienced one0 which do not allow you to say what you think. Dou may% in astandard case% have been offered a choice of several racial oriins, but may not believe in anysuch cateori>ation. 'here is no room on the form to write an essay on race identity politics.So you either you make an uncomfortable choice in order to et counted% and hope thatenouh of your comple+ity will be preserved by your set of answers to the form, or you don)tanswer the :uestion and perhaps decide to devote some time to lobbyin the producers of the

offendin form to reconsider their cateori>ation of people. 'he 8IC roup has wrestled withthe same strateic choice< fittin their classification system into the ;rocrustean bed of all theother classification systems that they have to articulate with in any iven medical settin inorder to form part a iven orani>ation)s potential memory, or reEectin the ways in whichmemory is structured in the orani>ations that they are dealin with. 7e will now look in turnat each of these strateies.

Let us look first at the arument for includin 8IC within the potential memory framework ofthe hospital. 'hey arue that 8IC has to respond to multiple important aendassimultaneously. Consider the followin litany of needs for a standard vocabulary of nursin

practiceed nomenclature of nursin dianoses in order to namewithout ambiuity those conditions in clients that nurses identify and treat without

prescription from other disciplines, such identification is not possible without areement as tothe meanin of terms. ;rofessional standards review boards re:uire discipline-specificaccountability, some urency in developin a discipline-specific nomenclature is provided bythe impendin 8ational ?ealth Insurance leislation% since demands for accountability arelikely both to increase and become more strinent followin passae of the leislation.&doption of a standardi>ed nomenclature of nursin dianoses may also alleviate problems incommunication between nurses and members of other disciplines% and improvement in

interdisciplinary communication can only lead to improvement in patient care.Standardi>ation of the nomenclature of nursin dianoses will promote health care deliveryby identifyin% for leal and reimbursement purposes% the evaluation of the :uality of careprovided by nurses, facilitate the development of a ta+onomy of nursin dianoses, providethe element for storae and retrieval of nursin data, and facilitate the teachin of nursin by

providin content areas that are discrete% inclusive% loical% and consistent . Castles% #34#% H40

I have cited this passae at lenth since it unites most of the motivations for the developmentof 8IC. 'he development of a new information infrastructure for nursin% heralded in this

passae% will make nursin more (memorable). It will also lead to a clearance of past nursinknowlede - henceforth prescientific - from the te+tbooks, it will lead to chanes in the

practice of nursin a redefinition of disciplinary boundaries0 - a shapin of nursin so thatfuture practice converes on potential memory.


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any nurses and nursin informaticians are concerned that the profession itself may have tochane too much in order to meet the re:uirements of the information infrastructure. 7emurder% they note% to dissect. In her study of nursin information systems in *rance% Ina7aner #33H0 speaks as follows of the amble of computeri>in nursin recordsedthrouh the use of computer systems is the interation of manaement criteria into the

practice of nursin.

She continues< &7orkin with a patient classification system with time units associated witheach care activity enforces a specific time discipline on nurses. 'hey learn to assess patients)needs in terms of workin time.H'his analytic perspective is shared by the Iowa nurses.

'hey arue that documentation is centrally important, it not only provides a record of nursinactivity but structures sameations they deal with. 'hey have adopted a Batesonian stratey ofrespondin to the threat of the new information infrastructure by movin the whole arumentup one level of enerality and tryin to supplant (data-driven) cateories with cateories thatreconi>e process on their own terms. 'hus the Iowa team pointed to the fact that women

physicians often spend loner with patients than male doctors% but they need to see patientsless often as a result< they arue that Eust such a process-sensitive definition of productivityneeds to arued for and implemented in medical information systems in order that nursinwork ets fairly represented II; 43@0. 'hey draw from their secret because unrepresented0reservoir of knowlede about process in order to challene the data-driven models fromwithin.

7ithin this stratey% the choice of allies is by no means obvious. Since with the developmentof 8IC we are dealin with the creation of an information infrastructure% the whole :uestionof how and what to challene becomes very difficult. Scientists can only% willy nilly% deal withdata as presented to them by their information base% Eust as historians of previous centuries

must% alas% rely on written traces. 7hen creatin a new information infrastructure for an oldactivity% :uestions have a habit of runnin away from one< a technical issue about how to code

process can become a challene to orani>ational theory and its database0. & defense ofprocess can become an attack on the scientific world view. 9ne of the chief attacks on the8IC scheme has been made by a nursin informatician% Susan Grobe% who believes that ratherthan standardi>e nursin lanuae computer scientists should develop natural lanuae

processin tools so that nurse narratives can be interpreted. Grobe arues for the abandonmentof any oal of producin< & a sinle coherent account of the pattern of action and beliefs inscience Grobe% #335% 350, she oes on to say that< &philosophers of science have lonacknowleded the value of a multiplicity of scientific views! 350. She e+coriates Bulechekand cCloskey% architects of 8IC% for havin produced work< &derived from the naturalscience view with its hierarchical structures and mutually e+clusive and distinct cateories.3H0. She on the other hand is drawin from conitive science% library science and socialscience 3$0. 9r aain% a recent paper on conceptual considerations% decision criteria anduidelines for the 8ursin inimum /ata Set cited *ritEof Capra aainst reductionism% Steven6ay Gould on the social embededness of scientific truth and praised *oucault for havindeveloped a philosophical system to &rapple with this reality 2ritek% #344% 5$0. 8ursescientists% it is arued% &have become :uite reductionistic and mechanistic in their approach toknowlede eneration% at a time when numerous others% particularly physicists% are reversinthat pattern 5A0. &nd nursin has to find allies amonst these physicistsation% the 8IC team will have one alon way to ensurin the future of nursin.

Part - Classification systems2 potential memory and forgetting

'hree social institutions% more than any others% claim perfect memory< the sister institutions ofscience% the law and reliion. 'he leal and clerical professions claim perfect memory throuhan intricate set of reference works which can be consulted for precedence on any current case.

'he applicability of past to present is a matter of constant concern< arued in the law courts orin theoloical disputes. Scientific professionals% thouh% tend to claim that by its very naturescience displays perfect memory< and they structure their recall primarily throuh a myriad ofclassification systems that ives them a vast reserve of potential memory scientific articlesare in principle - thouh never of course in practice - coded in such a way that an e+periment

performed one day in &leria can be entirely replicated a hundred years later in &fhanistan0.7e will now o on to draw some more eneral conclusions about the ways in whichclassification systems structure memory within orani>ations% takin as a chief e+ample thenature and operation of classification systems in science. 'here are two maEor reasons forchoosin the institution of science for our wider discussion - the 8IC development teamclaims to be renderin nursin scientific% and so these wider e+amples develop naturally outof ;art # above, and classification work has been more formali>ed in science than in otherinstitutions

It can readily be accepted that reat discoveries were made but not reconi>ed as such at thetime the cases of 2epler and endel are canonical0. But not that discoveries were made%reconi>ed% and then forotten. 'raditionally in science the discourse of perfect memory hasnot been that of the file folder - thouh notable publications have claimed to be (archives) fortheir respective disciplines. 'he more eneral claim to perfect memory is that this is in thevery nature of science. 'ake% for e+ample% ?enri ;oincare)s Science and ?ypothesis #3J@0.&ll scientific work% for ;oincare and many positivists% went towards the construction of an

eternal palace. ;oincare uses the metaphor of an army of scientists% foot soldiers% each addina brick or so to the edifice of science< &'he scientist must set in order. Science is built up withfacts% as a house is with stones #J#0. 'he thin about bricks is that they don)t et forottenations. 'here is a famouspassae in the Sherlock ?olmes stories where 7atson informs ?olmes that the earth circlesthe sun, ?olmes politely thanks 7atson and then remarks that he will try to foret this fact assoon as possible% since it is a kind of fact that cannot possibly be relevant to the task that isever at hand for him< the solution of crime. In scientific orani>ations% thins et deliberatelyforotten in a variety of ways. 'hey classify away traces that they know to be relevant butwhich should not be officially recorded. *or e+ample% when I looked at the early archives ofthe "clumbergercompany% I was struck by a chane in the written traces bein left ofcompany activity. In the early days the bo+es contained a series of hihly detailed reports ofdaily activity sent by enineers in the field across the world to the company)s center ofcalculation% to borrow Callon)s felicitous phrase% in ;aris Callon% #340. 'he theory% e+plicitlystated% was the company needed the best possible records of what went on in the field in orderto build up a sufficiently lare database so as to construct scientific knowlede% and so as toco-ordinate strateies for the insertion of the company into the oil field environment. 'henone day thins chaned. /etailed accounts in *rench of work practice became sketchy tablesin "nlish of numbers of oil wells loed. 7hat had happened 'he company had otteninvolved in a leal suit withHalliburtonand had come to reali>e that its own internal traces of

activity were open to potential scrutiny by US courts determinin patent claims. 'here weretwo simultaneous reali>ations< first the records should be in "nlish% since the *renchlanuae could be read by a Southern court as a forein code, and secondly the records shouldonly contain kinds of facts that leant weiht to the company)s official presentation of itselfation)s own potential memory system Bowker% #33$% Chapter H0. 'hisstratey of distributed erasure is more punctillist than that of clearance< it involves thesystematic and deliberate forettin of some actions in order to better remember others. In&drienne 1ich)s words% this is an act of silence &'he technoloy of silence'he rituals%eti:uettethe blurrin of termssilence not absence ... Silence can be a planriorouslye+ecuted 1ich% #3A4% #A00.


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Classification systems subtendin information infrastructures operate as tools of forettinwithout representation in the medical informatics infrastructure the profession of nursin is

proressively erased from the annals both of history and of science0. 'hey also operate astools for deleatin attention Latour% #33 has an e+tended discussion of this sense ofdeleation0. 8urses do not want to have to carry around in their heads what drus the patients

on their wards need to be takin and when< they either use written traces or electronic meansto hold the memory and perhaps automatically remind them either directly by commandinattention throuh a beepin sound or routinely by constitutin distributed traces that the nursewill encounter on their normal rounds - for e+ample the canonical chart at the foot of the

patient)s bed0. 'he storae of information in a section of an orani>ation)s permanent recorduarantees that heedful attention 7eick% #33H0 is paid to that information in either the

production of orani>ational knowlede formal accounts of how the orani>ation works0 orthe orani>ation)s production of knowlede how the hospital% say% contributes to the

production of nursin knowlede0.

In order to produce nursin and other0 knowlede% then% various kinds of forettin need to

be operated on the permanent record held by orani>ations. 'his suestion is fullycomplementary to the results from science studies and orani>ation theory that manysinificant memories are held outside of formal information infrastructures. 1avet> #3A#0%Latour #34A0 and many others have noted that one cannot do scientific work without beinable to draw on information about specific local% orani>ational details of the operation of aiven laboratory, and yet that information is nowhere systematically stored. In a series ofstudies of Nero+ technicians% 6ulian 9rr has shown that formal representations of faultdianosis is often% on the spot% supplemented and indeed replaced by the swappin of warstories (I had a machine that did somethin like that...) and so forth0. I do not o into the

preservation of nursin stories - which 6ulian 9rr)s work e.. 9rr% #33J0 and others) assuresus will be enerated alonside of and as a complement to formal representations of nursinwork. *urther% new information infrastructures such as a hospital information system adoptin

8IC will in fact retain traces of orani>ational work and will despite themselves allow for thesharin of orani>ational memory. Later work by Star and myself will develop the concept oforani>ational repression by analoy to repressed memories0 to discuss this. 'he arumentcomes down to askin not only what ets coded in but what ets read out of a iven schemefor e+ample for the latter% who learns what from the fact that the codin book always fallsopen on a iven pae - cf Brown and /uuid% #33$ on the importance of such peripheralclues0. ?owever% Eust as oral history is a sinificant form of community memory% it is adifferent kind of memory dates are far less important% stories mirate between characters andso forth - see =ansina% #3#0 from that retained in the written record. y emphasis in this

paper has been purely on the nature and articulation of what oes down in the continuinformal record that the orani>ation preserves of its own past activity. 'his latter area isinterestin in its own riht because it is by usin these memories that transportable formalaccounts used in law% science% manaement will be constructed.

Conclusion

Information% in Bateson)s famous definition% is about differences that make a difference./esiners of classification schemes constantly have to decide what really does make adifference, alon the way they develop an economy of knowlede which articulates clearanceand erasure and ensures that all and only relevant features of the obEect a disease% a body% a

nursin intervention0 bein classified are remembered - for in this case the classificationsystem can be incorporated into an information infrastructure that is deleated the role of


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payin due attention. & corollary of the (if it moves% count it) theory is the proposition (if youcan)t see it movin% foret it). 'he nurses we looked at tried to uarantee that they won)t beforotten wiped from the record0 by insistin that the information infrastructure pay dueattention to their activities.

In this paper% I have arued that here may indeed be ood orani>ational reasons forforettin. I have also arued that the ways in which thins et forotten are not merelyimaes in a lass darkly of the way thins et remembered, rather they are positive

phenomena worthy of study in their own riht. I have discussed two kinds of forettine before their eyes is ascience and a profession, the daner oblivion either bein definitively e+cluded fromonoin information practices and thus releated to an adEunct role or bein included but thendistributed throuh re-enineerin0.

'here is much to be done to understand the processes of commemoration% memory% historyand recall in orani>ations. 9rani>ational forettin and orani>ational memory are usefulconcepts here because they allow us to move fle+ibly between the formal and the informal%the material and the conceptual. /esiners of information superhihways need to take theoccasional stroll down memory lane.

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Bannon% L. and 2uutti% 2. #330. Shiftin ;erspectives on 9rani>ational emory< *rom

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