Realist social theory : the morphogenetic approach
TL;DR: The Morphogenetic Cycle: the basis of the morphogenetic approach 7. Structural and cultural conditioning 8. The morphogenesis of agency 9. Social elaboration.
Abstract: Building on her seminal contribution to social theory in Culture and Agency, in this 1995 book Margaret Archer develops her morphogenetic approach, applying it to the problem of structure and agency. Since structure and agency constitute different levels of stratified social reality, each possesses distinctive emergent properties which are real and causally efficacious but irreducible to one another. The problem, therefore, is shown to be how to link the two rather than conflate them, as has been common theoretical practice. Realist Social Theory: The Morphogenetic Approach not only rejects methodological individualism and holism, but argues that the debate between them has been replaced by a new one, between elisionary theorising and emergentist theories based on a realist ontology of the social world. The morphogenetic approach is the sociological complement of transcendental realism, and together they provide a basis for non-conflationary theorizing which is also of direct utility to the practising social analyst.
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TL;DR: Improving patient experience needs to go well beyond small-scale projects at the micro and meso level to incorporate a more critical understanding of systems, the wider organisational context and how power operates at multiple levels to enable and constrain action.
Abstract: Research shows that the way that healthcare staff experience their job impacts on their individual performance, patient experience and outcomes as well as on the performance of organisations. This article builds on this literature by investigating, with multi-disciplinary clinical teams as well as patients and relatives, what factors help or hinder changes designed to improve patient experience. Qualitative research looking at patient- and family-centred care (PFCC) on two care pathways (stroke and hip fracture) was conducted in England and Wales. A realist approach combined with participatory action research was used to account for the complexity of organisational context and power relations. Multiple methods were used, including documentary analysis, participatory steering groups with staff and patient representatives, observations of the care pathways (n = 7), staff and patient and relative focus groups (n = 8), and hospital staff, patient and PFCC staff interviews (n = 47). Findings highlight multiple factors that support and hinder good patient experiences. Within individual care, paternalistic values and a lack of shared decision-making and patient-centred care still exist. Supportive interdisciplinary teamwork is needed to address issues of hierarchy, power and authority amongst staff and managers. At the organisational level, key issues of waiting times, patient flow, organisational resources and timely discharge affect staff’s time and capacity to deliver care. In addition, macro contextual factors, such as finance, policy, targets and measures, set particular limits for improvement projects. Given this context, improving patient experience needs to go well beyond small-scale projects at the micro and meso level to incorporate a more critical understanding of systems, the wider organisational context and how power operates at multiple levels to enable and constrain action. In order to more meaningfully understand and address the factors that can help or hinder activities to improve patient experiences, PFCC frameworks and methods need to account for how power inequities operate and require the adoption of more participatory co-produced and empowering approaches to involve patients, relatives, carers and staff in improving complex healthcare environments.
25 citations
Cites background or methods from "Realist social theory : the morphog..."
...People may have limited capacity for action within their specific social contexts, but their actions are not predetermined by structural and cultural contexts [37]....
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...These findings illustrate how organisational structures and the power dynamics within them act as contextual constraints [37] that limit improvements in patient experiences at every level of the system....
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...We used elements of the PARiHS framework [53, 54] to situate Archer’s [37, 38] sociological theory within healthcare and to more finely analyse its different contextual elements....
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...The research study used realist social theory [37, 38] to take into account the complexity of the organisational Ocloo et al....
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...A specific coding and analytic framework (Appendix 2) was informed by Archer’s [37] realist social theory and the PARiHS (Promoting Action on Research Implementation in Health Services) framework [53, 54]....
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TL;DR: The results suggest that self-esteem reduced the effect of social support in the workplace on psychological distress levels in the workforce, and supported the hypothesis that working in regulated occupations exerts a direct effect on mental health.
Abstract: Background: This study uses a multidimensional theoretical model to evaluate the role of regulated occupations and working conditions in explaining psychological distress. Methods: Various multilevel regression analyses were conducted on longitudinal data for which measures repeated over time (n1 = 36,166) were nested in individuals (n2 = 7007). Results: Results showed that when we controlled for working conditions, family situation, the social network outside the workplace, and personal characteristics, the level of psychological distress was significantly lower among professional workers in regulated occupations than among professionals not in regulated occupations. Among the working conditions studied, skill utilisation, psychological demands, and job insecurity were positively associated with psychological distress levels, whereas social support in the workplace was inversely related to distress. Finally, our results suggest that self-esteem reduced the effect of social support in the workplace on psychological distress levels in the workforce. Conclusions: These results support our hypothesis that working in regulated occupations exerts a direct effect on mental health. These results also make clear the importance of developing new tools for measuring psychological distress among upper-level professional workers. Such tools will be much better suited to the realities characterising today's knowledge-based economies.
25 citations