10.6092/issn.2038-3460/17356
application/pdf
2038-3460
17356
1
en
Stefano Crabu
https://creativecommons.org/licenses/by-nc-sa/2.5/
Tecnoscienza – Italian Journal of Science & Technology Studies
Teun Zuiderent-Jerak, Situated Intervention: Sociological Experiments in Health Care, MIT Press, 2015
Text.Serial.Journal
https://tecnoscienza.unibo.it/
8
Book Reviews
2017-07-20
2023-06-22
2017-07-20
2023-08-21
175-178
TS
Stefano Crabu
2017/07/20
10.6092/issn.2038-3460/17356
175
Institut des sciences de la communication CNRS / Paris- Sorbonne / UPMC
2038-3460
1
en
178
Teun Zuiderent-Jerak, Situated Intervention: Sociological Experiments in Health Care, MIT Press, 2015
https://tecnoscienza.unibo.it/article/download/17356/16205
8
Book Review                                                                  175
        nology Studies: A Patchwork of Moving Subjectivities. An Interview with
        Geoffrey Bowker, Sandra Harding, Anne Marie Mol, Susan Leigh Star
        and Banu Subramaniam, in “Subjectivity”, 28 (1), pp. 334-344.
Lykke, N., Markussen, R. and Olesen, F. (2000) There Are Always More Things
       Going on Than You Thought! Interview with Donna Haraway, in
       “Kvinder, køn og forskning”, 4, pp. 52-61.
Lynch M. (in conversation with Lucy Suchman) (2016) Michael Lynch / Part II:
      That Delicate Balance, in “Backchannels. Society for Social Studies of Sci-
      ence” (available at: http://www.4sonline.org/blog/post/michael_lynch_-
      part_ii_that_delicate_balance.




                                       ***


    Teun Zuiderent-Jerak
Situated Intervention: Sociological Experiments in Health Care, Cam-
bridge, MA, MIT Press, 2015, pp. 248

Stefano Crabu Institut des sciences de la communication CNRS / Par-
is-Sorbonne / UPMC

     Situated Intervention: Sociological Experiments in Health Care is cer-
tainly a book that the community of S&TS scholars interested in studying
health care as sociomaterial knowledgeable doing could use to get a new
promising outlook. In this book, Teun Zuiderent-Jerak, undermining the
rigid opposition between basic and applied sociological knowledge, de-
velops an interesting new methodological perspective for researchers en-
gaged in studying and changing medical practices. Even from the opening
pages, Situated Intervention outlines a fascinating challenge addressed to
contemporary social scientists to advance the current understanding of
medical work by actively being immersed in the health care organizations.
     From the first moment I began to read the book, it brought to mind
the seminal article, “The Human Sciences in a Biological Age”, in which
Nikolas Rose (2013) offered a deep discussion about some crucial impli-
cations to the social and human sciences stemming from the most relevant
technoscientific transformations occurring in the field of contemporary
life sciences. In his work, Rose was interested in discussing (and, in a cer-
tain sense, eroding) the epistemological boundaries traditionally erected
between social sciences and life sciences to highlight how these two do-
mains may have profitably contaminated each other. Conceptually speak-
ing, Teun Zuiderent-Jerak’s book can be considered a further and inno-
176                                                          Tecnoscienza – 8 (1)

vative articulation of the intellectual project inaugurated by Rose by ex-
ploring the conditions of possibility of the social sciences’ regimes of
truth about life, medicine and health care.
    On the whole, the book is grounded in empirical data collected from
different qualitative research methods – such as ethnographic observa-
tions, interviews, focus groups and documentary analysis – within four
different projects on quality improvement and cost efficiency in Dutch
hospitals, in which the author has been engaged as “change agent” and
“evaluator” for over ten years. Within the five main chapters of Situated
Intervention, the author “considers the question of how the direct in-
volvement of social scientists in the practices they study can lead to the
production of interesting sociological knowledge” (3). In this sense, the
fundamental issue addressed in the book relates to the modalities through
which sociologically informed knowledge can be generated via the direct
transformative intervention of the researcher in the management and do-
ing of health care in situated context. This issue, in its complex ambiva-
lence, is addressed by Zuiderent-Jerak in how it relates, on the one hand,
to the situated processes of knowledge production in social sciences, and
on the other hand, to the reconfiguration of the researchers’ subjectivity
involved in doing intervention in health care context by cooperating with
practitioners and patients.
    The main theoretical insights on these two points are developed in the
introductory section, where Zuiderent-Jerak proposes a comprehensive
review of the broad debate concerning the engagement and involvement
of social researchers in doing fieldwork. Particularly, this section discuss-
es one of the main dilemmas circulating for a long time in social sciences:
How to find and evaluate a sensible balance between the (political) en-
gagement with and epistemological distance from the process researchers
are studying? Zuiderent-Jerak innovatively faced this cognitive dualism by
deconstructing many dualities embedded in it (such as objectivism and
activism; experimenting and intervening; efficiency and quality – just to
mention the most relevant), and therefore taken for granted by sociologi-
cal knowledge makers. In deconstructing these solid (but not necessarily
virtuous) traditions and customs performed by some “settled popula-
tions” in the world of the social sciences, the author conceptualises a new
methodological posture labelled situated intervention. According to the
author, this posture – emerging from the mutual entanglement between
knowing and acting (or representation of and intervention in) – enacts an
open-ended process able to generate new S&TS knowledge. Within this
framework, Zuiderent-Jerak developed a situated interventionist ap-
proach that can promote not only positive actions for organizational
changes in health care settings, but also enable the production of relevant
sociological knowledge of medical work and related practices.
    Starting with ten years’ worth of data collected by ethnographic inves-
tigations within the framework of the situated intervention, the five main
Book Review                                                               177
chapters of Zuiderent-Jerak’s book address, in radically innovative ways,
some of the major concerns that have characterized the STS debate on
medical practices in the last fifteen years, such as standardization, com-
pliance, safety and commitment of the patients and marketization of
health care assistance. In relation to these crucially relevant issues, both
for scholars and stakeholders interested in health care, a “thick” ethno-
graphic description brings the reader inside haemophilia, haematology
and oncology departments to highlight how situated intervention is per-
formed in practice.
    The first chapter investigates the possibilities and emerging outcomes
of a transformative interventionist approach in the context of home hae-
mophilia treatment implemented under the supervision of a haemophilia
care centre. Here the author makes visible the ordinary invisible work
that is aimed at attaining the compliance of the patient. Under the lens of
situated intervention, Zuiderent-Jerak conceptualizes compliance not as a
mere cognitive problem, but rather as a sociomaterial process composed
of situated negotiations between the patient and the technologically dense
environments which are encountered daily.
    In the second chapter, the issue of compliance is explored in relation
to the physicians' role and the readjustment of their daily work to clinical
standards. The standardization of the medical work is often seen by
health scientists as a problem to be addressed through top-down rational-
ization programs of the clinical action, so as to limit the ambiguity and
incertitude of the clinical decision making process. In this way, they re-
main entangled within a dichotomy between universal clinical knowledge
and patients’ idiosyncratic characteristics, namely what Lampland and
Star have labelled “the tyranny of structureless” and the “fallacy of one
size fits all” (p. 92). In order to dismantle this dichotomy which does not
help to explain the problems of clinical practice, the author proposes the
notion of situated standardization, with the aim to “focus on actual
changes in medical practices brought about by standardization and on the
perceivable renegotiations of orders and autonomies that come with the
standards” (p. 92). In this way, standards are not interpreted as regulato-
ry/normative devices to be constructed and implemented, but rather as a
collective competence and a practical accomplishment to help face pecu-
liar organizational problems.
    In a similar vein, the third chapter highlights the heuristic potential of
situated standardization in relation to “patient-centre care”, by showing
how patient-centredness may be the emerging result of the sociological
intervention in the organization of the care delivery. In the fourth chap-
ter, situated intervention is framed as an experimental strategy in the reg-
ulatory infrastructure of health care markets. In so doing, the author
highlights how sociological knowledge can get involved in configuring
market practices and “health care markets as driven by value rather than
by cost-saving” (p. 37).
178                                                         Tecnoscienza – 8 (1)

    Finally, Zuiderent-Jerak returns to the potential of sociological inter-
vention within national improvement programs in chapter five, where the
main topic relates to patients’ safety. In this context, the author adopts
Annemarie Mol’s notion of “multiple ontologies” (Mol 2002) as an ana-
lytical strategy to explore ways in which effective care is “enacted through
different approaches to dealing with patient safety and what their conse-
quences are for the care practices under study” (38). The exploration of
multiple ontologies of safety allows the author to develop an alternative
conceptualisation of “useful research” in respect to the utilitarian para-
digm. In this way, Zuiderent-Jerak situates the sociologist not only as an
external consultant who “discovers” latent factors that may impede the
assessment of and improvements in safety, but rather as an active actor
who reconfigures the problem space of patient safety in itself.
    Even if it is not an easy read, Zuiderent-Jerak's book is a challenging
experience as it proposes a new style of practicing social research in the
context of health care, which stimulates researchers to actively intervene
in the study settings. According to Zuiderent-Jerak, situated intervention
can allows to take the responsibility for undermining the certainties estab-
lished by the hegemonic medical discourse, or the organizational equilib-
riums within the health care contexts in which they are acting. At the
same time, this powerful stimulus leaves a significant problem in the
hands of the reader: What are the constraints and the risks in performing
situated intervention in practice, especially when the organization in
which the researcher is intervening is also the funding agency of the pro-
ject? Answers to this question can most likely be found by experimenting
with situated intervention as a new style of social research that seems to
have the potential to redefine the role of S&TS in public issues.


References
Mol, A (2002) The Body Multiple: Ontology in Medical Practice, London, Duke
       University Press.
Rose, N. (2013) The Human Sciences in a Biological Age, in “Theory, Culture
       and Society”, 30 (1), pp. 3-34
