Boyd,

Thank you for joining the discussion. Yes Foucault has discussed regimes of
truth, which was one of my initial thoughts about the structural hierarchies
and sanctioning of particluar truths within the modernising agenda and the
importance of the context within and out with the dialogue and aspect of care.
This pulls directly on the knowledge/power dynamic and the contextual and
historical use of the language to discuss care.

I must have missed the paper you recommend but will go and read it.

Is part of the problem the need for ultimate certainty and control, when in fact
the dialogical approach to care and the creativity that is inherent within many
of the interactions can not be controlled for, leaving a level of uncertainty
that most people find uncomfortable? Uncertainty and risk are an aspect of
health care that policy is trying to erradicate, but this denies the humanism
of the service and the dynamic within. 

I wonder though that where there are so many conversations and competing
dialogues, it can make it difficult to find the way forward and the traditional
appraoch of rational pragmatism kicks in. 

can any one recommend some further reading for me? I am fscinated by this.
Thanks
anita 

Quoting Boyd Rodger <[log in to unmask]>:

> Hi Ceri,
> 
> This is a fast-paced e-mail discussion!!!  As I am writing this one another
> three are in my in-box.
> 
> I like the reference to Bruno Latour, which was going to be my starting
> point.  The bad news, Ceri, is that complexity thinkers/practitioners
> struggle with the issue of replication.  Ranging from the localized Complex
> Responsive Processes “patterning themes” of Ralph Stacey to the rule-based
> Complex Adaptive System agency models, in my personal opinion, all have
> difficulty with this.  Stacey refers to the replication of organizing themes
> as “patching”, but offers little by way of explanation as to how this is
> achieved.
> 
> Even Foucault when writes about “regimes of truth” and “epistemic/knowledge
> regimes”, he argues that the institutional practices result from the local
> “micro-physics” of power.  This may be a useful perspective from which to
> explore the contemporary practice of the NHS since each of the localized
> interactions do not just happen in a contextual vacuum; they have a history.
> And as such, have perpetual openings for alternative activities.
> 
> Where I strongly disagree with you is that you claim creativity should be
> compartmentlized into an alternative activity to regularity.  Everything we
> do requires us to be creative.  Unless we are continuously creative,
> improvising our unending responses to one another, then we would never
> arrive at work or complete an ordinary working day.  The rejection of the
> dialogically-structured ongoing construction of reality maybe at the source
> of your angst.  Or perhaps you mean something else by creativity?
> 
> A paper that was recently circulated in this forum may be of relevance to
> you.  It was by Hugh Reeve (on 5/5/04) in which he distinguishes between
> activity (regularity, procedures, protocols, the way tasks are organized,
> etc) and actions (creativity, improvised responses, spontaneity, that way
> tasks are done).  Hugh advocates the need to consider both activity and
> actions in the organization of clinical care.
> 
> Returning to original question of definitions for
> modern/modernity/modernization, expect to be asking this same question
> several years from now as per Latour.
> 
> Regards,
> 
> Boyd Rodger
> 
> Tel      +44 (0)1869-321242
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> 
>