ZusammenfassungAusgangspunkt dieses Beitrags ist die Frage, wie die vier ethischen Prinzipien äztlichen Handelns – Respekt vor der Autonomie, Wohlergehen des Patienten, Schadensvermeidung und Gleichbehandlung – in der Berufspraxis realisiert werden können. Am Arzt-Patienten-Verhältnis wird die ethische Grundlegung jedes medizinischen Handelns erläutert, die auch das Lernen aus negativen Behandlungsverläufen umfasst. Um die Möglichkeiten für solche Lernprozesse untersuchen zu können, wird vorab eine Unterscheidung zwischen Fehler und Misserfolg vorgenommen. Als Handlungsansatz zur Aufarbeitung zahnärztlicher Misserfolge wird anhand einer empirischen Studie die Methodik des (...) Triadengesprächs vorgestellt. In diesen Gesprächen wurden 21 Misserfolge aus der Praxis reflektiert und rekonstruiert. Es wird aufgezeigt, ob und wie mit der Methode ein verändertes Verständnis des zahnärztlichen Misserfolgs ermöglicht wurde. Schließlich wird das Verfahren aus der Sicht aller an der Studie beteiligten Zahnärzte evaluiert. Die Ergebnisse der Studie zeigen, dass das Triadengespräch als Möglichkeit des expansiven Lernens eine exponierte Stellung erlangen kann. Das daraus resultierende Erfahrungskapital zahnmedizinischer Praktiker hat sodann Einfluss auf das Professionswissen und lässt gleichzeitig eine offene Kultur zum Lernen aus Misserfolgen entstehen. Abschließend werden die ethischen Implikationen des Umgangs mit Misserfolgen im Kontrast zum Umgang mit Fehlern erörtert. (shrink)

Drawing both on cultural-historical activity theory and on a dialogical approach to discourse, this article expands a method of analysis developed by Engeström & Sannino to capture discursive manifestations of contradictions in an activity system. The data consist of recorded meetings of an interprofessional team working with persons living with both a mental handicap and psychiatric disorders. The mission of this team is to coordinate socio-educative and psychiatric work. A sequence taken from one of these meetings was submitted to a (...) step-by-step discourse analysis and examined how the participants negotiated and managed the obstacles met with in their daily work. The analysis showed how an initial obstacle presented as a conflict was gradually turned into a critical conflict and finally into a dilemma between two rules: professional confidentiality and transparency towards the patient. It showed how the participants collectively coped with this dilemma, and came to define it as a problem related to work organisation, and not only to interpersonal relationships. The study shows the importance of discourse processes in collaborative work and in fostering professional learning and focus upon discourse processes through which team members deal with obstacles in their daily work and to provide a fine-grained analysis of systemic contradictions. (shrink)

This article maintains that a new wave in the development of the productive forces of society triggered by the revolution in information and communication technologies is taking place. Production carried out by single organizations is increasingly replaced by forms of production that are based on close long-term collaboration between specialized firms. This transition reflects the increasing importance of research and development as well as collective learning in business competition. New information and communication technologies enable new forms of distributed and collaborative (...) knowledge creation and learning. The article explores an emerging new form of innovation-oriented inter-firm collaboration called co-configuration and the new kind of dualistic agency it seems to be calling for. In this form of collaboration the traditional boundary between producer and provider as well as the boundaries between product development, sales and maintenance within the provider organization become blurred. The article presents a case of the development of co-configuration work in the provision of optimization software for pulp production. The case shows some of the contradictions involved in this new form of collaboration and the development of a new kind of object-oriented collaborative agency mediated through a real-time information and communication technological platform and uniting two processes of continuous development. (shrink)

The paper examines Developmental Work Research –based interventions from the perspective of qualitative research. The motive comes from two directions. First, the DWR has turned the scientific focus quite early toward trans- and interdisciplinary collaboration and methodology. However, the approach has been recognized more through its intervention theory and practice, and less as a particular research design, which can contribute to qualitative research strategy. Second, there is a trend towards one-dimensional evidence-based approach, which foregrounds standards of methods in the context (...) of new public management of science. The paper views developmental interventions as representing an alternative way of research with the practice-inspired methodology offering practice-based source of evidence. To examine more this alternative the paper deals with the question how developmental interventions can be considered research designs that make context and dialogue the basis of research. Considering the DWR methodology, the paper argues that although dialogue is central in actualizing an intervention, dialogical epistemology has remained as underdeveloped in the approach. The paper focuses on dialogicality and sense making in developmental interventions examining the processes of anchoring and objectification, object in relation to personal sense, and how the individual and collective processes are linked and coexist in the complex relationship between pragmatic activity and social processes. As illustrations of ideas, pieces of data from conducted developmental interventions are used. (shrink)

This paper explores the benefits that might arise from an appropriate fusion of the version of Activity Theory being developed by Yrjo Engestrom and the sociology of the late Basil Bernstein. It explores the common roots of the two traditions and on the basis of empirical work carried out in British special schools formulates an approach to the development of a language of description which would extend the analytical power of Activity Theory.