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 ##-#$% after
which time the family emirated to &ustralia!. 'his is a kind of reminiscence we can all relate
to% 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 film If 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 like
in 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 some
parts of my life -which make me like .alcolm .ac/owell in the film0 and foret others -less
heroic and less nihilistic0.
1ecall is in eneral a problematic concept% even when we can assume that people are tryin to
tell 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 be
often false -Brown and 2ulik% #3450. 6ohn /ean claimed fairly total recall at the time of
7aterate - but as Ulric 8eisser points out throuh analysis of the tapes made in the 9val
9ffice he remembered neither conversations% nor even ists of conversations - but rather an
ideal set of possible conversations which encoded his perceived truth of the situation and his
fantasies about his own role therein -8eisser% #345, but see the e+cellent criti:ue in "dwards
and ;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 in
their attitudes< thus when asked how you felt si+ months ao about% say% a '= series% your
memory 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 a
construction of the present. 'hese studies from conitive science suest that truth or falsity is
not 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 Bannon
and 2uutti% #33B stress that if C(orani>ational memory) is at all a useful concept% it is so to the
e+tent that it refers to active rememberin which carries with it its own conte+t - so that it
comes 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 semantic
memory -rememberin what vs rememberin how0 introduces a third kind of memory -
(repisodic memory) -rememberin what was really happenin0. &ainst this increasin
differentiation and speciali>ation in the concept of memory% we find a sinle and
undifferentiated definition of (forettin) - it is (not rememberin). *urther% forettin in all its
uises 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
paper on (orani>ational forettin) -#3440 discusses problems raised by the ways in which
doctors foret, thouh his activity theoretical perspective on the oranic links between
internal and e+ternal memory traces is particularly fruitful in that it provides a model for
ethnoraphic studies of collective memory. Bitner and Garfinkel -#3BA0 are amon the few to
observe 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 in
orani>ational theory has suested that perhaps it is ood on occasion to foret everythin
about 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 the
overhead of constructin a sufficiently precise archive so that a fine-rained situation can be
remembered is hih. 'hus in order to remember down to the level of detail that the "nlish
employees miht not understand (>) when pronounced (>ee) one would need an immense
archive 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 have
safety conse:uences. Secondly% e+tendin Chandler -#3AA0% one can see the development of
statistics as a filterin mechanism that allows a central office not to have to remember
everythin about a company)s day to day runnin in order to make thins run smoothly< the
filterin works as proactive forettin. & third positive mode of forettin is when an
orani>ation wants to chane its identity. In such a case the arument that (we have always
done thins this way) stands in the way of breakin new round. ?uhes -#343 G#44HC0
described the chane at 1uby school under &rnold in this liht% showin &rnold
imperceptibly chanin the way thins were done in such a way that roup memory was
never mobili>ed aainst the chanes. In eneral% if memory is bein used as a tool of
reification 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 of
producin knowlede. I shall arue that there are two maEor kinds of orani>ational forettin
in the process of producin and then maintainin classification systems in the workplace<
clearance - the erection of a barrier in the past at a certain point so that no information or
knowlede can leak throuh to the present,
erasure - the onoin destruction of selective traces in the present.
I shall then arue that the classification systems which are created permit the orani>ation to
move from heteroeneous forms of memory operatin within multiple frameworks to the
privilein of a form of memory -potential memory0 operatin within a well-defined
information 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 memory
frames and modes of forettin% or to stay out of it% is of reat political and ethical import . I
shall firstly follow this set of aruments throuh with respect to a case study of the
development of a classification of nursin work% and will then broaden the discussion out to
more 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 in
Iowa city is classifyin nursin work. 8ursin is particularly interestin with respect to
forettin% since nursin work has traditionally been invisible and removed at the earliest
opportunity 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 Interventions
Classification - henceforth 8IC -.cCloskey and Bulechek% #33B0% 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 there
was no standardi>ed lanuae for describin what it was that nurses did. 'he roup published
a first edition of their system in #335% and a revised and e+panded version came out in #33B.
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. &s
nursin informatician Castles notes% citin ?uffman on medical records manaement< &the
nursin records are the first to be pured from the patient records, there is thus no lastin
documentation of nursin dianoses or nursin interventions and no method of storae and
retrieval of nursin data. -Castles% #34#% p.$50
8IC itself is a fascinatin system. 'hose of us studyin it see it as an ethnomethodoloical
nirvana. Some cateories% like bleedin reduction - nasal% are on the surface relatively obvious
and codable into discrete units of work practice to be carried out on specific occasions. But
what about the e:ually important cateories of hope installation and humor -see /iaram H0I
?ope installation includes the subcateory of (&void maskin the truth). 'his is not so much
somethin 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 is
makin is to an implicit lifelon proram of spiritual development. 7ith respect to humor% the
very 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 to
establish relationships!, and it is unclear how this could ever be attached to a time line< it is
somethin the nurse should always do while doin other thins. *urther% contained within the
nursin classification is an anatomy of what it is to be humorous% and a theory of what humor
does. 'he recommended procedures break humor down into subelements. 9ne should
determine the types of humor appreciated by the patient, determine the patient)s typical
response to humor -e.. lauhter or smiles0, select humorous materials that create moderate
arousal for the individual -for e+ample (picture a forbiddin authority fiure dressed only in
underwear)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 to
the personality of the nurse -bein a cheerful and supportive person0 is now attached throuh
the 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% made
essentially three aruments for the creation of a nursin classification. *irst% it was arued that
without 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 articulated
with two other classification systems< 89C -the nursin sensitive patient outcomes
classification scheme0 and 8&8/& -the nursin dianosis scheme0. 'he three could work
toether thusly. 9ne could perform studies over a set of hospitals employin the three
schemes in order to check if a iven cateory of patient responded well to a iven cateory of
nursin intervention. 1ather than this comparative work bein done anecdotally as in the past
throuh 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 the
tune of ?ickory% /ickory% /ock to stress this interrelationship of the three schemes. 'he
second arument for classifyin nursin interventions was that it was a key stratey for
defendin the professional autonomy of nursin. 'he Iowa nurses are very aware of the
literature on professionali>ation - notably Schon -#34H0 - and are aware of the force of havin
an accepted body of scientific knowlede as their domain. -Indeed &ndrew &bbott% takin as
his 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% was
movin into the new world of computers. &s the representational medium chaned% it was
important 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 boo-s in
.1/)C! notes tat te Cief 0inister ad1ised 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 a1e not got rid of it a full tirty days after te order as reaced
tem! tey sould be branded and sent to do forced labor on te ,alls. tere sould be
e5emption for boo-s concerned ,it medicine! parmacy! di1ination 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 boo-s - 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 ma-e
te people stupid and ensure tat in all under Hea1en 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 a
complete wipin away of the past of nursin theory in order to start with a clean slate - much
as the first cultivators burned the forest to create land suitable for tillin in ordered rows -I am
drawin here on Serres) -#33H0 work on clearance and oriins in eometry0. 'he nurses said
that until now there had been no nursin science and therefore there was no nursin
knowlede to preserve. 'here is% one nursin informatician ruefully noted< &It is reconi>ed
that 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 by
members 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 codin
past knowlede and linkin it to current practice - it was noted at a conference to establish a
standardi>ed nursin minimum data set -information about nursin practice that would be
collected from every care facility0 that< !'he lists of interventions for any one condition are
lon partially because nursin has a brief history as a profession in the choosin of
interventions and lacks information for decision-makin. &s a profession% nursin has failed
to 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 else
does - should all previous nursin knowlede be abandonedI 7illiam Cody% in an open letter
to the Iowa Intervention 'eam published in 8ursin 9utlook in #33@ chared that this was
precisely what would follow from widespread adoption of 8IC< &It would appear that the
nursin theorists who ave nursin its first academic le to stand on% as it were% are
deliberately bein fro>en out. I would like to ask /rs .cCloskey and Bulechek% 7hy is there
no substantive discussion of nursin theory in your articleI ?ow can you advocate
standardi>in )the lanuae of nursin) by adoptin the lanuae of only one paradimI ?ow
do you envision the relationship between the )standardi>ed) masses and those nurse scholars
with differin viewsI -Cody% #33@% 3H0. 'he ;roEect team responded that indeed clearance was
an issue< &the Iowa roup contends that ta+onomic development represents a radical shift in
theory 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 the
conceptual models of nursin theorists as formin the science base of the discipline
-.cCloskey% 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 that
learnin to use 8IC toether with the new computer system it is embedded in is like oin to
a 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 from
bein e+perts to novicesG5C 'he arument was made that :uite simply there has been no work
done in the past< &'he discipline of nursin has not yet constructed a cohesive body of
scientific knowlede -'ripp-1eimer et al% #33B% p.50. ?owever% there is a comple+ity here that
often arises in connection with the stratey of clearance. 9ne wants to be able to say that
nurses no, do somethin which is valuable and adaptable to scientific principles, while at the
same time maintain that nurses have not yet -until the development of the classification
system0 been able to develop any nursin theory and thence any systematic% scientific
improvement in practice. 'his same article% on the dimensional structure of nursin
interventions% tackles this problem directly. 'ripp-1eimer arues that there must be a cycle of
forettin in the development of the new classification scheme. 'he article beins with a
:uote from Chun '>u<
'he purpose of a fish trap is to catch fish. 7hen the fish are cauht% the trap is forotten.
'he purpose of a rabbit snare is to catch rabbits. 7hen the rabbits are cauht% the snare is
forotten.
'he purpose of words is to convey ideas. 7hen the ideas are rasped% the words are forotten.
Seek those who have forotten the words. -p.50
It is arued that the traditional rand theories had a &certain limited utility beyond their
historical importance in that they provided a structure for educational prorams. ?owever% in
the field e+pert nurses soon (forot) these words and developed their own schemata to et at
the deep structure of the nursin situation -there is indeed a reference to transformational
rammar here0. 8ow usin 8IC cateories as a research tool% one could uncover the three key
dimensions of nursin work -the intensity% focus% and comple+ity of care0 - which e+perts
always already new about% without there havin been a nursin science. ?avin passed
throuh the purifyin cycle of forettin% one could finally &brin intuitive clinical decision-
makin to a conscious level. 'here is a double comple+ity to this cycle. *irst is the fact that
the first author% 'oni 'ripp-1eimer% is a cultural anthropoloist turned nursin informatician
well versed in 2uhn% Lakoff and others. 'he orani>ation that produces 8IC has to be broadly
enouh construed% on occasion% to include the community of socioloists of science and
linuistics% even thouh this inclusion may never be represented overtly in the records of the
classification scheme. -In passin% this can form a kind of orani>ational memory that can flip
into forettin - storin information in locations once within the network of an orani>ation
but now outside of it, a variety of outsourcin one sour0. 'he second is that it reflects a
tension between what nurses already know and what the science of nursin will tell them. 'he
8IC team in eneral are claimin both that nursin is already a science% and that it is one
which has not yet been formulated< they need to maintain the former in order to Eustify the
profession aainst current attacks% and the latter in order to Eustify their classification system%
which when in place will protect it from future attacks. 9ne is reminded of ;iaet)s -#3B30
assertion that our earliest intuitions are of the relativistic nature of time% and that we need to
unlearn our school lessons in order both to access the latest science and to et back in touch
with our childhood insihts. 'he act of clearance is to take away useless theory, then
ethnoraphic work will uncover the true science -always already there0 which 8IC can
e+press. 'he act of clearance% then% is not one of simple denial of the past - thouh comple+
historical narratives need to be constructed in order to distinuish the two.
I am not of course here acceptin the position that such clearance leads to the creation of true
science - the issue of the validity or not of nursin knowlede is entirely orthoonal to my
purpose. I am producin an anatomy of what it has meant in the case of nursin to create such
a science - and I will arue later that this is not an accidental feature of their work% but can be
seen as a core stratey over the centuries in the creation of sciences. 'he stratey itself
provides a way of manain a past that threatens to row out of control< one can declare by
fiat that the past is irrelevant to nursin science -while% in 'ripp-1eimer)s case validatin the
past as embodied in current best practice0 in the development of a classification scheme which
will provide for a ood orderin of memory in the future - so that nothin henceforth deemed
vital will be lost.
Forgetting . - 6rasure
4onald Cro,urst ,ent 9uietly mad on a round-te-,orld yacting race and lay becalmed on
te ocean de1eloping a teory of te cosmic mind ,ilst at te same time completing and
radioing in an immaculate official log tat ad im ,inning te race at a record pace.
Cro,urst:s double log surfaces ,itin is madness as contemplation on te nature of time2
38e ;ingdom of God as an area measured in s9uare ours. It is a -ingdom ,it all te
time in te ,orld - ,e a1e used all te time a1ailable to us and must no, see- an imaginary
sort of time: $8omalin and Hall! 1%<(! .=%+.
7ith the stratey of clearance% we saw the complete wipin-clean of the slate so that a sinle
oriin for nursin science could be created and so that from that point of oriin nursin
actions could be coded and remembered in an orani>ationally and scientifically useful
fashion. & second mode of directed forettin in orani>ations is erasure< the constant filterin
out of information deemed not worthy of preservin for orani>ation)s future purposes.
'he selective erasure of nursin records within hospital information systems has been drastic.
&s noted above% nursin records are the first destroyed when a patient is released< the hospital
administration does not need them -nursin is lumped in with the price of the room0, doctors
consider them irrelevant to medical research, and nursin theorists are not well enouh
entrenched to demand their collection. ?uffman -#33J% H#30% in a standard te+tbook on
medical records manaement writes<
&s nurses) notes are primarily a means of communication between the physicians and nurses%
they have served their most important function durin the episode of care. 'herefore% to
reduce the bulk and make medical records less cumbersome to handle% some hospitals remove
the nurses) notes from record of adult patients when medical record personnel assemble and
check the medical record after dischare of the patient. 'he nurses) notes are then filed in
chronoloical order in some place less accessible than the current files until the statute of
limitations has e+pired% and they are destroyed.
'raditionally nurses have facilitated themselves out of the e:uation< thouh they may not have
an official trace of their own past% their duty is to remember for others. In one of those vaue
but useful enerali>ations that characteri>e information statistics% it was asserted% in a book on
ne+t-eneration nursin information systems% that 5$ percent of total hospital operatin costs
were devoted to information handlin. 8ursin% it is stated% & accounted for most of the
information handlin costs -54 percent to H$ percent of nurses) time0, and what is worse% &in
recent years% e+ternal reulatory factors% plus increasin orani>ational and health care
comple+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 memory
system for doctors and hospital administrators but in so doin is denied its own official
memory.
"ven when the erasure is not mandated% it has been voluntary. 9ne te+t on a nursin
classification system cites as a motif of the profession an observation that< &)'he subEect of
record-keepin has probably never been discussed at a convention without some aitated
nurse arisin to ask if she is e+pected to nelect her patients in order to write down
information about them. ....) -.artin and Scheet% #335% 5# - echoin a #3#A source0. &nd
6oanne .cCloskey% one of the two principal architects of 8IC notes that< &...the most
convincin 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 to
spend time accurately fillin in a death certificate -itself a central tool for epidemioloists0
when 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% the
form fillers systematically erase comple+ representations that they hold in their heads in favor
of summary ones - in the case of the IC/ there are many complaints because of the overuse of
eneral 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 a
screen -which they can elect with a liht pen0 rather than searchin throuh the system for the
apt descriptor.
9ne of the main problems that the nurses have is that they are tryin to situate their activity
visibly within an informational world which has both factored them out of the e:uation and
maintained that they should be so factored - since what nurses do can be defined precisely as
that which is not measurable% finite% packaed% accountable. In nursin theorist 6enkins) terms<
&8urses have functioned in the post-7orld 7ar II era as the humanistic counterbalance to an
increasinly technoloy-driven medical profession -6enkins% #344% 350. 'hey have tried to
insert nursin as somethin that fits naturally into a world partly defined by the erasure of
nursin and other modes of invisible and articulation work - it is like technicians seekin new
ways of writin scientific papers so that their work ets acknowleded and yet the nature of
scientific truth is not impeached. Sometimes% as we will see% the nurses are driven by their
loic to impeach medical truth, sometimes to challene orthodo+y in orani>ation science,
sometimes to restructure nursin so that these challenes will not be necessary. &t the end of
the day there will be an information infrastructure for medical work which contains an
account of nursin activity< the move to informational panoptica is overwhelmin in this
profession as in many others. 7ith proEects like 8IC% which offer new classification systems
to embed in databases% tools% and reports we et to see what is at stake in makin invisible
work visible.
I have in this section e+plored two strateies% clearance and erasure. Some of the points made
here in the conte+t of orani>ational forettin relate to aruments within the socioloy of
science about the nature of scientific representations of nature - notably deletin the work
-Star% #343% #33#, Shapin% #3430% and the deletion of modalities in the development of
scientific te+ts -Latour% #34A0 - that is to say the arument that as a scientific statement ets
ever closer to bein accepted as fact% historical continencies et proressively stripped from
its enunciation. 7hy% then% talk at all about memory and forettin when representation and
its literature can do much of the same workI 'he concept of representation tends naturally to
abstract away the onoin work of individual or orani>ational aents -compare here
7oolar% #33@% #BH0. It is difficult to e+press the fact that the representation can have different
meanins at different times and places in the orani>ation in a lanuae which has been used
rather to demonstrate the conEurin of a sinle articulation of (fact). 'he act of rememberin a
fact orani>ationally involves not only mobili>in a set of black-bo+ed allies -in Latour)s
terms0 but also translatin from the conte+t of storae to the present situation -one miht store
a fact for reason + but recall it for reason y0. *urther% within an orani>ational conte+t it is
easier to e+plore the distribution of memory and forettin than the distribution of
representation. *inally% there it is always a temptation when talkin of representation to fall
into 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 supportin
that 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% a
modality 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 -the
work environment is chaned such that the modality is never encountered0, or simply
dismissed. 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 into
and out of circulation.
Clearance is a stratey employed internally within the profession of nursin as a tool for
providin an oriin for the science of nursin, erasure is employed e+ternally on the
profession 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 are
operatin the clearance of their own past in order to combat the erasure of their present in the
records of medical orani>ations. .edical information systems% they arue% should represent
the profession of nursin as if it Eust bean yesterday - for otherwise they will copy the
transparency of nursin activity from one representational space -the hospital floor and paper
archives0 to another -the electronic record0. 'his poses% then% the :uestion of what happens
when a new ecoloy of attention -what can be forotten and what should be remembered0 is
inauurated with the development of a new information infrastructure.
Forgetting! classification and potential memory
>ames Fentress and Cris Wic-am $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 disco1ery of te rigt logical category. 8e memory of
tis system of logical categories and scientific causes ,ould e5empt te indi1idual from te
necessity of remembering e1eryting in detail. ... 8e problem of memorizing te ,orld!
caracteristic of te si5teent century! e1ol1ed 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 sinle
coherent framework -see Schachter% #33B< 34-#HH0. "douard ClarapKde -who performed the
initial notorious e+periment of havin a straner rush into the classroom% do somethin
outraeous% and then have students describe what happened0 noted as early as #3JA that< !that
the 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%
#33B< #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 smooth
runnin of the orani>ation. 9rani>ations fre:uently want to know everythin relevant about
some past action. *or e+ample if there is a black-out alon in the 7est due to a tree fallin in
Idaho% an awful amount of information needs to be recalled in order for the connection to be
made. *re:uently% a prime function of record keepin in the orani>ation is to keep track of
what is oin on such that% should anyone ever want to know -auditors% a commission of
in:uiry and so forth0 a complete reconstruction of the state of the orani>ation at a particular
moment 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 a
problem% the crew will be able to show e+actly where the ship was and what it was doin at
the time of the mishap!. ?owever% in order for somethin to be remembered officially by an
orani>ation it must be recorded on a form, and forms necessarily impose classification
systems -Ber and Bowker% forthcomin0. 'he reconstruction will not cover literally
everythin that was oin on at a particular moment% but only thins that fit into the
orani>ation)s accepted classification scheme of relevant events. I shall refer to the kind of
memory 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 the
distributed% mediated nature of the record< no one person remembers everythin about a
medical intervention, and enerally it can be processed throuh an orani>ation without ever
havin been recalled. ?owever% there is a possible need to recall any one intervention in hue
detail< and the only way that the possible need can be met is throuh the construction of a
classification system which allows for the efficient pieon-holin of facts.
7ithin the hospital% nursin work has been deemed irrelevant to any possible future
reconstruction, it has been canonically invisible% in Star)s -#33#0 term. 'he loic of 8IC)s
advocators is that what has been e+cluded from the representational space of medical practice
should be included.
9peratin within the space of erasure which is at once home for them and a threat to their
continued e+istence% the nurses in Iowa have thouht lon and hard about the politics and
philosophy of classifyin their activities such that they fit into the hospital)s potential memory.
'hey do not want to flip over from bein completely invisible to bein far too visible. 'hey
have decided to name% but not to name too much. 'o this end they have adopted their own
practice of continuin partial erasure -where tey limit the nature and scope of erasure0 - for
three reasons<
'hey have decided to specify uni:uely down to the level of interventions% but to leave the sub-
cateories of activities as relatively fluid - several possibly contradictory activities are
subsumed under a sinle intervention -see /iaram H0. 'his allows% they arue% for a
reconition of local differences and local autonomy -so central to the nursin self-imae0
whilst providin the necessary deree of specification for entry into the world of potential
memory.
It is harder to hive off aspects of nursin duties and ive them to lower paid adEuncts if that
work is relatively opa:ue. 'he test sites that are implementin 8IC have provided some
deree of resistance here% aruin that activities should be specified - so that% within a soft
decision support model a iven dianosis can trier a nursin intervention constituted of a
sinle% well-defined set of activities. &s .arc Ber -forthcomin #33B0 has noted in his study
of medical e+pert systems% such decision support can only work universally if local practices
are rendered fully standard. & key professional stratey for nursin - particularly in the face of
the ubi:uitous process re-enineer - is reali>ed by deliberate non-representation in the
information infrastructure. 7hat is remembered in the formal information systems resultin is
attuned to professional stratey and to the information re:uisites of the nurses) take on what
nursin science is.
'here is a brick wall that they come up aainst when dealin with nurses on the spot< if they
overspecify an intervention -that is break it down into too many constituent parts0% then it ets
called% in the field% an 8SS classification - where 8SS stands for (8o shit% Sherlock) and is not
used -'immermans% Bowker and Star% forthcomin0. 'he proEect team sees the classification
scheme as havin to be very proli+ at present, but when the practice of nursin itself is fully
standardi>ed% some of the words will be able to wither away. 'hey point to intervention
classifications used by doctors% which are much less verbose - and can afford to be% they
arue% because every doctor knows the standard form of treatment for% say% appendicitis.
-'houh they also arue that there are local variations in medical practice which have been
picked up by ood reportin procedures% and that 8IC will be able to provide such a service
for nursin - leadin to an improvement in the :uality of practice0. It is assumed that any
reasonable education in nursin or medicine should lead to a common lanuae wherein
thins do not need spellin out to any ultimate deree. 'he information space will be
sufficiently well pre-structured that some details can be assumed. &ttention to the finer-
rained details is deleated to the educational system% where it is overdetermined.
'hese 8IC erasure strateies - dealin with overspecification and the political drive to relative
autonomy by droppin thins out of the representational space - are essential for the
development of a successful potential memory. 'he two forms of erasure of local conte+t are
needed in order to create the very infrastructure in which nursin can both appear as a science
like any other and yet nursin as a profession can continue to develop as a rich% local practice.
'he onoin erasure is uaranteed by the classification system< only information about
nursin practice reconi>ed by 8IC can be coded on the forms fed into a hospital)s computers
or stored in a file cabinet.
8ursin informaticians aree as a body that in order for proper healthcare to be iven and for
nurses 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 forms
should be enerated which utili>e these classifications. ?owever% there has been disareement
with respect to stratey.
'o understand the difference that has emered% recall one of those forms you have filled in
-we have all e+perienced one0 which do not allow you to say what you think. Dou may% in a
standard case% have been offered a choice of several racial oriins, but may not believe in any
such 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 that
enouh of your comple+ity will be preserved by your set of answers to the form, or you don)t
answer 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 with
the same strateic choice< fittin their classification system into the ;rocrustean bed of all the
other classification systems that they have to articulate with in any iven medical settin in
order to form part a iven orani>ation)s potential memory, or reEectin the ways in which
memory is structured in the orani>ations that they are dealin with. 7e will now look in turn
at each of these strateies.
Let us look first at the arument for includin 8IC within the potential memory framework of
the hospital. 'hey arue that 8IC has to respond to multiple important aendas
simultaneously. Consider the followin litany of needs for a standard vocabulary of nursin
practice<
It is essential to develop a standardi>ed nomenclature of nursin dianoses in order to name
without ambiuity those conditions in clients that nurses identify and treat without
prescription from other disciplines, such identification is not possible without areement as to
the meanin of terms. ;rofessional standards review boards re:uire discipline-specific
accountability, some urency in developin a discipline-specific nomenclature is provided by
the impendin 8ational ?ealth Insurance leislation% since demands for accountability are
likely 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 in
communication 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 delivery
by identifyin% for leal and reimbursement purposes% the evaluation of the :uality of care
provided by nurses, facilitate the development of a ta+onomy of nursin dianoses, provide
the 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 development
of 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 nursin
knowlede - 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 that
future practice converes on potential memory.
.any nurses and nursin informaticians are concerned that the profession itself may have to
chane too much in order to meet the re:uirements of the information infrastructure. 7e
murder% they note% to dissect. In her study of nursin information systems in *rance% Ina
7aner -#33H0 speaks as follows of the amble of computeri>in nursin records<
8urses miht ain reater reconition for their work and more control over the definition of
patients) problems while findin out that their practice is increasinly shaped by the necessity
to comply with reulators) and employers) definitions of )billable cateories) -*eldber #33J0.
Indeed% a specific feature of this )thouht world) into which nurses are radually sociali>ed
throuh 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 with
each care activity enforces a specific time discipline on nurses. 'hey learn to assess patients)
needs in terms of workin time.GHC 'his analytic perspective is shared by the Iowa nurses.
'hey arue that documentation is centrally important, it not only provides a record of nursin
activity but structures same<
7hile nurses complain about paperwork% they structure their care so that the re:uired forms
et filled out. If the forms reflect a philosophy of the nurse as a dependent assistant to the
doctor who delivers technical care in a functional manner% this is the way the nurse will act. If
the forms reflect a philosophy of the nurse as a professional member of the health team with a
uni:ue independent function% the nurse will act accordinly. In the future% with the
implementation of price-per-case reimbursement vis-a-vis dianosis related roups%
documentation will become more important than ever. -Bulechek and .cCloskey% #34@% $JB0.
&s the 8IC classification has developed% observes 6oanne .cCloskey% the traditional cateory
of (nursin process) has been replaced by (clinical decision makin plus knowlede
classification). &nd in the representation of 8IC that she produced -/iaram @0% both the
patient and the nurse had dropped entirely out of the picture -both were% she said% located
within the (clinical decision makin bo+) on her diaram0 -II; BL4L3@0. & recent book about
the ne+t eneration nursin information system arued that the new system<
cannot be assembled like a patchwork :uilt% by piecin toether components of e+istin
technoloies and software prorams. Instead% the system must be rebuilt on a desin different
from that of most approaches used today< it must be a data-driven rather than a process-driven
system. & dominant feature of the new system is its focus on the ac:uisition% manaement%
processin% and presentation of )atomic-level) data that can be used across multiple settins for
multiple purposes. 'he paradim shift to a data-driven system represents a new eneration of
information technoloy, it provides strateic resources for clinical nursin practice% rather
than Eust support for various nursin tasks. -Fielstorff et al.% #33H% #0.
'his speaks to the proressive denial of process and continuity throuh the sementation of
nursin practice into activity units. .any arue that in order to (speak with) databases at a
national and international level Eust such sementation is needed. 'he fear is that unless
nurses can describe their process this way -at the risk of losin the essence of that process in
the description0% then it will not be described at all. 'hey can only have there own actions
remembered at the price of havin others foret% and possibly forettin themselves% precisely
what it is that they do.
Some nursin informaticians have chosen rather to challene the memory framework e+istin
in the medical orani>ations they deal with. 'hey have adopted a Batesonian stratey of
respondin to the threat of the new information infrastructure by movin the whole arument
up one level of enerality and tryin to supplant (data-driven) cateories with cateories that
reconi>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 patients
less often as a result< they arue that Eust such a process-sensitive definition of productivity
needs to arued for and implemented in medical information systems in order that nursin
work ets fairly represented -II; BL4L3@0. 'hey draw from their secret -because unrepresented0
reservoir of knowlede about process in order to challene the data-driven models from
within.
7ithin this stratey% the choice of allies is by no means obvious. Since with the development
of 8IC we are dealin with the creation of an information infrastructure% the whole :uestion
of how and what to challene becomes very difficult. Scientists can only% willy nilly% deal with
data 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 old
activity% :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 of
process can become an attack on the scientific world view. 9ne of the chief attacks on the
8IC scheme has been made by a nursin informatician% Susan Grobe% who believes that rather
than standardi>e nursin lanuae computer scientists should develop natural lanuae
processin tools so that nurse narratives can be interpreted. Grobe arues for the abandonment
of any oal of producin< & a sinle coherent account of the pattern of action and beliefs in
science -Grobe% #335% 350, she oes on to say that< &philosophers of science have lon
acknowleded the value of a multiplicity of scientific views! -350. She e+coriates Bulechek
and .cCloskey% architects of 8IC% for havin produced work< &derived from the natural
science 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 social
science -3$0. 9r aain% a recent paper on conceptual considerations% decision criteria and
uidelines for the 8ursin .inimum /ata Set cited *ritEof Capra aainst reductionism% Steven
6ay Gould on the social embededness of scientific truth and praised *oucault for havin
developed a philosophical system to &rapple with this reality -2ritek% #344% 5$0. 8urse
scientists% it is arued% &have become :uite reductionistic and mechanistic in their approach to
knowlede eneration% at a time when numerous others% particularly physicists% are reversin
that pattern -5A0. &nd nursin has to find allies amonst these physicists<
8urses who deliver care enae in a process. It is actually the cyclic% continuous repetition of
a comple+ process. It is difficult% therefore% to sketch the boundaries of a discrete nursin
event% a unit of service% and% therefore% a unit of analysis. 'ime is clearly a central force in
nursin care and nursin outcomes. 8urses have only beun to strule with this factor. It has
a centrality that eludes e+plication when placed in the conte+t of :uantum physics. -Ibid.% 540
'he point here is not whether this arument is riht or wron. It is an interestin position. It
can only be maintained% as can many of the other possible links that bristle throuh the 8IC
literature% because the information infrastructure itself is in flu+. 7hen the infrastructure is
not in place to provide a (natural) hierarchy of levels% then discourses can and do make strane
connections between themselves.
In order to not be continually erased from the record% nursin informaticians are riskin either
modifyin their own practice -makin it more data driven0 or wain a Mui+otic war on
database desiners. 'he correspondin ain is reat% however. If the infrastructure itself is
desined in such a way that nursin information has to be present as an independent% well
defined cateory% then nursin itself as a profession will have a much better chance of
survivin throuh rounds of process re-enineerin and nursin science as a discipline will
have a firm foundation. 'he infrastructure assumes the position of Bishop Berkeley)s God< as
lon as it pays attention to nurses% they will continue to e+ist. ?avin ensured that all nursin
acts are potentially remembered by any medical orani>ation% the 8IC team will have one a
lon 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 of
science% the law and reliion. 'he leal and clerical professions claim perfect memory throuh
an 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 or
in theoloical disputes. Scientific professionals% thouh% tend to claim that by its very nature
science displays perfect memory< and they structure their recall primarily throuh a myriad of
classification systems that ives them a vast reserve of potential memory -scientific articles
are 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 which
classification systems structure memory within orani>ations% takin as a chief e+ample the
nature and operation of classification systems in science. 'here are two maEor reasons for
choosin the institution of science for our wider discussion - the 8IC development team
claims to be renderin nursin scientific% and so these wider e+amples develop naturally out
of ;art # above, and classification work has been more formali>ed in science than in other
institutions
It can readily be accepted that reat discoveries were made but not reconi>ed as such at the
time -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 has
not been that of the file folder - thouh notable publications have claimed to be (archives) for
their respective disciplines. 'he more eneral claim to perfect memory is that this is in the
very 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 addin
a brick or so to the edifice of science< &'he scientist must set in order. Science is built up with
facts% as a house is with stones -#J#0. 'he thin about bricks is that they don)t et forotten<
they are there in the nature of the edifice. 8obody need actively recall them< buildins don)t
remember. But each brick that is in a buildin is continuously present and is therefore aeless.
In another metaphor% he sees the work of doin physics as similar to buildin a collection of
books - with the role of the theorist bein to facilitate information retrieval% to cataloue<
Let us compare science to a library that ouht to row continually. 'he librarian has at his
disposal for his purchases only insufficient funds. ?e ouht to make an effort not to waste
them.
It is e+perimental physics that is entrusted with the purchases. It alone% then% can enrich the
library.
&s for mathematical physics% its task will be to make out the cataloue. If the cataloue is
well made% the library will not be any richer% but the reader will be helped to use its riches.
-#J$0
'he very nature of theory% then% is that it furnishes a classification system which can then be
used to remember all -and only that0 which is relevant to its associated practice.
&ll classification systems% however% face a bootstrappin problem. In a world of imperfect
knowlede% any classificatory principle miht be ood% valid% useful< you won)t know what
makes a difference until you have built up a body of knowlede that relies% for its units of
data% on the classification scheme that you have not yet developed. 'his is Spino>a)s problem.
Consider its form in the world of medical record keepin - a world in which every trace miht
count. In order to maintain a ood system of medical records% a state needs to classify a hue
mount of information about not only its own citi>ens% but about citi>ens of countries that it is
in contact with -classification systems are necessarily imperialistic, witness the protests of
&frican doctors to pressures from western &I/S researchers0. 'he need for information and
thence the burden of classificatory activity is effectively infinite. & wish-list for a national
medical information system in &merica included the followin<
all factors affectin health ... enetic and bioloical% environmental% behavioral%
psycholoical% and social conditions which precipitate health problems, complaints%
symptoms and diseases which prompt people to seek medical care, and evaluation of severity
and functional capacity% includin impairment and handicaps -1othwell% #34@% #B3-#AJ0.
"ach of these sets of factors involves a classification scheme. 'here is no tellin what
information will be relevant<
to classify a chisel% a hand drill% and a spanner toether as (hand tools)% or the first two as
(cuttin and piercin instruments) may be obscurantist% or even misleadin. 7hereas to one
accident researcher it is sinificant that a chisel is eded% a drill pointed% and a spanner
neither% to another it may be more important that the chisel is pushed% the spanner turned and
the drill operated by rotary motion. -?eidenstrom% #34@% AB0
In a world in which% as &nn *aot-Lareault -#33J% B0 has pointed out% it is impossible to die
of old ae -the cateory of bein (worn out) havin been removed from the IC/0 it appears
that we are afloat in a sea of multiple% fractured causalities each demandin their own
classification systems - and their own apparatus of record collection. 'o deal with the plenum
of information that all ood orani>ations loically need% one can operate a distribution of
memory in space -such and such a subroup needs to hold such and such knowlede0 and a
distribution of memory in time -such and such a memory will only be recalled if a iven
occasion arises0.
Classification systems provide both a warrant and a tool for forettin at the same time as
they operate this distribution. 'o take an overview of this process% let us consider the case of
the classification of the sciences. &uuste Comte wrote about this in the first volume of his
course of positive philosophy% wherein he lays out a new classification of all the sciences in
hierarchical order% each science havin a statics and a dynamics. ?e arued that it was only at
the current state of advancement of science that a true classification system could emere<
since only now were the forces of reliion and metaphysics sufficiently at bay that a true
picture of the nature of knowlede could emere. &t the same time% the sum total of scientific
knowlede was sufficiently reat that it was inconceivable to learn a science by tracin its
history< there were too many wron turns% blind allies% vaaries. -6ust% one miht note% as one
does not want to remember where one)s keys are by tracin the series of actions that one has
made in the past several hours0. 7ith the new classification system% knowlede could be
arrayed loically and naturally - one would lose chronoloical order but ain coherence.
Indeed% only in this way could science be loically tauht, indeed< &... the most important
property of our encyclopedic formulation ... is that it directly ives rise the true eneral plan
of an entirely rational scientific education. -Comte% #3A@ G#4HJ-$@C% @J0G$C 7hat is left% in
Comte)s work% is the positivist calendar% where certain reat scientists have their days% Eust as
the saints had theirs in the ae of reliion. Serres annotates this passae with the observation
that the formation -trainin0 of scientists covers up and hides the formation -production0 of
scientific knowlede -@#0.
Indeed Comte sets in train a double motion. 9n the one hand% you will only learn science if
you foret its history, on the other hand% you will only understand the history of science if you
look at the entire history of humanity<
'his vast chain is so real that often% in order to understand the effective eneration of a
scientific theory% the mind is led to consider the perfectionin of some art with which it has no
rational link% or even some particular proress in social orani>ation without which this
discovery would not have taken place. ... It follows therefore that one cannot know the true
history of any science% that is to say the real formation of the discoveries it is composed of%
without studyin% in a eneral and direct manner% the history of humanity. -@50
9n the one side we have the complete history of humanity% where nothin can be forotten
because everythin miht be relevant, and on the other an efficient classification system
which allows us to remember only what we need to remember about science. 'he
classification system operates a clearance% in that all that was reliious and metaphysical is
wiped away with a sinle esture, it operates selective erasure in that even in the current
scientific ae the processes of the production of knowlede will have to be erased from the
account of the knowlede itself. 'he classification system tells you what to foret and how to
foret it. It operates a double distribution in space of scientific memory. *irstly% the social
story of science will be e+cluded from the orani>ation of the sciences% and held outside of it
-if at all0 by historians. 'his is a form of erasure. Secondly% it offers a naturally hierarchy of
the sciences% sayin that a iven discipline -say eoloy% statics0 will need to remember all
and only a iven set of facts about the world. It also operates a distribution in time% sayin that
all scientific problems can be proressively unfolded - so that at one point alon the path in
treatin a social problem you will need to draw on bioloy% then chemistry% then physics% then
mathematics< each type of memory which has been distributed in space will also be se:uenced
in time. 'he plenum is contained by the overarchin orani>ation constituted by the scientific
community precisely throuh a controlled proram of first clearance then continuin erasure.
'he work of conEurin the world into computable form -cf ?utchins% #33@0 has already been
beun by the settin up of a certain kind of formal memory system - for e+ample% one in
which facts can be stored in linear time and space.
In the history of science% we fre:uently encounter an apposition between clearance% the
deliberate destruction of the past% and establishment of a classification system. 7hen
Lavoisier set out to found the new discipline of chemistry% he wrote a te+tbook which
standardi>ed the names of the elements -so that & became silver< not /iane)s metal% a name
that )remembered) the alchemical prehistory of the discipline0. ?e also rewrote the history of
chemistry so that his rivals% aruin the theory of affinities% no loner occupied a place in the
te+tbooks< they were written out of the historical record. -Bensaude-=incent% #3430.
'he stratey of clearance is a complete wipin clean of the slate% so that one can start anew as
if nothin had ever happened. &s in the e+ample of the burnin of the books% it is doubtful if
clearance can ever work in the short term since people do remember thins and institutional
arranements do bear traces of their past - as in the case of an outmoded classifcation system
bein reflected in the arranements of artifacts in a museum, however in the lon term% by the
time that the curricula have been redesined% the manuals rewritten and new nursin
information systems produced it can be a hihly effective tool. Clearance is a pramatic
stratey< it may well be the case that a iven orani>ational routine or piece of knowlede has
roots in the distant past% and yet it may also be the case that dealin with said routine or
knowlede it is easier to act as if it had Eust arrived on the scene. It is for this reason that the
issue of truth or falsity of memory can be a red herrin in treatments of orani>ational
memory as well as analytically undecidable< a false memory% well constructed throuh a
proram of forettin% can be of reat use.
"rasure is a key dimension of classification work in all orani>ations. 'here is a famous
passae in the Sherlock ?olmes stories where 7atson informs ?olmes that the earth circles
the sun, ?olmes politely thanks 7atson and then remarks that he will try to foret this fact as
soon as possible% since it is a kind of fact that cannot possibly be relevant to the task that is
ever at hand for him< the solution of crime. In scientific orani>ations% thins et deliberately
forotten in a variety of ways. 'hey classify away traces that they know to be relevant but
which should not be officially recorded. *or e+ample% when I looked at the early archives of
the "clumberger company% I was struck by a chane in the written traces bein left of
company activity. In the early days the bo+es contained a series of hihly detailed reports of
daily activity sent by enineers in the field across the world to the company)s center of
calculation% to borrow Callon)s felicitous phrase% in ;aris -Callon% #34B0. 'he theory% e+plicitly
stated% was the company needed the best possible records of what went on in the field in order
to build up a sufficiently lare database so as to construct scientific knowlede% and so as to
co-ordinate strateies for the insertion of the company into the oil field environment. 'hen
one day thins chaned. /etailed accounts in *rench of work practice became sketchy tables
in "nlish of numbers of oil wells loed. 7hat had happenedI 'he company had otten
involved in a leal suit with Halliburton and had come to reali>e that its own internal traces of
activity were open to potential scrutiny by US courts determinin patent claims. 'here were
two simultaneous reali>ations< first the records should be in "nlish% since the *rench
lanuae could be read by a Southern court as a forein code, and secondly the records should
only contain kinds of facts that leant weiht to the company)s official presentation of itself<
that is to say the cycle of accumulation of messy half-truths should be carried out elsewhere
than in the orani>ation)s own potential memory system -Bowker% #33$% Chapter H0. 'his
stratey of distributed erasure is more punctillist than that of clearance< it involves the
systematic 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 silenceL'he rituals%
eti:uetteLthe blurrin of termsLsilence not absence ... Silence can be a planLriorously
e+ecuted -1ich% #3A4% #A00.
Classification systems subtendin information infrastructures operate as tools of forettin
-without 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 as
tools for deleatin attention -Latour% #33B has an e+tended discussion of this sense of
deleation0. 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 means
to hold the memory and perhaps automatically remind them -either directly by commandin
attention throuh a beepin sound or routinely by constitutin distributed traces that the nurse
will 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 record
uarantees 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 or
the 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 fully
complementary to the results from science studies and orani>ation theory that many
sinificant 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 bein
able to draw on information about specific local% orani>ational details of the operation of a
iven laboratory, and yet that information is nowhere systematically stored. In a series of
studies of Nero+ technicians% 6ulian 9rr has shown that formal representations of fault
dianosis is often% on the spot% supplemented and indeed replaced by the swappin of war
stories -(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) assures
us will be enerated alonside of and as a complement to formal representations of nursin
work. *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 the
sharin of orani>ational memory. Later work by Star and myself will develop the concept of
orani>ational repression -by analoy to repressed memories0 to discuss this. 'he arument
comes down to askin not only what ets coded in but what ets read out of a iven scheme
-for e+ample for the latter% who learns what from the fact that the codin book always falls
open on a iven paeI - cf Brown and /uuid% #33$ on the importance of such peripheral
clues0. ?owever% Eust as oral history is a sinificant form of community memory% it is a
different kind of memory -dates are far less important% stories mirate between characters and
so forth - see =ansina% #3B#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 continuin
formal record that the orani>ation preserves of its own past activity. 'his latter area is
interestin in its own riht because it is by usin these memories that transportable formal
accounts 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 a
difference, alon the way they develop an economy of knowlede which articulates clearance
and 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 classification
system can be incorporated into an information infrastructure that is deleated the role of
payin due attention. & corollary of the (if it moves% count it) theory is the proposition (if you
can)t see it movin% foret it). 'he nurses we looked at tried to uarantee that they won)t be
forotten -wiped from the record0 by insistin that the information infrastructure pay due
attention to their activities.
In this paper% I have arued that here may indeed be ood orani>ational reasons for
forettin. I have also arued that the ways in which thins et forotten are not merely
imaes 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 forettin<
clearance and erasure. *rom this emered a consideration of forettin and potential memory
-mediated by classification systems0.
I have stressed that representation in the formal record is not the only way to be remembered<
indeed there is a comple+ ecoloy of memory practices within any one orani>ation.
?owever% the shift into lon-term memory that the infrastructure provides is sinificant% if
frauht. 'he production of transportable knowlede used in other reisters -scientific te+ts%
the law0 at present assumes that this knowlede can be stored and e+pressed in a :uite
restricted rane of enres. &t the limit% as we saw with ;oincare% it can be arued that
scientific theory is about the storae of information in such lon-term memory. In order to
prevent continuin erasure within hospital information systems% nurses have had to operate a
clearance of their own past -recorded history beins today0. 'he pri>e before their eyes is a
science and a profession, the daner oblivion -either bein definitively e+cluded from
onoin information practices and thus releated to an adEunct role or bein included but then
distributed throuh re-enineerin0.
'here is much to be done to understand the processes of commemoration% memory% history
and recall in orani>ations. 9rani>ational forettin and orani>ational memory are useful
concepts 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 the
occasional stroll down memory lane.
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Acknowledgments:
I am rateful to Leih Star% .arc Ber% 6esper /oeppin% /ick Boland% two anonymous
reviewers and to members of the Illinois 1esearch Group on Classification for comments on
this paper. I wish to acknowlede the unfailin support and interest of the Iowa Intervention
;roEect% notably 6o&nne .cCloskey% Gloria Bulechek and Bill /onahue.