A longitudinal ethnographic exploration of actor power and agency in healthcare systems: The role of human and non-human actors in shaping care delivery and outcomes

Healthcare systems are complex socio-material assemblages shaped by the interactions between human and non-human actors. This study applies Actor-Network Theory (ANT) to identify the actors influencing healthcare delivery within three Community Healthcare Networks (CHNs) in Ireland. A 23-month longitudinal ethnographic design combining photo-ethnography, ethnographic interviews, and focus groups was applied to comprehend the natural setting through which care is delivered and to trace the actors influencing care delivery. 47 site visits provided contextual observations of everyday practices and interactions. Additionally, 22 interviews identified actors influencing the delivery of care, while 3 ethnographic focus groups explored the scope of actors' power and agency. The study revealed the presence of human (22%) and non-human actors (78%) within the healthcare network, and although agency and power were distributed relationally across human and non-human actors' interactions, this distribution was uneven, with actors possessing varying capacities to shape interactions and control outcomes. A novel actor typology, mapping combinations of power and agency, was developed to classify actors within the network. The study suggests the importance of granting analytical symmetry when considering human and non-human actors in the delivery of healthcare, and the varying levels of power and agency occupied by these actors. Further, this study extends ANT's analytical scope, providing a more advanced theoretical perspective for understanding the complex socio-material realities of contemporary healthcare networks.