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Keywords:

  • attention;
  • health care;
  • organization theory;
  • regulation;
  • routinization

Abstract

If the core problem for decision making is the limited capacity of people and organizations to collect and process information, it is their limited capacity to pay attention that poses the challenge for regulation. Much regulatory activity is thus focused on devising methods for ensuring that organizations and their staff pay attention to the “right” things. Yet outsiders’ claims on attention often are trivialized by insiders because outsiders make those claims without understanding what will be displaced. Drawing on a study of how rules are used in five HIV clinics, this article analyzes forms, training and meetings, and delegation to new occupations as devices for conserving attention. In asking how much thought is required, what should be thought about, and who should do the thinking, people argue about the moral priority of treatment, research, and administration. Allocation of attention is not just about using a scarce resource efficiently, but is also about the right to decide for oneself what is important.