S.TRUEMAN PhD THESIS 2016

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actions was not planned. The technological reliance had occurred insidiously and incrementally as the technology evolved, developed and was adopted. There was no plan to engineer the degree of technological reliance of nurses. Similarly for remote nurses, their indispensability as an obligatory passage point to deliver mental healthcare, has not arisen from a ‘master’ or specific plan. It has occurred incidental to nurses assuming the position of being the dominant health workforce in remote Australia. Not every attempt to create an obligatory passage point succeeds. It requires a degree of negotiation, shared commitment and compromise by the various actors. The creation of an obligatory passage point is not a fait accompli . An example is Thunus’s study (2015) of Belgium’s deinstitutionalisation of psychiatric patients into the community, to be cared for by collaborative inter-organisational networks. The innovative and envisaged mental healthcare system failed to materialise. The necessary networks did not materialise because of horizontal disagreements, power struggles and jostling between actors (groups) to assume the obligatory passage point. ‘Conflicts between mental health professionals, scientific experts and experiential experts were underpinned by their respective attempt to position themselves as ‘obligatory passage points’ (Callon, 1986a) in deciding how to reorganise the Belgian system’ (p. 113), hence its ultimate failure. An obligatory passage point can accommodate a level of flexibility and does not have to be, at the time of establishment or creation for a set, fixed or determined result. Rooke, Cloatre and Dingwall (2012) outline the history of the development of nicotine chewing gum as a substitute for smoking. At the initial stage of developing a substitute (for smoking), all that was known was that nicotine was the main element in perpetuating the smoking habit. Nicotine therefore was an obligatory passage point for all future research.