Breaching, Bridging, and Bonding: Interweaving Pathways of Social-symbolic Work in a Flanked Healthcare Movement

This article explores how heterogeneous and distributed forms of social-symbolic work combine over time to yield synergistic relationships that precipitate institutional change. We study a collective effort by patient activists to change the technological and regulatory standards of Type-1 diabetes care. We offer contributions to radical flank theory by conceptualizing radical and moderate flanks as dynamic and overlapping pathways of action rather than fixed actor positions, and we show how a medial ‘bonding’ pathway can provide important social glue to connect the radical and moderate flanks. While in our case the material and discursive ‘hacking’ work in the breaching pathway disrupted institutions, triggered technology innovation, and created momentum for change, material and relational ‘bridging’ embedded these efforts into existing institutional structures and longer-term innovation trajectories. Values and amplification work in the bonding pathway served to keep the two other pathways aligned over time. By addressing how a complex social problem – patient-centric innovation - may be affected through heterogeneous social-symbolic work that leads to institutional accommodation, our study holds considerable policy and societal relevance.