Paper short abstract:

This study explores the institutionalization of reflexivity practices in healthcare organizations to address the need for continuous transformation. Based on thirteen Dutch healthcare projects, cyclical routes to healthcare impacts are described and applied to a tool for healthcare professionals.

Paper long abstract:

Healthcare organizations require continuous transformation to address an evolving landscape. Here, healthcare professionals are simultaneously navigating a changing context and shaping the direction of transformation through advocacy or resistance. To address this everchanging context, institutionalization of a continuous reflective learning process is needed. It is simultaneously individual and collective, and the level of reflection (a focus beyond behavior on underlying goals, values, strategies, and assumptions) influences the depth of change that can be established. This study describes routes to healthcare impacts through continuous learning and improvement practices at the (intra)organizational level. To achieve this, representatives of 13 learning and improvement projects in various Dutch healthcare contexts were interviewed. Using a theory of change approach for analysis, routes to impact were defined, including: inputs, activities, learnings and changes, and impacts. Importantly, these routes are cyclical in nature, meaning that each subsequent cycle can further establish a sustainable culture of reflexivity. Next, our routes to impact were converted into a tool for healthcare professionals, using design principles formulated during feedback and brainstorm sessions with both researchers and stakeholders. At the core of the tool is the idea that learning is situated; abstract concepts require active recontextualization (i.e. giving new meaning through reflecting on application in a new context) to be effective and enduring. Therefore, the tool contains broadly applicable indicators and definitions, exemplary quotes, and reflective questions for recontextualization. We argue that it can be applied in practice for meaningful reflexivity, contributing both to the quality and efficiency of health care.

Paper short abstract:

This paper employs infrastructural imaginaries to explore a digital health initiative for Integrated and Close Care. Despite transformative goals, our study shows how infrastructure perpetuates existing ways of working. Our insights aid in aligning infrastructures with intended outcomes.

Paper long abstract:

This paper identifies how the concept of infrastructural imaginaries may help us analytically to understand the tensions behind a digital health initiative. In Sweden, the government is investing heavily in Integrated and Close Care (ICC), where the patient is promoted as an active co-creator through person-centered care. With the ICC transformation everything should be up for grabs; moving healthcare to people's homes and changing what it means to be a patient. Amidst this rhetoric, vendors for example describe how they offer innovative interfaces for an integrated patient journey, yet the existing infrastructure hides other aspects that hinder this change and perpetuates existing practice. The consequence is paradoxical: these changes aim to emancipate patients as active participants, yet further cement them into passive roles. Such digital transformation aims for change but instead entrenches the status quo.

Our objective is to identify the characteristics of a digital infrastructure enabling ICC. Our study is based on interviews with stakeholders involved in the implementation of a platform for automated triage and virtual consultations, one of the first digital developments in this initiative’s person-centered approach. Additionally, we draw on secondary data from public documents to enrich our analysis. This allows us to critically explore how infrastructures can both give shape to imagined implementations, but also hinder our ability to create meaningful change. We contribute to broadening the discourse at the intersection of digital health and infrastructures as well as providing insight in how to increase the fit between infrastructures with the practices it should support.

Paper short abstract:

In this paper I examine the production of burnout inventories in the medical profession and the pitfalls of quantifying emotional states.

Paper long abstract:

Burnout has become an important topic in health professions education in the United States and globally since 2010 As the ongoing COVID-19 pandemic continues to severely impact the healthcare workforce, hospital systems and universities in the United States have increasingly devoted resources to measuring and intervening upon burnout among trainees. In this talk, I examine the unsettled science of burnout using data from content analysis and interviews with leaders in the field. I argue that the incorporation of positive psychology into health professions education and the quantification of psychological states through burnout metrics shifts institutional focus away from the structural causes of burnout toward individual-level explanations and personal responsibility.

Paper short abstract:

This research will draw on Actor Network Theory and Constructivist Grounded Theory to examine the sociomaterial significance of virtual care and its role in configuring health care access for women from a refugee background.

Paper long abstract:

Virtual care has changed traditional health care encounters in Australia, bringing with it new dimensions to healthcare access. While it has demonstrated benefits for many Australians, for many culturally and linguistically diverse and minority populations including refugee women, there are concerns about systematic disparities in virtual care models implemented during the Covid-19 pandemic. These models were developed and employed based on necessity, not equity, and despite the ongoing use of virtual care, the evaluation and adaptation of these models has been slow.

The implicit and systematic discrimination in the design and implementation of virtual care raises important concerns about the resourcing, policies and priorities of Australian health systems. There is currently little literature on the specific experiences of refugee women utilizing virtual care in high income countries and research into the systemic issues associated with virtual care access is essential to identifying and addressing the root causes of these inequities.

This research draws on Actor Netwok Theory and Constructivist Grounded Theory to examine the socio-material significance of virtual care. Through in-depth interviews with refugee women and health care professionals this research explicates virtual care in practice. It reveals the often-unseen factors that make virtual care networks accessible, the impact of inaccessible networks, and the often-invisible work that those from minority backgrounds undertake to access health services. It examines how virtual care constructs the identities of both patients and providers and explores power dynamics that privilege certain kinds of citizenship and societal participation.

Paper short abstract:

(How) can telemedicine be used to provide "just" infrastructures of care to people who are incarcerated? I explore which notions of "just health(care)"—for instance, health that is fair, equitable, sufficient—are embedded and negotiated in healthcare infrastructures for correctional facilities.

Paper long abstract:

Correctional facilities, and "carceral healthcare" more generally, are scrutinized worldwide for neglecting the basic health needs of people who are incarcerated. Simultaneously, labor shortages in healthcare professions make it difficult to find adequate in-person care for incarcerated patients. With healthcare and policy actors alike conceptualizing of people who are incarcerated both as extremely vulnerable and notoriously "difficult to treat," telemedicine tools are being implemented and touted as providing "just" (alternative) healthcare infrastructures for incarcerated populations. Following the implementation process of telemedical care infrastructures in 28 correctional facilities in Austria, my research project explores different notions of what it means to provide "just health(care)" in the context of correctional facilities and the carceral state. Based on extensive interviews with employees of correctional facilities, my research shows that "just" infrastructures for healthcare span to include notions of equity and fairness, ethical and "good" (quality of) care, but also "justice" in the sense of adequacy and proportionality in solidarity-based healthcare systems with finite resources. I hypothesize that when changes are made to infrastructures of care, e.g. by implementing telemedicine, the existing strengths and weaknesses of systems are concurrently revealed. As such, the implementation of telemedicine is an opportunity to expand our understandings of what health, well-being or "being well," could truly mean in the context of incarcerated life and beyond—and how technologized infrastructures of care can help (re)imagine transformations of care in the penal system writ large.

Paper short abstract:

This talk examines how women carve out unique ways to provide health care within stigmatized and illicit practices. Drawing on ethnographic accounts of women “hit doctors” who provide assisted injection of illicit drugs for compensation, I discuss how they develop techniques and perform care work.

Paper long abstract:

This talk examines alternative ideas of health and care and how women carve out unique ways to provide care within stigmatized and illicit practices. It presents the case of “hit doctors,” people who provide assisted injection of illicit drugs for compensation, to examine how people navigate the ethics of care work in a marginalized community of people who inject drugs. Assisted injection is a common and high-risk practice that can be difficult to provide without injuring recipients. Since it is illegal, some people who need assistance turn to lay practitioners, called “hit doctors” by themselves and others.

Drawing on ethnographic work from 2013 to 2021 in San Francisco, California, I show how women hit doctors construct an ethic of care in their work. In addition to developing extensive techniques and robust anatomical knowledge, many women hit doctors perform care work. They have detailed techniques for relaxing recipients, including asking them about activities or people who make them happy, listening as they recount traumas, or having recipients perform physical or breathing exercises. Many consider their practices a form of palliative care. However, their care work practices also involve taking care, for they can put them at risk of assault.

Women hit doctors’ care work practices are part of a relational ethics of care that intertwines caring for others with needing care and taking care, and centers vulnerability and interdependence. These practices illustrate how care work is constructed to fill community needs in high-risk illicit contexts where institutionalized, credentialed care is unavailable.

Paper short abstract:

This article explores the healthcare inside Taiwanese prisons. By channeling and connecting the healthcare infrastructure outside the penal institution, Taiwanese prisons encounter the intersected and contradicting logic between punishment and rehabilitation.

Paper long abstract:

Prisoners are often considered a sicker, unhealthier, and unprivileged population. Healthcare inside prisons, therefore, is one of the social safety nets that provide the minimum healthcare to vulnerable inmates around the world, leading to debates and discussions about the care standards inside correctional facilities. By interviewing and doing ethnographic observation and participation inside a prison clinic in Taiwan, this article illustrates the healthcare inside Taiwanese prisons after the inauguration of National Health Insurance (NHI) in 2013. These just health infrastructures for punishing prisons were delayed almost 20 years after initiating the NHI. With NHI, the civilian hospitals replaced the prison physicians and established prison clinics under contracts with the Department of Corrections, providing clinics with multiple medical specialties and promoting health for prisoners. Although this induction made a breakthrough with the scarcity of prison healthcare, the correctional officials and medical staff from the civilian hospitals encountered the channeling and the balancing between punishment and rehabilitation in their daily work. They diagnose, medicate, manage, and even mandate healthcare with the logic of security and correction, complicating the healthcare inside. This article provides insights into making just healthcare infrastructure inside penal institutions considered unjust for exacerbating and manifesting certain social inequalities. The case of Taiwan, an East Asian post-colonial and developmental society, also shows how one of the most famous welfare and efficient healthcare systems around the world suffered from its high incarceration.