Visible persons, invisible work? Exploring articulation work in person-centered care
Doris Lydahl (University of Gothenburg)
Paper short abstract:
Person-centered care is one of the many initiatives developed in response to new uncertainties and challenges in healthcare, promising to increase patient satisfaction while decreasing costs. This presentation explores the articulation- and invisible work involved in sustaining such care.
Paper long abstract:
Designed in response to new societal and economic uncertainties, intensifying demands and growing challenges to healthcare, a growing number of patient-focused initiatives have been developed in the last decades. Person-centred care is a particular approach to patient-focused care, in which it is argued that by centring care on the patient as a person, inviting them to share their stories and participate in the delivery of their own health care, patient satisfaction will increase, as well as efficiency furthering a more appropriate allocation of health care resources. Drawing on the concept of articulation work and invisible work, this presentation investigates the efforts involved in sustaining the realisation of person-centred care. The presentation builds on an ethnographic study conducted at a Swedish hospital ward implementing person-centred care. Following a nurse, and her patient, through a 'person-centred' admission process and its subsequent procedures, I argue that person-centred care depends on nurses performing many new tasks, which are rarely recognized and appreciated. Secondly, I argue that nurses are continually asked to perform articulation work, coordinating between these different new tasks and established duties. Thirdly, I discuss the tensions arising when implementing a formalized model of care, which builds on a critique of standardization and objectification, and the work that is excluded and invisible in such routinized operationalization. Finally, I conclude that while the successful implementation of person-centred care is often argued to rely on the willingness of nurses to surrender old habits, it seems rather to hinge on the skilled inven¬tiveness of these nurses.
- Discovery, discussion and decision