The Art of Caring: dwelling, affective relationality and the organization of hospital work
A colloquium
Hosted by the People, Organizations and Work Research Group,
Swansea University Business School
Thursday 12th of July 2012
Swansea University
Sponsored by the Older People & Ageing Research & Development Network & Swansea University Business School.
This inter-disciplinary colloquium brings together scholars from across the social sciences, management and health care to pay attention to fundamentally re-think what has become a set of seemingly intractable problems of caring for elderly populations in acute hospital settings. Recent years have seen a growing emphasis on the humanization of care provision to older people in acute hospitals, for example through agendas that institute dignity as a core value (Patterson et al., 2011). Despite this, the care of older people remains deeply problematic (e.g. NCEPOD, 2010; Tadd, et al., 2011,) as they have frequently been seen to receive substandard or undignified care as evidenced through increased media attention, particularly of neglect. In this colloquium we will explore the relationship between the treatment of older people and the ‘moral universe’ or ethos instituted through everyday organizational and professional practice in acute hospitals. Such an approach to thinking about health and care will focus less on the technical or individual reasons associated with the care of older people, and more on the entrenched institutional conditions that serve to propagate poor care.
Crucially, what remains unstated in current research and practice are the cultural effects of these forms of organising health care practice. This is so despite existing preliminary evidence that the regard held for patients is affected by contemporary forms of organising health care systems (Hillman et al., 2010; Rudge, 2009). This lack of attention has tremendous implications for patients in as much as they are becoming viewed as an obstacle which interferes with the smooth running of the system, bringing into question who and what the organisation is servicing; the market, the system, or the public (Weber, 1978; cf. Du Gay, 2000). This problematisation of the individual portends a shift from the organization of care based on pathologising (e.g. Berg, 1997; Parsons; 1975) as a means of organising the sick body and towards the homogenizing of bodies into managerial processes of auditability. Yet, it is within such organizations that affect is commercialized through the ‘managed heart’ (Hochschild, 2003) and reduced in value to emotional capital. The result is that the sick become reduced to countable units of cost.
At the same time as sites of human interaction would not health care organizations be a prime location that one might expect people to come in contact ethically and with embodied affect? Or are there organizational reasons for legitimating only those affective displays which would benefit the organization instrumentally (Bauman, 1989)? Ultimately we ask are there strong moral reasons to think through the effects of modes of organising upon vulnerable individuals?
Drawing on recent research in the humanities and social sciences concerning affect, this colloquium will see affective human relations as vital within the health care sector as indicative of the human and emotional component of care work in health care. Frequently it is affective processes that enable a particular form of ‘care’ practice to be conducted (Latimer, 2000; Schillmeier & Domènech, 2010) making affective patient relationships crucial to health care work. Drawing together management principles and effects, we are keen to understand the extent to which a lack of care impacts upon the lives of the sick and in turn the relative moral worth of the individual as considered by health care staff. That is, within broader systems of auditability as practiced in European health systems (Power, 2000; Ceci, et al., 2011; Mesman, 2012), the extent to which health care staff labour to ensure the integrity of multiple systems of accountability, rather than care for patients themselves. As multiple systems of accountability are in play through processes of audit (for example ‘care pathways’, patient safety monitoring, risk assessment, care standards monitoring, clinical protocols), the focus of labour and the visible product of care work, relations are altered. Here we examine such forms of work in relation to the elderly who (within acute settings) are felt institutionally to be in the wrong place (Latimer, 2000; White et al., 2012) and already suffer with forms of stigmatisation within health care (Latimer, 2011). We aim to make visible the human costs of rationalising older persons within broader frameworks of organisation and its effects on the affective dimensions of health care.
Speakers:
Dr Elena Bendien, University of Humanistic Studies, Utrecht
Dr Miquel Domènech, Universitat Autònoma de Barcelona
Dr Alexandra Hillman, Cardiff School of Social Sciences
Professor Joanna Latimer, Cardiff School of Social Sciences
Dr Michael Schillmeier, Ludwig-Maximilians-Universität, München
Dr Paul White, Swansea University Business School
Organised by: People Organisations & Work research group, Swansea University Business School
Spaces are extremely limited, to book a place or for further details please contact Paul White.
References
Bauman, Z. (1989) Modernity and the Holocaust. Cambridge: Polity.
Berg, M. (1997). Rationalizing Medical Work: Decision-Support Techniques and Medical Practices. Massachusetts: Massachusetts Institute of Technology Press.
Ceci, C., Björnsdóttir, K., Purkis, M.E. (eds.). (2011). Perspectives on Care at Home for Older People. London: Routledge.
Du Gay, P. (2000) In Praise of Bureaucracy: Weber-Organization-Ethics. London: Sage.
Hillman, A., Latimer, J., White, P. (2009). Accessing Care: Technology and the Management of the Clinic. In: Schillmeier, M., Domènech, M. (eds.). New Technologies and Emerging Spaces of Care. Surrey: Ashgate.
Hochschild, A.R. (2003) The Managed Heart. 2nd Ed. Berkeley: University of California Press.
Latimer, J. (2000). The Conduct of Care: Understanding Nursing Practice. Oxford: Blackwell Science.
Latimer, J. (2011). Home, Care and Frail Older People: Relational extension & the art of dwelling. In: Ceci, C., Purkis, M.E., Björnsdóttir, K. (eds.). Homecare: International and Comparative Perspectives. London: Routledge .
Mesman, J. (2012). Moving in With Care: About Patient Safety as a Spatial Achievement. Space and Culture. 15(1): 31-43.
National Confidential Enquiry into Patient Outcome and Death. (2010). An Age Old Problem: A review of the care received by elderly patients undergoing surgery. London: NCEPOD.
Parsons, T. (1975). The Sick Role and the Role of the Physician Reconsidered. The Milbank Memorial Fund Quarterly. Health and Society. 53(3): 257-278.
Patterson, M., Nolan, M., Rick, J., Brown, J. Adams, R., Musson, G. (2011). From Metrics to Meaning: Culture Change and Quality of Acute Hospital Care for Older People. NIHR, SDO Project (08/1501/93). London: HMSO.
Power, M. (2000). The evolution of the audit society, its politics of control and the advent of CHI’. In:Miles, A.Hampton, J., Hurwitz, B. (eds.). NICE, CHI and the NHS Reforms: Enabling Excellence or Imposing Control? London: Aesculapius Medical Press.
Rudge, T. (2009). Beyond caring? discounting the differently known body. In: Latimer, J., Schillmeier, M. (eds.). Un/Knowing Bodies. London: Sociological Review.
Schillmeier, M., Domènech M. (2009). Care and the Art of Dwelling. Space and Culture. 12(3): 288-291.
Tadd, W., Hillman, A., Calnan, S., Calnan, M., Bayer, A., Read, S. (2011). Right place – wrong person: dignity in the acute care of older people. Quality in Ageing and Older Adults. 12(1): 33- 43.
Weber, M. (1978[1956]). Economy & Society: an outline of interpretive sociology. Los Angeles: University of California Press.
White, P., Hillman, A., Latimer, J. (2012). Ordering, Enrolling, and Dismissing: moments of access across hospital spaces. Space and Culture. 15(1): 68-87.