ConferCare


Organisational Ethnographies of Health and Care

Damian Hodgson, Simon Bailey, Adam Brisley and Kath Checkland

Despite the domination of the randomised controlled trial and rationalist, evidence-based models in research in healthcare, it is striking that some of the most important contributions in this field result from ethnographic work. Indeed, some of the landmark medical ethnographies, such as Erving Goffman’s Asylums (1961) and Howard Becker’s Boys in White (1961) have had a far wider influence on the discipline of ethnography and social science more generally (Bloor, 2001). Such research has proved seminal in opening up settings as diverse as medical schools, hospitals, asylums, clinics, hospices, morgues and street-level healthcare, drawing out the social arrangements which surround, infuse and inform medical encounters (Mol, 2008; Allen, 2014).

The typical realist orientation inherited from the symbolic interactionists, while persistent in medical ethnography, has faced fundamental challenges from developments in ethnography more broadly, in terms of philosophy, method and focus. The diffuse arrangements through which contemporary healthcare is produced and enacted demands the extensive multi-site focus, from clinic to street, from hospital to home, or indeed from laboratory to government office (Moreira, 2013; Das, 2015).

Ethnography offers the possibility of addressing global health institutions, global events, and transnational flows of medical knowledge and technology, as they are mediated in local settings (Livingston, 2012). Ethnography has also been used to trace the trajectories of individuals as they “navigate” institutional arrangements and attempt to gain access to healthcare provision (Petryna, 2013; Street, 2014). It has shown how local moral worlds are (re)made in relation to organisational forms, such as healthcare markets (Das, 2015); how institutional boundaries are constituted by processes of patient negotiation; and how subjectivities and identities are remoulded as people try to fit into and live with organisational categories, rules and definitions (Brkovic, 2012; Biehl, 2013). The fragmentation of healthcare in the UK (often in a context of privatisation or austerity) (Mulligan, 2014), the near collapse of public healthcare provision in countries in the South and East of Europe (often in a context of crisis and state restructuring), and the diffuse and heterogeneous arrangements that exist elsewhere in the world reinforce the need for an ethnographic sensibility to piece together healthcare realities and trace the emergence of networks of care and welfare between institutional and other settings (Stubbs, 2002).

Increasingly, ethnographic work seeks to influence and inform policy decisions in this area, leading ethnographers into murkier epistemological and political waters when competing with positivist, quantitative clinical science. Nevertheless, the history of medicine is in part a history in which understanding and control are closely intertwined, and where ethics have been defined, whether explicitly or not, in relation to value (Vatin, 2013). The ethnographic and scientific gaze, therefore, come into complex relationships with one another, raising questions about power, complicity, and colonisation. Rosenhan (1973) argued that his covert methods were a necessary means to lift the lid on the containing practices of psychiatry; related claims are made by policy ethnographers aspiring to look inside contemporary technologies of government (Shore, Wright & Pero, 2011). Yet policy makers interest in ethnography may be more as a means to the legitimacy that ‘credible’ evidence can lend. This draws attention to the problematic of the ‘uniqueness’ of ethnography – how this claim is constituted, what means are justified on the basis of it, and what broader agendas might also be served.

Topics of particular interest include;

  • Temporalities and spatialities of health and healthcare
  • Bodies and beyond, organising health and un-health
  • Boundary work at the interstices of communities; between professionals and patients, clinicians and managers, market and public sector
  • The making of healthcare worlds; transnational knowledge, national institutions, local practices
  • Complicity, compromise and critical performativity in applied health research

Please submit a 500 word abstract or proposal by Tuesday 28th February 2017 to damian.hodgson@manchester.ac.uk.

References

Allen, D., 2014. The invisible work of nurses: Hospitals, organisation and healthcare. London: Routledge.

Becker, H.S., Geer, B. and Hughes, E.C. (1961) Boys in White: Student Culture in Medical School. Chicago: University of Chicago Press.

Biehl, João (2012). Vita: Life in a Zone of Social Abandonment. Berkeley, California: University of California Press

Bloor, M. (2001) ‘The Ethnography of Health and Medicine’ in Atkinson, P., Coffey, A., Delamont, S., Lofland, J. and Lofland, L. (eds.) Handbook of Ethnography London: Sage

Brkovic, Carna (2012). Navigating Rules and Wills: Healthcare and Social Protection in a Bosnian Border Town. [Thesis] Manchester, UK: The University of Manchester; 2012.

Das, V., 2015. Affliction: health, disease, poverty. NY: Fordham University Press. Rosenhan, D. (1973). “On being sane in insane places” Science 179 (4070): 250–258.

Goffman, E. (1968) Asylums: Essays on the social situation of mental patients and other inmates. Harmondsworth: Penguin

Livingston, J., 2012. Improvising medicine: an African oncology ward in an emerging cancer epidemic. Durham, NC: Duke University Press.

Mol, A., 2008. The logic of care: Health and the problem of patient choice. London: Routledge.

Moreira, T., 2013. The transformation of contemporary health care: the market, the laboratory, and the forum. London: Routledge.

Mulligan, J.M. (2014) Unmanageable Care: An Ethnography of Health Care Privatization in Puerto Rico. NY: NYU Press.

Petryna, A., 2006. Life exposed: biological citizens after Chernobyl. Princeton: Princeton University Press.

Shore, C., Wright, S., Pero, D (2011) Policy worlds: anthropology and the analysis of contemporary power. Oxford: Berghahn Street, A. (2014) Biomedicine in an unstable place: Infrastructure and personhood in a Papua New Guinean hospital. Durham, NC: Duke University Press.

Stubbs, P (2002) Globalisation: memory and welfare regimes in transition: towards an anthropology of transnational policy transfers. International Journal of Social Welfare, 11(4), 321-330

Sudnow, D. (1967) Passing On: The social organization of dying. Englewood Cliffs, NL: Prentice-Hall

Vatin, F (2013) Valuation as evaluating and valorizing, Valuation Studies 1(1), 31-50

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