Organiserande och identitet : om arbetsorganisation i geriatrisk sjukvård

Detta är en avhandling från Stockholm : Pedagogiska institutionen, Stockholm universitet

Sammanfattning: The study is mainly about informal organising. The aim is to describe and interpret processes of organising in a health care unit and, from that example, to accomplish understanding of how power relations are handled and expressed by different actors in health care. I also intend to gain a deeper insight in how people produce subjectivity and social identity in a health care context and what prerequisites that context is offering for different actors to accomplish their projects.The site of the empirical study is a rehabilitation ward in a geriatric clinic. The work organisation, work routines and the management of the clinic is investigated through observations, interviews and organisational documents. The findings are presented as narratives of the organisation, where organising is interpreted as actor's interrelating projects. Four themes are in focus, A workplace in change, where the ward and clinic are introduced; Organising in the daily work, which includes team working and computerisation; Routines and rituals, which is about routinising, reporting and rounds; Organisation and management, where corporate features, organisation plans, meetings and decision-making are brought to the fore.In a reflective discussion, Organising as discursive and social practice, the organising processes are understood in terms of discourse, subjectivity and construction of social identity. Here I refer to foucauldian thinking about organisations. Actor's projects in the empirical example show a complexity of discourses, which are producing different kinds of subjectivity and constructions of social identity. The professional bureaucracy creates subjectivity from an institutionalised social order, the medical hierarchy, where the medical profession is in power. Furthermore there are other contemporary discourses such as the logic of the corporate organisation, which produces subjugation to economical outcomes. Demands for independence and autonomy are in different ways created in discourses of the developing professions of nurses and paramedics, their increasing documentation obligations, and the computerisation. An ambiguous picture emerges, where discursive and social practices are in some cases congruent but not in other. Social identity is still produced to a great deal from the medical hierarchy, which has become the social order. The above mentioned other discourses introduce competing discursive practices, which create possibilities to constructions of social identity with an increased autonomy for all professional groups.

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