Onder de radar. Alledaagse omgang als kenbron voor zorgorganisaties in transitie

Onder de radar. Alledaagse omgang als kenbron voor zorgorganisaties in transitie

Zorgorganisaties staan voor de taak om in de transitie van de zorg en een steeds complexer wordende samenleving hun maatschappelijke opdracht vorm te geven. Dan is de vraag aan de orde welke bronnen zorgorganisaties hebben om te weten waarheen zij wensen te navigeren. Voor zorgorganisaties die ondersteuning bieden aan jongeren met een licht verstandelijke beperking (lvb-jongeren) heeft deze opdracht een dubbel karakter. Enerzijds bestaat ze uit het beschermen van de lvb-jongeren en de samenleving, anderzijds uit het realiseren van een leven in vrijheid. Op basis van zorgethisch georiënteerd, conceptueel en kwalitatief empirisch onderzoek wijzen wij op de morele betekenis van alledaagse omgang tussen lvb-jongeren en hun professionele ondersteuners. Aan de hand van fragmenten uit ons institutioneel etnografisch onderzoek die gerelateerd worden aan de theorie van Rahel Jaeggi over levensvormen, laten we zien dat er in de alledaagse omgang een bron van moreel kennen aanwezig is die oplossingskracht in zich draagt. Het antwoord op de vraag “wat behelst goed samenleven?” blijkt verborgen te liggen in de alledaagse omgang tussen lvb-jongere en zorgprofessional zelf. Deze bron wordt veelal over het hoofd gezien. In plaats van enkel op oriëntatie van buitenaf te koersen hebben zorgorganisaties “onder de radar” een interne morele kenbron ter beschikking. 

Under the radar: everyday contact as a source of knowledge for healthcare organizations in transition

The Dutch healthcare and welfare are systems in transition (RVS, 2016) and healthcare organizations are facing the task of reinventing their mission in society. Which compass should they use in this respect? The mission of organizations that support MID youngsters is dual in nature. On the one hand, it consists of protecting the MID youngsters and society; on the other, it should assist them in realizing a life of freedom. The ultimate issue is: What constitutes the good life for MID youngsters? On the basis of ethical and care-oriented, qualitative empirical and conceptual research we provide some answers, suggesting that if healthcare organizations were more willing to inquire into the everyday dealings of MID youngsters and their care professionals, they would detect moral orientations that already support a good life. Care organizations can find their moral compass in the good life that MID youngsters and professionals invent on an everyday basis.

The ethical care perspective of our research reveals the moral relevance of everyday interactions (Tronto, 1993; Sevenhuijsen, 1998; Pols, 2014; Barnes, 2012; Barnes, Branelly, Ward & Ward, 2015). In addition, an ethics of care can capture an ideal of the good life in everyday life in an institutional context (Laugier, 2014a). As Michel de Certeau pointed out in his ethnographic theory (1984), where everyday life is institutionally constricted, people themselves: 1) keep appropriating freedom and 2) generating knowledge. Thus, we are encouraged to pay closer attention to the epistemological dimensions of “power” – who provides the knowledge that counts and in what, possibly unexpected, ways is this effective?

In the qualitative empirical part of the study, Institutional Ethnography (Devault, 2013; Prodinger & Turner, 2013; Smith, 2006) is used as a research methodology. This approach enabled the identification of the role of institutions in everyday dealings. We recruited nineteen respondents from three Dutch healthcare organizations, all aged between 18 and 27. Each youngster was shadowed (Johnson, 2014) during the course of one day. The observation reports were analysed using the constant comparative method (Patton, 2002; Boeije, 2005). Here we focus on results that are of relevance to care organizations attempting to find an appropriate position in society.

The first finding is that while the institutional context projects contradictory normative ideas about what is “good” in everyday dealings, it does allow for these dealings by means of the physical infrastructure (building), the professionals involved, etc. Framed praxeologically (Nicolini, 2012), the institutional context itself is regarded as an actor in everyday dealings. The second finding is that in every meeting MID youngsters constantly highlight their concerns: what matters to them (Sayer, 2011). Finally, care professionals appear to respond in two ways to the dynamics implicit in the everyday dealings, either by: 1) responding to specific requirements arising from the institutional context; or 2) responding by engaging with the concerns of the youngster. Below, we expound on the latter, calling it “attending to the relationship”.

This characterization is based on Hannah Arendt’s concept of power (Vosman, 1999). According to Arendt, power is not the same as dominance but is the ability to express what matters in an interaction. If the everyday interaction is fostered: 1) the professional’s involvement will be visible, 2) the MID youngster’s concerns will be voiced and heard, and 3) it will become apparent that care relationships are located at the intersection of the private and the public.

To obtain a clearer picture of the way in which a healthcare organization shapes society, we refer to Rahel Jaeggi’s (2014) theory and critique of life forms. We consider these everyday dealings between MID youngsters and their care professionals as a “life form” in Jaeggi’s sense: as a bundle of practices. Jaeggi also offers a well-argued case for how these can be critically evaluated. First and foremost, have these life forms proved to be morally decent?

According to Jaeggi, every life form addresses a problem. The particular life form we are concerned with here exists because MID youngsters cannot independently participate in society because of their learning disabilities, whereas paradoxically this participation is demanded by society. Every life form is characterized by an ensemble of conflicting, normatively charged practices. At the same time, life forms are “instances of problem solving” (Jaeggi, 2014), in which problems are transformed. In this way, while problems do not disappear, ways of dealing with them are found. The criteria for determining whether such a “solution” can be regarded as morally satisfactory are immanent to the practices. This is because the criteria are located in the dynamic of the “solution” itself. A “solution”: a) is provided for the actual problem, b) provides a critical reflection on how the problem has arisen, c) allows room for the experiences of all of the people concerned and d) does not result in stagnation but leads to transformation.

These “instances of problem-solving” are key to a morally well-organized society (Jaeggi, 2014). Finally, the life form, as problem solver, enables all parties involved to construct or adjust life forms. In this case, this can only be achieved with the knowledge of the MID youngsters themselves, which allows them to manoeuvre through the adversities associated with their vulnerability.

If healthcare organizations in transition focus their attention on the everyday interactions between healthcare professionals and MID youngsters they will discover that: 1) they have an implicit source of moral wisdom that grounds their critical knowledge about living well together and 2) they can create a space in society from which the voice of MID youngsters can be heard (De Certeau, 1984) and from where, following Arendt, their personality can appear in a significant way – in this relationship. This touches on the political heart of the organizations themselves (Heijst & Vosman, 2010). Healthcare organizations are in the position to create a “social arrangement” in which everyday life can be lived and simultaneously examined in a critical way.

For healthcare organizations in transition it is important to not only focus on external ideological concepts or on developing professional expertise, but also to search “under the radar” and draw insight from the source of the good life in everyday dealings.