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dc.contributor.authorAsplin, Betina Riis
dc.date.accessioned2024-06-24T06:23:28Z
dc.date.available2024-06-24T06:23:28Z
dc.date.created2024-06-12T12:56:46Z
dc.date.issued2024
dc.identifier.isbn978-82-8247-389-7
dc.identifier.urihttps://hdl.handle.net/11250/3135465
dc.description.abstractThis thesis is about patient representation Norwegian patient-centred care. In Norway as well as globally, users are increasingly pointed out as central actors in strategies and policies aimed at innovation and the organization of services. In healthcare, calls are made for patient-centric innovation and patient-centred care to integrate care models more closely oriented around the needs of the patient. Despite the explicit focus on patient-centred ideals and various forms of user involvement, there is often a struggle to make such ideals a reality. Existing research in patient-centred care discuss patient representation, highlighting challenges such as conceptual ambiguity (Liberati et al., 2015), which complicates implementation. They also identify obstacles, such as existing power structures enacted in patient-provider encounters, through the use of new technologies or new organizational roles and set-ups. From this position the project of patient-centred care might come across as a tough nut to crack. Arguably, patient representation produce difference, but can we make better sense of how this happens? The object of enquiry in this thesis is the representation of patients—or users, as they are often referred to in policy and health care contexts—and how user representation is formed, negotiated and transformed through practices in the quest for user-centred organization and innovation. The research question pursued in this thesis is: How can “patient representation” help us understand the performance of patient-centred care as practice?” Methodologically, I follow Liberati et al., (2015) and explore practices of patient-centred through ethnographic methods, specifically I explore how patient representation unfold in two different Norwegian public health care settings: The first setting, ‘the inclusive patient project’, was a user-centred innovation project seeking to integrate the patient voice and coordinate care around frail elderly patients. The second setting, ‘Fields Community Service’, was a low threshold mental health service that systematically built on patient feedback both in mental therapy and organizational learning. I have found inspiration in performative perspectives conveying the idea that representations are not true reflections, rather engines that ‘do’ things and part of creating the world they are representing. In this thesis I follow Garud et al.’ (2018) notion of performativity as ‘ongoing journeys’ wanting to understand both how user representation is practiced, but also how such performances make a difference. I found that by approaching patient representation as organisational doing we can advance new understanding of how the policy ideal of patient-centred translates into practice. Hence, in this thesis I advance understanding of user representation as organizational doing, both a theoretical resource to explain power challenges in the field, and one that can potentially be informative to everyday care practices. Through my ethnographic and reflexive approach informed by a performative lens, I contribute to the stream of research considering patient-centred care a set of practices. Further, through my study I have identified practices that may hinder or successfully lead to the outcome of patient-centred care combining the concepts of ignorance and vulnerability in a new way in relation to patient-centred care. For example, by bringing the concept of vulnerability in contact with the field of organised ignorance, my research offers a perspective on how ignorance could potentially be a resource for those considered vulnerable, such as patients. Seeing these two concepts together can thereby inform the debate about why patient-centred care is difficult to achieve, but also as a potential avenue to deal with challenges. The first paper in this thesis is conceptual and based on an integrative literature review across social sciences on the phenomenon of user representation. The paper contributes a concept and theoretical foundation of user representation as practices as a lens to study organisational dynamics of patient-centred care. The empirical papers have individual contributions by making theoretical connections between patient representation and organised ignorance through the concept of ‘unintended ignorance’, advancing understanding of the material dimension of ignorance (paper 2), and between patient representation and epistemic vulnerability, by advances understanding of epistemic vulnerability as a relational, co-produced capability, addressing its material-discursive dimension (paper 3).en_US
dc.language.isoengen_US
dc.publisherBI Norwegian Business Schoolen_US
dc.relation.ispartofSeries of Dissertations
dc.relation.ispartofseriesSeries of Dissertations;
dc.titleUser representation as organisational doing. A study of ignorance and vulnerability in Norwegian patient-centered care.en_US
dc.title.alternativeUser representation as organisational doing. A study of ignorance and vulnerability in Norwegian patient-centered care.en_US
dc.typeDoctoral thesisen_US
dc.description.versionpublishedVersionen_US
dc.source.pagenumber261en_US
dc.source.volume2024en_US
dc.source.issue5en_US
dc.identifier.cristin2275583
cristin.ispublishedtrue
cristin.fulltextoriginal


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  • Series of Dissertations [101]
    This collection contains doctoral dissertations in full text (monographs), and article based dissertations' mantels since the start of BI's doctoral programme in 2000.

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