Layering risk work amidst an emerging crisis: an ethnographic study on the governance of the COVID-19 pandemic in a university hospital in the Netherlands.

IF 1.8 4区 医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Health Risk & Society Pub Date : 2021-04-05 eCollection Date: 2021-01-01 DOI:10.1080/13698575.2021.1910210
Bert de Graaff, Jenske Bal, Roland Bal
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引用次数: 16

Abstract

The start of the COVID-19 pandemic early 2020 has confronted healthcare sectors with risks and uncertainties on an unprecedented scale in recent history. Healthcare organisations faced acute problems, the answers to which had to be provided, and recalibrated, at short notice and informally. University hospitals played a pivotal role in providing these answers and in (re)calibrating institutional arrangements. Based on ethnographic research in an elite university hospital in the Netherlands, in this article we explore the concrete practices of governing risks and uncertainties that COVID-19 posed for the organisation of healthcare. Our fieldwork consisted of the observation of meetings at the level of the hospital boards, the staff, and the regional level. We collected relevant documents and interviewed key-actors. This approach offers us a large dataset on acute risk governance 'from within' and allows us to offer a layered ethnographic account of managerial practices. In our analysis we focus on conceptualising the work-as-done in the university hospital as risk work. We show how the risk work of our participants is generally characterised by high speed and delineated by scarcities. We differentiate between three modes of risk work: working on numbers, working on expertise and working on logistics. This risk work appears innovative, but our analysis stresses how participants' work happened in interaction with traditional institutional logics and routines.

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在新出现的危机中分层风险工作:荷兰一所大学医院对COVID-19大流行治理的民族志研究
2019冠状病毒病大流行于2020年初开始,给医疗保健部门带来了近代史上前所未有的风险和不确定性。医疗保健组织面临着严重的问题,必须在短时间内非正式地提供答案并重新校准。大学医院在提供这些答案和(重新)校准制度安排方面发挥了关键作用。本文以荷兰一所精英大学医院的民族志研究为基础,探讨了治理COVID-19给医疗保健组织带来的风险和不确定性的具体实践。我们的实地工作包括观察医院董事会、工作人员和区域一级的会议。我们收集了相关文件并采访了关键人物。这种方法为我们提供了“来自内部”的急性风险治理的大型数据集,并允许我们提供管理实践的分层民族志描述。在我们的分析中,我们着重于将大学医院已完成的工作概念化为风险工作。我们展示了参与者的风险工作通常是如何以高速和稀缺性为特征的。我们将风险工作分为三种模式:处理数字、处理专业知识和处理物流。这种风险工作似乎具有创新性,但我们的分析强调参与者的工作是如何与传统的制度逻辑和惯例相互作用的。
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来源期刊
CiteScore
3.30
自引率
14.30%
发文量
23
期刊介绍: Health Risk & Society is an international scholarly journal devoted to a theoretical and empirical understanding of the social processes which influence the ways in which health risks are taken, communicated, assessed and managed. Public awareness of risk is associated with the development of high profile media debates about specific risks. Although risk issues arise in a variety of areas, such as technological usage and the environment, they are particularly evident in health. Not only is health a major issue of personal and collective concern, but failure to effectively assess and manage risk is likely to result in health problems.
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