Everyday Organisation of Care in Times of Workforce Shortages

Healthcare systems across the Global North are struggling to meet increasing healthcare demands whilst also trying to overcome structural workforce shortages. Policy solutions are often framed in terms of digitalisation and more efficient collaboration between healthcare organisations. In this line of thought, digitalisation can help to replace healthcare work and/or to provide ‘care at a distance’, whilst improved collaboration between healthcare providers should help to overcome fragmentation and streamline individual healthcare trajectories. But in a system where collaboration between care institutions is becoming more important, professional interdependencies extend beyond disciplinary and organisational boundaries. In this context, all sorts of competing value orientations exist that impact the accessibility and continuity of healthcare for individual patients. In this study, I explore the everyday organisation of care by asking how healthcare workers organise, provide and account for individual care trajectories in daily practice and across organisational boundaries.

Insights are drawn from ongoing ethnographic research in which I have shadowed healthcare professionals at the critical entry- and exit-points of a hospital, including the emergency care unit and discharge unit, in a medium-sized town of the Netherlands. In doing so, I shed light on the intricate and micro political practices through which healthcare workers organise care on a daily basis. I show how healthcare workers need to make situated, timely, and sometimes difficult decisions, such as who to provide care to, transfer to other providers, or strategically ignore – which can be based on very different value orientations. This does not only have consequences for individual healthcare trajectories but can also undermine the self-regard of healthcare professionals involved in making and executing these decisions. Therefore, in the light of current challenges, developing empirical insights that capture the consequences of structural workforce shortages for healthcare professionals and their profession is critical.