Academic journal article Nordic Journal of Working Life Studies

Struggles of Professionalism and Emotional Labour in Standardized Mental Health Care

Academic journal article Nordic Journal of Working Life Studies

Struggles of Professionalism and Emotional Labour in Standardized Mental Health Care

Article excerpt

Introduction

Work in the public health sector in Denmark, as well as in other Nordic countries, has in the last 15-20 years undergone radical changes due to ongoing rationalization and market orientation under headings such as New Public Management, Quality reform, and Lean production (e.g. Bovbjerg, 2011; Christensen, 2012; Sahlin-Andersson, 1999). The ramifications of these reforms for healthcare professionals and their working life have been intensively debated. In particular, the position, status and identities of the professionals, and their autonomy and possibility to exert professional assessment have been at focus (Hjort, 2001). Several studies explore how different groups of professionals experience ambiguity between a new managerial identity and the traditional care-oriented professional identity (Blomberg, 2003; Rasmussen, 2012). They also point out how professionals struggle and partly resist this development toward a market-oriented rationality, in some cases by taking on extra work in order to satisfy profession norms an standards, thus leading to self-intensification (Kirschhoff & Karlsson, 2013; Rasmussen, 2004; Selberg, 2013), in other cases by reframing the new market-oriented ideas in order to make ends meet (Dahl, 2009). Also, the bureaucratic and tayloristic traits of the reforms are attended to, as they tend to undermine professional autonomy and meaningfulness (Dybbroe, 2012; Kamp, 2012; Kröger, 2011).

However, while these general insights are indeed valuable, we will argue that it is important to scrutinize how these reforms are embedded into the specific fields within healthcare with their particular history, context, and practices. Thus, we will explore how ideas on the overall aim of work, configurations of professional groups, and organization of work are negotiated and resisted in ways that bear markings of traditions and experiences in the field.

In Denmark, work in mental healthcare is often organized in interdisciplinary teams comprising social, educational and care workers, nurses, psychologists, and psychiatrists, all involved in the work of diagnostics and treatment. Emotional labor is an ongoing part of work in mental health care that involves interaction with patients and their networks. It is a highly skilled and varied professional activity, where emotions are managed, processed, or contained, and may represent the very core of the job, or merely an element needed to 'get the job done'. We explore how this interdisciplinary and emotionally skilled work is practised and at the same time transformed through the different market-oriented reforms that have swept over the psychiatry in recent years, and how transformations of social relations and positions are instigated.

In studying these very complex processes, we focus on standardization, as this is one of the main measures used in these reforms in order to enable central management and control of work, quality, and output. New Public Management, for example, implies a division of sectors into different (economic) self-contained units, which 'sell to' and 'buy from' each other, and here standardization of services to enable counting and pricing and centrally controlling the units via contracts. Standardization of services thus becomes the political prerequisite for contract management and outsourcing (Busch et al., 2005; Greve, 2003, 2007).

Setting standards implies establishing a uniform description of a field. This might facilitate the division and intensification of work that characterize a neo-tayloristic work organization. But it also implies creating a specific vocabulary for work activities and for what is being accomplished through work, thus voicing and privileging particular forms of knowledge and practises, while silencing other forms (Timmermans & Berg, 2003). These new uniform descriptions alongside experiences of working in new fragmented and disruptive organizations may transform ideas of professionalism and challenge professional identities, inter-professional relations, and positions in hierarchical professional institutions, such as in the health system (Evetts, 2011). …

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