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Maintaining “Good” Care: An Articulation Work Perspective on Organizational Ethics in the Healthcare Sector

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Abstract

The literature on organizational ethics has paved the way for a situated and intersubjective understanding of ethics through caring practices. In this article, we try to extend this perspective by looking beyond the interactions of caregivers among themselves or with care seekers to reveal ethics as the ongoing collective accomplishment of a variety of actors. We do so by mobilizing Strauss’s theoretical perspective of articulation work in the context of healthcare. Based on an ethnography, we show how actors of care (e.g., nurses, caregivers, or doctors) operate within care arrangements that need to be frequently rearticulated to face ethical threats and protect their patients’ well-being. We distinguish three types of rearticulation corresponding to different degrees of rearticulation, individual actor stance, and specific ways of working things out. We discuss their implications for the maintenance of organizational ethics.

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Notes

  1. However, although the physicians were not the hierarchical superiors of the paramedics (in contrast to the health executive), they nevertheless exercised their authority over the latter, if only because they established the medical prescriptions.

  2. Insofar as these two trajectories are being “disarticulated” incessantly, they allow us to observe the collective work of caregiver rearticulation on the spot.

  3. Although the functional unit in which we conducted our observations was not a palliative care unit, it could nevertheless accommodate people at end of life. In this 36-bed unit, there were always at least two or three beds reserved for people at the end of life. The situations of Ms. D1 and D2 are therefore not exceptional, but representative of a certain type of trajectory, what Strauss calls “end-of-life” and/or “death” trajectories (death being understood by Strauss as a process).

  4. Following the visit of the palliative care specialists to the department. On this occasion, it was decided to stop tube feeding and reduce the amount of care provided.

  5. This does not mean, of course, that we condone these resource-constrained environments, quite the contrary.

  6. From an ethical point of view, we should clearly distinguish between what happens in interactions with the patient—where ethics in dialog means respect for the individual and, therefore, for the rules of politeness and decorum—and what goes on and is said behind the scenes, between colleagues, which is not intended to be heard by patients or families.

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Acknowledgements

We would like to thank all the members of the geriatric operational unit in which the ethnographic survey was carried out (orderlies, nurses, doctors and health executive). The article also benefited from a paper development workshop in December 22, and a writing seminar held in Avignon in June 23 (both organized by Neoma Future of Work Area). Jane MacKinnon was very helpful in revising our ideas and refining the expression. Finally, we would like to thank the editor and the two anonymous reviewers for their support and constructive comments on early drafts of the document.

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  1. Neoma Business School, Reims, France

    Jean-Baptiste Suquet

  2. Université de Franche-Comté, Besançon, France

    Damien Collard

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Correspondence to Jean-Baptiste Suquet.

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All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Research Involving Human and Animal Rights

Before conducting the observation, the second author exposed his project to and received an agreement from the head of the hospital service. After having observed the service, he presented a diagnosis report to a research monitoring committee, constituted of representatives of the service (orderlies, nurses and doctors). They provided him with their feedbacks, which he took into consideration to amend his report, until a shared diagnosis was reached. As for the ethical approval from their respective institutions, none of the authors’ had an ethic committee when the research project was undertaken, nor were in capacity to provide them with ethical approval.

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Suquet, JB., Collard, D. Maintaining “Good” Care: An Articulation Work Perspective on Organizational Ethics in the Healthcare Sector. J Bus Ethics (2024). https://doi.org/10.1007/s10551-024-05616-z

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