Home-help staff may break rules for their patients

Sep 21 2009

A new thesis from the University of Gothenburg, Sweden, reveals that out of loyalty to the people for whom they provide care, groups of home-help staff sometimes break the rules dictating how their work should be performed.
- Sometimes they do more work, or they do it differently, and as it delivers good quality care and keeps things moving the management turn a blind eye to it, says Marie Hjalmarsson.

This thesis aims to shed light on the dynamics and the complexity in the relationship between power and resistance in labour, from an employee-perspective. This is done by describing and analyzing how a group of employees in municipal home help services interpret and make use of their possibilities to act, in relation to a process of change, initiated by the management, involving new technology. Hand-held computers were implemented by the management and the home helps were supposed to use them to register their daily work performance. A theoretical framework based on power and resistance in accordance with Michel Foucault and Jon McKenzie, together with Ackroyd & Thompson's concept of self-organization, is used.

The study has an ethnographic approach. The empirical material is based on a combination of participant observation, interviews and document analysis. Two major periods of observations were conducted. The first period focused on understanding the work performance and its routines. During the second period, the use of (or rather attempts to use) the hand-held computers was in focus. The interviews with the 11 home helps focused on the meaning and content of their work with regards to work performance, skills and knowledge, possibilities and limitations and their opinions of the ICT project. Five management representatives, a local councillor, a software consultant and a union representative were also interviewed in order to grasp a management perspective.

The results show a pattern in the actions of the home helps. It is a rational way of acting where adaptability, responsibility and reliability permeate thoughts and actions. It functions as a premise for how the home helps interpret their possibilities to act at work. They address their loyalty in several directions: to the care recipients, but also to their colleagues, to the management and to the organization as such. This rationality of loyalty is reproduced by the home helps but also by the management. The home helps are aware to a certain extent of the loyalties in their actions and every so often they use them in a conscious way. They reflect on how strong the loyalty should be and towards whom or what it should be directed. The actions of the home helps at work in general and in relation to the ICT project in particular is characterised by loyalty and consent rather than by formal resistance. The home helps don't show any formal resistance but they do self-organization.

They strive towards a relative autonomy and to maintain their dignity. This way of acting is however related to the rationality of loyalty that has a regulating influence on their informal resistance. Despite the limited and informal character of the self-organization of the home helps, it can be considered subversive. It has a possibility of undermining the exercise of power and it creates an alternative professional identity to the one offered by the management.