"The Patient comes First"! The Patient as a construction Enabling and Disabling change.

Carina Beckerman


The contribution of this paper is a discussion about how the concept the patient is constructed and used by employees for different purposes, enabling or disabling change. The perspective taken is that the health-care employees belong to a collective that is characterized by a special thought style. How they talk about the patient is part of a unique language and an identity which allows these group members to learn who knows what, what is accepted behaviour and coordinate their activities. The results presented in this paper are based on a three years interpretative case study of how a patient record was constructed and reconstructed and then computerized. The questions asked are: How is the patient constructed? Why is the patient constructed like she is? When is the patient constructed like she is? Data has been collected using interviews and then analyzed within a framework consisting of theories about interpretative schemes, cultural knowledge and communication as institutional talk. The findings indicate that the core expression in a practice such as “the patient comes first” has implications for how management of change-projects are conducted and a patient record reconstructed in a hospital. It might be used for not doing things that might have been in the interest of the patient. This paper is meant to be thoughtprovoking and directs itself towards people in health-care involved in different development-and changeprojects.

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Scandinavian Journal of Public Administration

School of Public Administration, Box 712 - SE-405 30 Göteborg

ISSN: 2001-7405, E-ISSN: 2001-7413