Ethnographic reflections on access to care services

Abstract

Purpose The purpose of this paper is twofold: to explore how gatekeepers’ ways of regulating the researchers’ access to knowledge in/about care services reflect the systemic and interpersonal values that inform Danish welfare systems’ daily workings at the street level; and also explore how the authors’ methodological experiences mirror the value-informed regulatory strategies that professionals and users themselves experience in their daily encounters in the same local practices that the authors have studied. Design/methodology/approach The paper takes its empirical point of departure in a multisited ethnographic field study of the management of citizens with complex problems in Danish welfare systems. Findings By means of Michael Lipsky’s outline of access regulation, the authors will analyze the following regulatory strategies that are identified during the fieldwork: “Gatekeepers’ sympathy and creaming,” “Queuing and delay,” and ‘Withdrawal of consent and “no resources.” The paper suggests that trust, shared goals and sympathy seem to be key to the process of getting access. Originality/value Despite principles of neutrality, equal rights and access to services in welfare systems, the authors’ experiences thus tend to support other research within bureaucratic and care organizations, which has found that interpersonal relations, sympathy, dislikes, norms and values, etc., can heavily influence timely access to services, tailored information and support.

“That's not a proper ethnography”: a hybrid “propportune” ethnography to study nurses' perceptions of organisational culture in a British hospital

“…Access to the field is always an issue for the ethnographer because of the intense and intimate nature of observational research and is especially difficult within healthcare settings because of the highly regulated environment and presence of vulnerable persons/patients. Oute and Bjerge (2019) highlight the difficulties in gaining access to care organisations, and Buskermolen (2023) considers similar challenges in bureaucratic organisations. We suggest researchers need to be able to navigate ethics boards and adapt their data collection activities to fit their temporal frameworks.…”

What are dually diagnosed patients’ problems represented to be in mental health? A WPR analysis of the multistability purpose of digital health records

“…In Denmark, social studies are not formally regulated by host institutions, and the Danish National Committee on Health Research Ethics only assesses biomedical studies such as psychosurgery or clinical trials. Nevertheless, psychiatric frontlines and Danish Health authorities both informally and formally regulate the access to obtaining patients’ consent to allow the inclusion of their records in the study (Oute & Bjerge, 2019). Access to the records was thus thoroughly regulated, although approval to conduct this study from the host institution and the Danish National Committee on Health Research Ethics is not a legal requirement, as WPR studies are a form of inquiry rooted in the social sciences.…”

Innledning

“…Ved fx at betegne pårørende som «ressourcer» for medicinsk pleje og behandling og andre sundhedsfaglige indsatser portraetteres pårørende og diagnosticerede personer og deres inddragelse overordnet set i målsaetninger om systemreform, effektivisering og målstyring (Glasdam & Oute, 2018). I Skandinavien ses dette ikke bare inden for det psykiatriske område, men også på aeldreområdet (Alvsvåg, 2018), kraeftområdet (Glasdam, 2007), stofbehandlingsområdet og beskaeftigelsesområdet (Oute & Bjerge, 2018). Disse neoliberale reformer af velfaerdsstaterne former professionelles forestilling om pårørendeinddragelse i praksis (Alvsvåg, 2018;Garrett, 2019).…”