Narratives about Negative Healthcare Service Experiences: Reported Events, Positioning, and Normative Discourse of an Active Client

Abstract

Narratives about clients’ service experiences in healthcare organizations constitute a crucial way for clients to make sense of their illness, its treatment, and their role in the service process. This is important because the client’s role has recently changed from that of a passive object of care into an active responsible agent. Utilizing Bamberg’s narrative positioning analysis as a method, and 14 thematic interviews of healthcare clients with multiple health-related problems as data, we investigated the expectations of the client’s role in their narratives about negative service experiences. All the narratives addressed the question of the clients’ “activeness” in some way. We identified three narrative types. In the first, the clients actively sought help, but did not receive it; in the second, the clients positioned themselves as helpless and inactive, left without the care they needed; and in the third, the clients argued against having to fight for their care. In all these narrative types, the clients either demonstrated their own activeness or justified their lack of it, which—despite attempts to resist the ideal of an “active client”—ultimately just reinforced it. Attempts to improve service experiences of clients with considerable service needs require a heightened awareness of clients’ moral struggles.

Healthcare providers’ narratives about interactionally troubling patient exchanges: Accounting for and against an active patient role

“…Patients themselves may have very different perceptions of their position on this continuum, and this warrants further investigation. Weiste and colleagues ( 2022 ), for example, found that healthcare patients with chronic conditions orient towards cultural expectations of patient activeness. In this study, when healthcare providers complained about passive patients, patient passiveness as being understandable; instead, patient activeness was seen as an expectation that everyone should adhere to.…”

“…However, while complaints about patient passiveness are unproblematic from the perspective of these ideals, complaints about patient over-activeness are much more difficult to account for, due to their inherent connotations with paternalism. There is thus a need to address the discrepancy between the ways in which participants perceive and interpret trouble at work on an experiential level and the ways in which they can account for these experiences in interaction—a topic that has lately been generally addressed in various contexts and with various participants (see, e.g., Olakivi et al, 2024 ; Stevanovic et al, 2024 ; Weiste et al, 2022 ).…”

“…Patients’ passiveness was not described as understandable to service providers, regardless of the patients’ difficult life situations (cf. Weiste et al, 2022 ). Rather, activeness became an obligation, something that patients could, and should, choose in their lives.…”

“…For instance, in Denniston and Rees’s ( 2018 ) study, patients in positively evaluated service narratives described themselves as actively communicating with healthcare providers and experiencing trust and appreciation from providers; however, in negatively evaluated client narratives, patients depicted themselves being passive in the patient-provider relationship and experienced this relationship as lacking trust and sufficient safety (Denniston & Rees, 2018 ). In another study (Weiste et al, 2022 ) about negative healthcare service experiences, patients recognized that providers expect them to be active, but objected to this expectation by, for example, claiming that they are not to blame for the loss of their activeness due to illnesses.…”