Performing accountability in health research: A socio-spatial framework

Abstract

The article explores how spaces aimed at improving accountability in health systems are socially produced. It addresses the implications of an initiative to promote patient involvement in government-funded research in the context of a large cancer research network in England.We employ a socio-spatial theoretical framework inspired by insights from Henri Lefebvre and Judith Butler to examine how professional researchers, doctors and patients understand and perform accountability in an empirical context. Our data reveals fundamental tensions between formally-required and routinely-enacted dimensions of accountability as these are experienced by patients. Consequently, our analysis argues for a need to augment abstract, professionalised discourse about accountability in health services by acknowledging embodied spaces of representation, in which patients themselves can contribute to making participatory accountability a reality. We suggest that such a shift will provide a more rounded appraisal of patient experiences within health research, and health systems more widely.

Politicizing the Body in the Anti-Mining Protest in Greece

“…In doing so, we stress the performative capacity of the body as a means to organize and build support for alternative social movements. We also adopt the notion of umbrage emerging from embodied experience, to theorize practices of resistance in public space (Butler, 2015) and beyond (see Komporozos-Athanasiou, Thompson, & Fotaki, 2018, for an application of this idea to the context of healthcare). Inspired by Butler's (2015) contention of the performative power of the body in space, which constitutes and recreates it by altering relationships of power within it, we suggest that the body is never located in neutral space, but that space and the body within it exist in relation to others.…”

Whistleblower Subjectivities: Organization and Passionate Attachment

“…Theories emphasizing emotions are frequently critiqued from a poststructuralist, Foucauldian standpoint because they focus on the sovereign autonomous self who ‘feels’, rather than the individual subject’s location amid discourses of power, but this is not the case here. Rather, Butler’s affects are different to emotions, relating to unconscious psychic dynamics of the body’s desire to be (Fotaki, Kenny, & Vachhani, 2017; Komporozos-Athanasiou, Thompson, & Fotaki, 2018). They are expressed as the ‘force’ that fuels the ‘form’ of subjective attachment to discourse (Kenny & Gilmore, 2014, p. 166; Hook, 2007; Parker, 2005).…”

The dialectics of spatial performances: The interplay of tensions in activity-based organizing

“…Second, unlike the majority of research that adopts Lefebvre (1991), this study focuses on the micro-processes of everyday actions and interactions that produce space as a holistic performance. Yet, unlike past research (Komporozos-Athanasiou et al, 2018), it shows how organizational members embrace and manage tensions in their everyday interactions, rather than resolving them. Resolving suggests that tensions disappear, whereas managing them focuses on moving forward, making decisions, and embracing opposites (Schad et al, 2016).…”

“…Even though these studies embrace Lefebvre’s (1991) triad, researchers typically focus on macro-organizational levels. Only Komporozos-Athanasiou et al (2018) examine how organizational members enact space in the micro-level tensions among the three spatial dimensions. Their study of a healthcare clinic reveals that tensions between conceived space and the rules for governing it clash with social expectations (perceived space).…”

“…In the research that employs Lefebvre's theory, tensions are mentioned, but are rarely treated as the central focus of a study (see Komporozos-Athanasiou et al [2018] for an exception). Similarly, the research on organizational workspaces acknowledges the importance of tensions, but rarely makes it the focus for investigations.…”