Temporal typifications as an organizational resource: Experiential knowledge and patient processing at the emergency department

Abstract

The connection between time and power has been studied extensively. A common strategy through which street-level bureaucrats exert power and dominance over their clients consists of imposing protracted waiting and maintaining uncertainty regarding the outcomes of waiting. In this study, I argue that another facet of power in organizations is related to the temporal typification of cases. By exploring the triage work in two emergency departments (EDs), I show that nurses and clerks identify patterns in the temporal distribution of visits and attach clinical and moral meanings to them. The temporal typifications are sense-making devices through which triage workers orient to patients. They form a stock of tacit experiential knowledge that delineates specific expectations about the legitimacy of cases and the worth of patients. These expectations impact the unfolding and structure of triage admission interviews and contribute to the prioritization of cases. The study brings into conversation the sociological literature on time and power with the study of the moral evaluation of patients to examine temporal typifications as an organizational resource in healthcare settings. It contributes to a better understanding of triage workers’ experiential knowledge and the practical accomplishment of moral evaluation in EDs.

Governing the “Unmarked” Citizens: Romania’s Roma in the Grip of Socialist Technologies of Power

“…Another case of pre-defined stock of knowledge that the Romanian authorities used was the “hygienic-sanitary condition of the Gypsies,” who were evading the medical-sanitary controls and immunization programs, which determined “an increased frequency of infant mortality, venereal diseases, typhoid fever, tuberculosis,” within the Roma communities (Council of Ministers - State Undersecretary for National Minorities 1952b; Romanian Communist Party 1977). This stock of knowledge that circulated over decades functioned as typifications (Schutz and Luckmann 1989) through which the powerholders could subdue the object of governing to a “limited set of familiar, recurrent features that can be adequately interpreted and dealt with in order to achieve desired outcomes” (Wamsiedel 2021, 4).…”

Informal payments by patients, institutional trust and institutional asymmetry

“…For many decades the phenomenon of informal payments by patients was thought to be disappearing in the context of economic development and the modernization of health authorities and a minor practice. However, the starting point of this paper is recent data from Kantar (2020) , amid the COVID-19 pandemic, when an investigation into informal payments across different sectors in the European Union revealed that the highest share of informal payments (6% of all respondents) was in health services ( Kukutschka, 2021 ), and is connected to the social-economic environment ( Balabanova and McKee, 2002 ; Wamsiedel, 2022a , b ). Such informal payments by patients can be seen as “gratitude payments” or “unofficial fees” ( Ensor, 2004 ) that patients offer for receiving preferential access to public health services.…”