User involvement in care work: challenging professional work and identities

In recent years user involvement has become a paradigm for transforming the health and social care sector. This development–also labelled empowerment, co-creation, partnership, patient-centeredness - is seen as a means to reform organizations in ways that enhance quality, economic cost effectiveness and shared responsibility for care pathways. While NPM position users as consumers making their free choice, the user involvement paradigm underlines the users’ active participation in the mastering of their problems and disease. Research is scarce on this theme, and has until now primarily addressed the way this paradigm affects the users, in specific sectors. However user involvement also affects working life. It may imply change and redistribution of tasks and identities between users and professionals, and may also transform the relations of care. In this paper we explore the possible implications of this for care professionals, their practices, professional identities and positions in the work organization.

Based on tree explorative qualitative studies in Danish homecare, psychiatry and cardiology, we illustrate first how user involvement may assume very different forms; in some instances user-involvement is informed by evidence-based medicine and thus supports a quite standardized interaction between professional and user. In other instances professional standards are more or less replaced by the users’ subjective assessments of the situation. In yet other instances user involvement is constructed as an idealization of the “correct patient” reflecting dominating norms and morals rather than standards. We will discuss these different forms of user involvement and illuminate empirically as well as theoretically how they change relations between patients and health professionals, promote new forms of professionalism, and imply tensions in health and social care work.