Exploring difference as a dynamic of dialogue: A study of the relational construction of “person-centred” care in an interdisciplinary social and health care team

In dialogue-based communication, communication is configured as dialogue in which multiple social actors co-produce knowledge collaboratively across multiple knowledge forms and knowledge interests. According to dialogic ideals, expert knowledge is democratized as multiple ways of knowing are recognized as legitimate. Crucially, difference is viewed as the transformative force in the co-construction of knowledge in dialogue. By harnessing difference as a transformative force, it is claimed, dialogue can generate knowledge across difference, including differences of organizational position and professional background, theoretical perspective, gender, ethnicity, class and so on.
But how exactly is knowledge co-produced in dialogue through the harnessing of “difference” as a transformative force?
And what tensions are in play in dynamics of inclusion and exclusion where some voices, articulating particular forms of knowledge and subjectivities, dominate and others are marginalised?
The paper examines these questions through empirical analysis of the collaborative practices of an interdisciplinary social and health care team in Australia which offers advice to residential care home workers on “person-centred” care for residents with dementia. The theoretical framework, The Integrated Framework for Analysing Dialogic Knowledge Production and Communication (IFADIA), is based on a combination of Bakhtinian dialogic communication theory and Foucault’s theorization of discourse and power/knowledge. The theoretical framework is applied in empirical analysis of how knowledge is co-produced collaboratively across difference in social interaction in six team case meetings. Methods of data production are video and audio recording and participant observation.
The focus of the analysis is on the relational construction of “person-centred care” and the collective identity of the team in opposition to the practices and identities of residential care workers and relatives of residents. The analysis shows how knowledge is co-produced within a discourse which constructs a particular understanding of “person-centred care”, particular social relations within the team and between the team, residential care workers, residents and relatives, and particular identities for team members, care workers, residents and relatives. Within the discourse, “person-centred care” is ascribed meaning qua its difference from non-person-centred care, and a collective identity as advisory team is created through the difference from care-workers. A strong team “we” is (re)produced that engages in “person-centred care” and treats residents in the normatively correct, “person-centred” way in opposition to the residential care personnel-“Other” who treat residents in the normatively wrong, non-person-centred way.
The conclusion explores the implications of the empirical results in relation to dynamics of inclusion and exclusion at work in the harnessing of “difference” in dialogue. It is concluded that inclusion and exclusion are in play in the relational construction of “person-centred care” and identities as advisory team and residential care workers. In particular, the construction of residential care workers as the Other who do not treat residents in the normatively correct way has implications for the knowledge about “person-centred care” that is produced and the relations that are established and maintained in social interaction between the team and residential care workers. It can be argued that it limits how dialogic and person-centred that social interaction can be.