Providing rehabilitation online – invisible work and diagnostic agents
Journal of Health Organization and Management
ISSN: 1477-7266
Article publication date: 16 November 2015
Abstract
Purpose
Telecare promises to deliver healthcare services more efficiently while, at the same time, improving the quality of care. The purpose of this paper is to challenge these promises by analysing the implications of introducing telecare in the rehabilitation of patients suffering from chronic obstructive pulmonary disease.
Design/methodology/approach
Empirically, the paper is based on interviews with and observations of rehabilitation therapists and patients taking part in a Danish telerehabilitation programme. Theoretically, the paper draws on Science and Technology Studies.
Findings
The introduction of telecare alters rehabilitation practices in multiple ways. First, several new time-consuming work routines, carried out in collaboration between therapists, patients and technical professions, emerge. Although crucial in establishing and maintaining telerehabilitation infrastructures, this work remains invisible in evaluations of the programme. Second, rather than simply increasing patient agency, responsibilities are redistributed and negotiated in subtle and non-uniform ways. These negotiations make it less transparent where one responsibility begins and where another potentially conflicting one ends.
Practical implications
Evaluations of telecare technologies should pay more attention to work- and responsibility-related effects of introducing telecare in order better to account for predicted and unpredicted as well as desirable and undesirable socio-technical changes.
Originality/value
Using an ethnographic approach, the paper points to the discrepancy between simplistic political promises that telecare technologies can serve as tools for improvement, on the one hand, and the substantial changes in the organisation and management of healthcare observed in practice, on the other. Rather than regarding telecare as technologies of improvement, it is more productive to regard them as technologies of change.
Keywords
Acknowledgements
The authors wish to thank everyone who participated in this study. The authors thank the healthcare professionals for allowing us to observe their work practices and for sharing their unreserved and honest reflections on Online COPD Rehabilitation. The authors thank the patients for allowing us into their homes and for sharing their experiences with participating in Online COPD Rehabilitation. The authors owe a special thanks to the managing nurse for facilitating contact to patients and for providing useful support and information during the entire study.
Citation
Bødker, M. and Juul Nielsen, A. (2015), "Providing rehabilitation online – invisible work and diagnostic agents", Journal of Health Organization and Management, Vol. 29 No. 7, pp. 948-964. https://doi.org/10.1108/JHOM-06-2014-0091
Publisher
:Emerald Group Publishing Limited
Copyright © 2015, Emerald Group Publishing Limited