Abstract
Contemporary meanings of care are described for HealthCare Otago workers, through research carried out during 1997/98 in two sites - Wakari and Dunedin hospitals. Data came from participant observation and open ended interviews with forty informants; grounded theory (Strauss and Corbin 1994) was used to interpret the results.
The external research environment saw repeated government restructuring of state provided health services with reductions in funding for hospital services in Otago. Healthcare Otago was placed under severe political pressure to maintain its current level of services within these constraints. This was achieved by withdrawing support from rural Otago hospitals and beginning dramatic internal restructurings marked by the formation of Clinical Practice Groups and the disestablishment of departmental heads and senior ancillary staff positions in favour of hybrid managerial/clinician positions.
The research reveals two major understandings of care - able to be predicted on the basis of occupational group - called Type One and Type Two care. Type One care is associated with clinical workers and includes orderlies, consultants, nurses, dieticians, receptionists, radiation therapists, medical radiation technologists and social workers. Type Two care was described by the senior
administration workers, the computer specialists, the managers and the C.E.O. Type One care is a relationship between strangers where for giving good care the carers receive the gift of knowing their care is appreciated. The techne of good Type One care must be close to perfection, but it also contains instruments of care which arise from the carer's personalities. Excellent Type One Carers
are collegially oriented technicians who can blur the borders of their occupational categories. They juggle three occupational difficulties referred to by the concepts of cost, risk and distance. Their orientation to their work is best explained by Weber (1984 [1930]) in his description of work as a calling. Shortage of time was the principal impairment to the production of Type One care.
The object of care for Type Two Carers is the hospital system, which they regard as being metaphorically ill and in need of treatment. Type Two Carers have tenuous relationships with patients whom they conceptualize as customers. Care means medical procedures plus "good customer service" and excellent care is that which is mass produced, of consistent high quality, what the consumer would like, and from which all variation has been removed. It is an abstraction produced from measurements and monitored constantly. Evidence based medicine, clinical practice groups, care pathways, continuous quality improvement and information systems are the instruments of care associated with this style. Type Two Carers have an orientation to work described by Saul (1992, 1997) as those of a technocrat.
These care styles are a new division in the labour of care with Type Two Carers taking over the administrative and accounting aspects of Type One Care, due to the cost of Western medicine and the prevailing political climate. Both styles produce problems for the other and operate in mutual hostility and the proponents need to learn to broker tradeoffs between their conflicting demands.