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This article draws on 2 years' worth of ethnographic observation of team meetings to explore decision‐making in an NHS clinical genomics service. The focus of discussions was on ambiguous genomic results known as VUS or Variants of Uncertain Significance, which may be pathogenic but which also may turn out to be benign. In examining decision‐making around such results, we note how, in contrast to much policy and promotional material in this area, clinicians in these meetings (clinical geneticists and genetic counsellors) place great emphasis on parental phenotypes and whether the parents of a patient share the symptoms and signs of the suspected condition. This information is then combined with the result of genomic tests to decide whether the variant a patient has is responsible for their condition. This article explores the way in which clinicians attempt to flexibly enrol parents into genomic explanations through informal diagnosis of their possible phenotypes and the way in which actually meeting parents allows some clinicians to trump explanations based on documentary or photographic data. The paper sheds light on the way that earlier scholarly understandings of such decisions (around, say dysmorphology) remain relevant and explores claims that laboratory tests overrule clinical decision‐making. [ABSTRACT FROM AUTHOR]

Health‐related ethnography undertaken in a context marked by social inequalities and colonial legacies requires critical attention to power imbalances in the fieldwork. In this paper, I draw on my own experiences from studying genetic research in Pakistan. As a Danish‐born female researcher with roots in Pakistan, I have followed genetic researchers and families dealing with genetic conditions in Pakistan. Through examples I unearth how encounters in the field were shaped by complicities of being in‐between the Danish and the Pakistani, of studying and doing international research at the same time, and of my inaction towards suffering families. I base my analysis on the notion that complicity manifests in a generative, and unavoidable, engagement with both complex structures of inequality and interlocutors. We can never fully understand the specificities or consequences of complicity—whether moral or epistemic—when entering, engaging with or representing our fields. However, by staying constructively with the tensions, instead of attempting to move beyond the discomfort that they might create, we can learn how to deal with the consequences and in that, build further the value of ethnographic activity. [ABSTRACT FROM AUTHOR]

Social prescribing, a way of connecting patients to local services, is central to the NHS Personalised Care agenda. This paper employs ethnographic data, generated with 19 participants between November 2018 and July 2020, to explore the socio‐temporal relations shaping their experiences of a local social prescribing intervention. Our focus is on the ways in which the intervention synchronised with the multitude of shifting, complex and often contradictory 'timespaces' of our participants. Our focus on the temporal rhythms of everyday practice allows us to trace a tension between the linearity and long horizon of the intervention and the oft contrasting timeframes of participants, sometimes leading to a mismatch that limited the intervention's impact. Further, we observed an interventional 'drift' from continuity towards unsupported signposting and 'out‐of‐the‐blue' contacts which favour the temporality of the intervention. We demonstrate a need for intervention planning to be flexible to multiple, often conflicting, temporalities. We argue that health interventions must account for the temporal relations lived by the people they seek to support. [ABSTRACT FROM AUTHOR]

In the past decade, the figure of the algorithm has emerged as a matter of concern in discussions about the current state of the healthcare sector and what it may become. While analytical focus has mainly centred on 'algorithmic entities', the paper argues that we have to move our analytical focus towards 'algorithmic assemblages', if we are to understand how advanced algorithms will affect health care. Departing from this figure, the paper explores how an algorithmic system, designed to 'take on' the role of a physiotherapist in physical rehabilitation programmes in Denmark, was designed and made to work in practice. On the basis of ethnographic fieldwork, it is demonstrated that the algorithmic system is a fragile accomplishment and outcome of negotiations between the imaginaries embedded in its design and the ongoing adjustments of IT workers, patients and professionals. Drawing on recent work on the fragility and incompleteness of algorithms, it is suggested that the algorithmic system needs to be creatively 'repaired' to build and maintain enabling connections between bodies in‐motion and professionals in arrangements of care. The paper concludes by addressing accountability for the workings of algorithmic systems in medical practice, suggesting that such questions must also be discussed in relation to encounters between algorithmic imaginaries, health professionals and patients, and the various forms of 'repair work' needed to enable algorithmic systems to work in practice. Such acts of accountability cannot be understood within an ethics of transparency, but are better thought of as an ethics of 'response‐ability', given the need to intervene and engage with the open‐ended outcomes of algorithmic systems. [ABSTRACT FROM AUTHOR]

The financial and capacity pressures facing healthcare systems call for new strategies to deliver high‐quality, efficient services. 'Coproduction' is a concept gaining recognition as an approach to create patient partnerships that enable better functioning healthcare systems. Yet, this framing obscures coproduction's 'everyday and unavoidable' character, already part of healthcare service delivery. This paper aims to understand these everyday and unavoidable dimensions of coproduced healthcare services by drawing upon thematic and process analyses of a 15‐month ethnography of 45 patients in three HIV clinics in New York. A 'health practices' approach guided exploring patients' activities, their effects on clinical processes, and the conditions surrounding their performances. By constructing a typology of activity types – Building, Accepting, and Objecting – and tracing patients' descriptions of activity performances, the paper shows how coproduction is forged by making and relying upon clinic‐based relationships, and for patients also with a broader human community. These dynamics reveal how patients' bodily and temporal understandings are brought into and shape coproduced services. From these insights, we recommend that healthcare practitioners incorporate into their coproduction analytic methods and perspectives to engage patients as capable and aware individuals, who can support clinic efficiencies while producing new delivery possibilities. [ABSTRACT FROM AUTHOR]

Attending to the material discursive constructions of the patient body within cone beam computed tomography ( CBCT) imaging in radiotherapy treatments, in this paper I describe how bodies and machines co-create images. Using an analytical framework inspired by Science and Technology Studies and Feminist Technoscience, I describe the interplay between machines and bodies and the implications of materialities and agency. I argue that patients' bodies play a part in producing scans within acceptable limits of machines as set out through organisational arrangements. In doing so I argue that bodies are fabricated into the order of work prescribed and embedded within and around the CBCT system, becoming, not only the subject of resulting images, but part of that image. The scan is not therefore a representation of a passive subject (a body) but co-produced by the work of practitioners and patients who actively control (and contort) and discipline their body according to protocols and instructions and the CBCT system. In this way I suggest they are ' con-forming' the CBCT image. A Virtual Abstract of this paper can be found at: . [ABSTRACT FROM AUTHOR]

The social positioning and treatment of persons with dementia reflects dominant biomedical discourses of progressive and inevitable loss of insight, capacity, and personality. Proponents of person-centred care, by contrast, suggest that such loss can be mitigated within environments that preserve rather than undermine personhood. In formal organisational settings, person-centred approaches place particular responsibility on 'empowered' direct-care staff to translate these principles into practice. These staff provide the majority of hands-on care, but with limited training, recognition, or remuneration. Working within a Foucauldian understanding of power, this paper examines the complex ways that dementia care staff engage with their own 'dis/empowerment' in everyday practice. The findings, which are drawn from ethnographic studies of three National Health Service ( NHS) wards and one private care home in England, are presented as a narrative exploration of carers' general experience of powerlessness, their inversion of this marginalised subject positioning, and the related possibilities for action. The paper concludes with a discussion of how Foucault's understanding of power may help define and enhance efforts to empower direct-care staff to provide person-centred care in formal dementia care settings. [ABSTRACT FROM AUTHOR]

This paper explores nurses' experiences as members of primary care organisations set up to develop and commission health services for local communities. Nurses, alongside GPs and other health professionals, were given a place on the governing bodies (boards) of Local Health Groups - a move widely welcomed by the nursing profession as long overdue recognition of the important contribution nurses and nursing could bring to the policy arena. Nurse board members faced a number of challenges in their attempts to contribute to and influence local health policy. This ethnographic study (which involved non-participant observation of 33 board meetings and interviews with 29 board members including nurses) suggests that medical authority and control, and hierarchical power relations between doctors and nurses on the board, were seen by nurses as significant obstacles to their participation in this new policy arena. In response to their perceived lack of power and subordinate status, nurses employed a number of strategies to negotiate their participation as board members - these included 'getting it right', 'achieving the right balance', 'self-presentation' and 'unassertiveness'. These strategies reflected and reproduced gendered identities and relations of power and raise important questions regarding the influence of nurses and nursing within policy making. [ABSTRACT FROM AUTHOR]

Drawing on an ethnographic study of the transition to contemporary British fatherhood, this paper discusses men’s experiences of the ultrasound scan. Seeing the baby on the screen seemed to herald an escalation of their awareness of the baby, reinforcing its reality. Visual knowledge, as opposed to other forms of knowledge, therefore became a primary means of knowing the baby. In this paper I provide a theoretical analysis of men’s empirical accounts of seeing the baby during the ultrasound scan. After a description of method, I set the context by presenting data to illustrate the significance of the ultrasound within men’s pregnancy experience. The paper then sets up the theoretical foundations for an analysis of these accounts by first, examining the development of the primacy of vision within medicine and secondly, discussing the illumination of the body interior, initially by dissection but now via contemporary technologies of vision including ultrasound. The final section, draws upon further data and discusses how ultrasound can be constructed as simultaneously both a medical and a social event with the potential to generate epistemological conflicts. [ABSTRACT FROM AUTHOR]

Prescribing is the most common healthcare intervention, and is both beneficial and risky. An important source of risk in UK general practice is the management of 'repeat prescriptions', which are typically requested from and issued by non-clinically trained reception staff with only intermittent reauthorisation by a clinical prescriber. This paper ethnographically examines the formal and informal work employed by GPs and receptionists to safely conduct repeat prescribing work in primary care using Strauss's (1985, 1988, 1993) concept of 'articulation work' across eight UK general practices. The analytical lens of articulation work provided an investigative framing to contextually map the informal, invisible resources of resilience and strength employed by practice team members in the achievement of repeat prescribing safety, where risk and vulnerability were continually relocated across space and time. In particular, the paper makes visible the micro-level competencies and collaborative practices that were routinely employed by both GPs and receptionists across different socio-cultural contexts, with informal, cross-hierarchical communication usually considered more effective than the formal structures of communication that existed (e.g. protocols). While GPs held formal prescribing authority, this paper also examines the key role of receptionists in both the initiation and safe coordination of the repeat prescribing routine. [ABSTRACT FROM AUTHOR]

Prevention enthusiasts show great optimism about the potential of health apps to modify peoples' lifestyles through the tracking and quantification of behaviours and bodily signs. Critical sociologists warn for the disciplining effects of self‐tracking. In this paper we use an empirical ethics approach to study the characteristics and strivings of the various types of 'ethico‐psychological subjects' that emerge in practices of self‐quantification by analysing how people and numbers relate in three cases of self‐quantification: in prevention discourse, in testimonies from the quantified self (QS) movement and in empirical work we did with people with Diabetes type I and with 'every day self‐trackers'. We show that a free subject that needs support to enact its will is crucial to understand the optimism about prevention. In the QS‐movement the concern is with a lack of objective and personalised knowledge about imperceptible processes in the body. These subjects are decentered and multiplied when we trace how numbers in their turn act to make sense of people in our empirical study. We conclude that there are many different types of ethico‐psychological subjects in practices of self‐tracking that need to be explored in order to establish what good these practices of self‐quantification might do. [ABSTRACT FROM AUTHOR]

This article uses ethnographic methods to explore how transgender people engage the medicalisation of transgender experience in a U.S. context under the purview of the American Psychiatric Association. Building on sociological literature related to medicalisation, this paper argues that the lived experience of medicalisation is a non‐linear, complex process whereby individual engagement with medical authority is both empowering and constraining in the lives of trans people. Inductive qualitative analysis of 158 hours of participant observation and 33 in‐depth interviews with members of a transgender community organisation revealed that transgender individuals (i) reject a medical frame for gender dysphoria, (ii) embrace and stress the importance of gender‐affirming medical technologies for individual identity development and social interaction and (iii) strategically reintroduce medical logics and embrace medical authority in order to facilitate medical and social recognition, validation and acceptance. [ABSTRACT FROM AUTHOR]

This ethnography within ten English and Welsh hospitals explores the significance of boundary work and the impacts of this work on the quality of care experienced by heart attack patients who have suspected non‐ST segment elevation myocardial infarction (NSTEMI) /non‐ST elevation acute coronary syndrome. Beginning with the initial identification and prioritisation of patients, boundary work informed negotiations over responsibility for patients, their transfer and admission to different wards, and their access to specific domains in order to receive diagnostic tests and treatment. In order to navigate boundaries successfully and for their clinical needs to be more easily recognised by staff, a patient needed to become a stable boundary object. Ongoing uncertainty in fixing their clinical classification, was a key reason why many NSTEMI patients faltered as boundary objects. Viewing NSTEMI patients as boundary objects helps to articulate the critical and ongoing process of classification and categorisation in the creation and maintenance of boundary objects. We show the essential, but hidden, role of boundary actors in making and re‐making patients into boundary objects. Physical location was critical and the parallel processes of exclusion and restriction of boundary object status can lead to marginalisation of some patients and inequalities of care (A virtual abstract of this paper can be viewed at: https://www.youtube.com/channel/UC_979cmCmR9rLrKuD7z0ycA). [ABSTRACT FROM AUTHOR]

Abstract: The case of cultured red blood cells (RBCs) currently being grown in a laboratory for future use in human transfusion raises questions about the ontological status of such products of modern biotechnology. This paper presents results from a six‐year ethnographic study involving interviews, focus groups and other forms of engagement with the scientific research team and other stakeholders, including public groups, which sought to understand respondents’ reactions to cultured RBCs. These cells, derived from stem cell technology, have the potential to address the global shortage of donated blood. How these blood cells are situated within the spectrum of ‘natural’ to ‘synthetic’ will shape expectations and acceptance of this product, both within the scientific community and by wider publics: these blood cells are both novel and yet, at the same time, very familiar. Drawing on discussions related to classification and ‘anchoring’, we examine the contrasting discourses offered by our respondents on whether these blood cells are ‘natural’ or not and consider the impact that naming might have on both their future regulation and the eventual uptake of cultured RBCs by society. [ABSTRACT FROM AUTHOR]

This paper argues for the importance of a broad sociological engagement with bioethics. It begins by considering why sociologists should be interested in bioethics and then goes on to explore the cognitive critique of bioethics developed by ethnographers. Some of these authors have also suggested that a more robust bioethics might emerge through the incorporation of the tools of ethnographic analysis. In this paper, it is argued that this is an important claim which needs to be analysed further and that Foucault's concept of discursive formations provides a useful framework for doing so. Once bioethics is redescribed as a discursive formation, the paper explores the challenges and obstacles that sociology and ethnography face in their attempt to open up a space for themselves in bioethics. The paper concludes by suggesting that sociologists and ethnographers need to reflect on the ways in which they might democratically secure legitimacy for their own claims in the field of social ethics. [ABSTRACT FROM AUTHOR]

This paper presents data from a recently completed ESRC funded ethnography of social relations and case formulation in an integrated child health service, comprising paediatric inpatient and outpatient, child and adolescent mental health and child development services. Children present to the services with symptoms or troubles for which there are often competing biological, neurological, genetic and/or psychosocial models of causation. As a consequence, clinicians’ talk is oriented to deciding between three main potential types of case formulation – medical, psychosocial and not just medical. These three formulations are not static ideal-types. They are highly contestable and require complex practical and rhetorical work, through which facts and evidence are selectively invoked and different parties to the case are granted attributes which construct and reconstruct past events to render ambiguous symptoms or events understandable. In particular, moral judgements and complex characterizations about the child’s parents, or significant others, often form an indispensable warrant for these formulations. By analysing professional narratives about cases, this paper develops previous ethnographic work on the classification in medical work of children and adults as good or bad, appropriate or inappropriate, culpable or blameless, and renders visible a repertoire of moral formulations about childhood and child care. In particular, judgements about the adequacy of parental love are central to clinical reasoning. [ABSTRACT FROM AUTHOR]

This paper contributes to the sociological study of humour in health care settings by analysing its use by community mental health team members dealing with referrals made by consultant psychiatrists. It is about humour and hierarchy, and specifically about humour as a strategy used by rank and file team members to resist or attenuate instructions coming from powerful professionals. The paper draws on tape-recorded data from meetings of community mental health teams and describes the ways in which humour is used by participants to subvert or challenge existing occupational hierarchies. [ABSTRACT FROM AUTHOR]

In the wake of Peters and Waterman's In Search of Excellence few NHS managers are unaware of culture :management as a tool for shaping organisational change. Yet the first wave of post-Griffiths studies found little evidence of 'culture management' in action. This paper draws on data from an ethnographic study carried out in 1988-90 to suggest that the symbolic facet of management action is an important, though neglected, element in the 1991 NHS reforms. It argues that rhetorical skills were a valuable resource for general managers overseeing the change process, and explores some of the ways in which rhetoric may have influenced cultural adaptation. However, many of the specific claims of the 'excellence genre', including ideas about the importance of strong, homogeneous cultures, are rejected. Rhetoric is an aspect of micro-political struggles over meaning, which rarely result in straightforward cultural 'manipulation', and are more likely to re-shape organisations through pragmatic accommodation than to win the hearts and minds of members. [ABSTRACT FROM AUTHOR]

Sociologists who do field work in medical settings face an intractable tension between their disciplinary field, which takes a critical perspective toward medicine, and their ethnographic field, which often includes physicians. This paper explores the ethical problems that result from the collision of the two fields. While in the field, ethnographers are forced to choose between sociology and their obligations to host members, as they decide whether to disclose their actual research agendas, whether to ask tough questions or to reveal their concerns, and whether to give advice. The tension persists when field workers leave the field to write, forcing them to choose between competing interpretations and to decide what to reveal or conceal in the interests of confidentiality. Through these moral choices about what to ask, record or present to the reader, ethnographers shape the academic field even as it shapes them. [ABSTRACT FROM AUTHOR]

Healthcare staff are encouraged to use feedback from their patients to inform service and quality improvement. Receiving patient feedback via online channels is a relatively new phenomenon that has rarely been conceptualised. Further, the implications of a wide, varied and unknown(able) audience being able to view and interact with online patient feedback are yet to be understood. We applied a theoretical lens of dramaturgy to a large ethnographic dataset, collected across three NHS Trusts during 2019/2020. We found that organisations demonstrated varying levels of 'preparedness to perform' online, from invisibility through to engaging in public conversation with patients within a wider mission for transparency. Restrictive 'cast lists' of staff able to respond to patients was the hallmark of one organisation, whereas another devolved responding responsibility amongst a wide array of multidisciplinary staff. The visibility of patient‐staff interactions had the potential to be culturally disruptive, dichotomously invoking either apprehensions of reputational threat or providing windows of opportunity. We surmise that a transparent and conversational feedback response frontstage aligns with the ability to better prioritise backstage improvement. Legitimising the autonomous frontstage activity of diverse staff groups may help shift organisational culture, and gradually ripple outwards a shared responsibility for transparent improvement. [ABSTRACT FROM AUTHOR]

This article draws on ethnographic research to conceptualise how nurses mobilise assemblages of caring to organise and deliver COVID care; particularly so by reorganising organisational infrastructures and practices of safe and good care. Based on participatory observations, interviews and nurse diaries, all collected during the early phase of the pandemic, the research shows how the organising work of nurses unfolds at different health‐care layers: in the daily care for patients and their families, in the coordination of care in and between hospitals, and at the level of the health‐care system. These findings contrast with the dominant pandemic‐image of nurses as 'heroes at the bedside', which fosters the classic and microlevel view of nursing and leaves the broader contribution of nurses to the pandemic unaddressed. Theoretically, the study adds to the literature on translational mobilisation and assemblage theory by focussing on the layered and often invisible organising work of nurses in health care. [ABSTRACT FROM AUTHOR]

We present findings from a longitudinal ethnographic study of infertile couples seeking treatment following initial GP referral to specialist fertility services. Repeated observations and interviews were undertaken with the same 14 heterosexual participants over an 18‐month period. Heterosexual, non‐donor couples comprise the majority of fertility clinic patients; however, research interest in this group has dwindled over time as IVF cycles have increased. In the United Kingdom, IVF is presented as a logical response to involuntary childlessness, and as an entirely predictable, and linear, course of action. The market is well‐developed and often patients' first experience of privatised health care in the NHS. Our couples were challenged by this, and while they felt expected to move on to IVF, some wished to explore other options. While IVF is ubiquitous, the discomfort and challenge around fertility treatments remain; experiences are prolonged and characterised by recursive narratives and expressions of disequilibrium, which are rarely acknowledged and reflected in ongoing clinic‐patient interactions. Our findings develop understanding of the process of 'mazing' (Image ‐ The Journal of Nursing Scholarship, 1989, 21, 220), the pursuit of parenthood, by showing that the routine and normative status of IVF, at least in the current health care context, is at odds with the lived experiences of individuals. [ABSTRACT FROM AUTHOR]

Breastmilk is a transmission source of HIV. Therefore, mothers living with HIV are able to avoid exposing their infants to HIV‐contaminated breastmilk if they replacement feed them. This article draws on an ethnographic study of an acute National Health Service HIV specialist antenatal clinic in London and explores the ontological multiple HIVs that the practice of replacement feeding takes part in enacting within the fluid space of the HIV diaspora. The term articulates the circumstances of racialised people affected by HIV who are originally from countries where access to life sustaining medication, care and resources—that enable a decoupling of the illness from death—are not readily accessible, and who have (temporarily) relocated themselves to geographical places where these resources are on offer. Arguing that Black African and Caribbean migrant women's ability to benefit from the technologies and care that have turned HIV into a chronic illness in England is delimited by race and their diasporic positionality. In so doing, the article contributes to Sociology by showing how race is part of practice–ethnographic research and medical care even when it is seemingly absent. [ABSTRACT FROM AUTHOR]

Integrated care is an aim and a method for organising health and care services, particularly for older people and those with chronic conditions. Policy expects that integrated care programmes will provide person‐centred coordinated care which will improve patient or client experience, enable population health, prevent hospital admissions and thereby reduce costs. However, empirical evaluations of integrated care interventions have shown disappointing results. We analysed an in‐depth case study using Strong Structuration Theory to ask: how and why have efforts to integrate health and social care failed to produce desired outcomes? In our case, integrated case management and the creation of cost‐saving plans were dominant practices. People working in health and social care recursively produced a structure of integrated care: a recognised set of resources created by collective activities. Integrated care, intended to help patients manage their long‐term conditions and avoid hospital admission, was only a small part of the complex network that sustained patients at home. The structures of integrated care were unable to compensate for changes in patients' health. The result was that patients' experiences remained largely unaffected and hospital admissions were not easily avoided. [ABSTRACT FROM AUTHOR]

Sociologists have made fundamental contributions to the study of race and health in the United States. They have disrupted biological assumptions of race, uncovered individual and structural factors that drive racial health disparities and explored the effects of racism on health. In recent years, however, with broader shifts towards big data, the work to understand the dynamics between race and health has been increasingly pursued from a quantitative perspective. Often, such analyses isolate intermediary mechanisms to further explain race as a cause of disease. While important, these approaches potentially limit our investigations of underlying assumptions about race and the complexity of this critical social construct. We argue that the resulting dearth of qualitative research on race and health substantially limits the knowledge being produced. After providing an overview of the overwhelming shift towards quantitative methods in the study of race and health, we present three areas of study that would benefit from greater qualitative inquiry as follows: (1) Healthy Immigrant Effect, (2) Maternal Health and (3) End‐of‐Life Care. We conclude with a call to the discipline to embrace the critical role of qualitative research in exploring the dynamics of race and health in the United States. [ABSTRACT FROM AUTHOR]

An ethnographic study of health and wellbeing was undertaken in a deprived urban neighbourhood in the UK Midlands. Drawing on Bourdieu's concepts of habitus, capital and field, we discerned three different, even conflicting, ways of understanding and acting on health: (i) older adults discussed their wellbeing in relation to the local context or field, walking the dog, helping at the community centre and visiting the off licence, (ii) young professionals and students who lived in the neighbourhood were oriented towards leisure facilities, career opportunities and supermarkets outside of the neighbourhood, disdaining local facilities and (iii) community activists and carers discussed health in terms of providing for others but not themselves. Bourdieu is frequently used in medical sociology to highlight how poor people's lifestyle is constrained by their habitus; we suggest paying more attention to its both enabling and differentiating contradictions as well as the constraints it entails. Empirically and in terms of health promotion findings suggest that supposedly healthy activities, such as going to the gym, may also be a means of rejecting the local community; similarly, older people's pottering about in the neighbourhood, which is not usually recognised as a healthy activity, may enhance wellbeing in this context. [ABSTRACT FROM AUTHOR]

In this article I argue for the need to situate deceased organ donation in and as a hospital practice. This study puts the spotlight on the practical conditions that enable and emplace organ donation in the hospital setting. The analytical move serves the political purpose to inform and interrogate dominant policy framings intended to address the problem of organ shortage. I present an ethnographic investigation that draws upon a Science and Technology Studies (STS) approach to make visible the sociomaterial arrangements that bring together people, things and politics in the assembling of organ donation at a Catalan hospital. A progressive and indeterminate process which might fall through and become disassembled at any given time. This, as I explain, challenges current opt‐out policy that unnecessarily reduces donation to an individual choice to be decided upon in life. Instead, and drawing on ethnographic materials, I propose a situated and relational understanding of organ donation: an embedded health care and procurement practice enacted as a collective accomplishment. I conclude that (more) responsible donation policies need to be informed by, and attuned to, the situated practicalities and enduring tensions that condition and constrain the assembling of organ donation at the hospital setting. [ABSTRACT FROM AUTHOR]

Patient‐centred care has become the touchstone of healthcare policy in developed healthcare systems. The ensuing commodification of patients' experiences has resulted in a mass of data but little sense of whether and how such data are used. We sought to understand how front‐line staff use patient experience data for quality improvement in the National Health Service (NHS). We conducted a 12‐month ethnographic case study evaluation of improvement projects in six NHS hospitals in England in 2016–2017. Drawing on the sociology of everyday life, we show how front‐line staff worked with a notion of data as interpersonal and embodied. In addition to consulting organisationally sanctioned forms of data, staff used their own embodied interactions with patients, carers, other staff and the ward environment to shape improvements. The data staff found useful involved face‐to‐face interaction and dialogue; were visual, emotive, and allowed for immediate action. We draw on de Certeau to re‐conceptualise this as 'wild data'. We conclude that patient experience data are relational, and have material, social and affective dimensions, which have been elided in the literature to date. Practice‐based theories of the everyday help to envision 'patient experience' not as a disembodied tool of managerialism but as an embedded part of healthcare staff professionalism. [ABSTRACT FROM AUTHOR]

Within health and social care, academic attention is increasingly paid to understanding the nature and centrality of body work. Relatively little is known about how and where body work specifically fits into the wider work relations that produce it in healthcare settings. We draw on ethnographic observations of staff practice in three National Health Service acute hospital wards in the United Kingdom to make visible the micro‐processes of patient care sequences including both body work and the work contextualising and supporting it. Our data, produced in 2015, show body work interactions in acute care to be critically embedded within a context of initiating, preparing, moving and restoring and proceeding. Shades of privacy and objectification of the body are present throughout these sequences. While accomplishing tasks away from the physical body, staff members must also maintain physical and cognitive work focussed on producing body work. Thus, patient care is necessarily complex, requiring much staff time and energy to deliver it. We argue that by making visible the micro‐processes that hospital patient care depends on, including both body work and the work sequences supporting it, the complex physical and cognitive workload required to deliver care can be better recognised. (A virtual version of this abstract is available at: https://www.youtube.com/channel/UC_979cmCmR9rLrKuD7z0ycA) [ABSTRACT FROM AUTHOR]

Coercive practices, such as physical restraint, are used globally to respond to violent, aggressive and other behaviours displayed by mental health service users.1 A number of approaches have been designed to aid staff working within services to minimise the use of restraint and other restrictive practices. One such approach, the 'REsTRAIN Yourself' (RYS) initiative, has been evaluated in the UK. Rapid ethnography was used to explore the aspects of organisational culture and staff behaviour exhibited by teams of staff working within 14 acute admission mental health wards in the North West region of the English NHS. Findings comprise four core themes of space and place; legitimation; meaningful activity; and, therapeutic engagement that represent characteristics of daily life on the wards before and after implementation of the RYS intervention. Tensions between staff commitments to therapeutic relations and constraining factors were revealed in demarcations of ward space and limitations on availability of meaningful activities. The physical, relational and discursive means by which ward spaces are segregated prompts attention to the observed materialities of routine care. Legitimation was identified as a crucial discursive practice in the context of staff reliance upon coercion. Trauma‐informed care represents a potentially alternative legitimacy. [ABSTRACT FROM AUTHOR]

In the face of warnings about total institutions and growing concern about the quality of care, healthcare professionals in Western Europe and North America have increasingly been exhorted to tailor their services to individuals in their care. In this article, we invite our readers to become more interested in the kinds of differences care is being tailored to, and with what effects. Focusing on food provision for residents with dementia, we present three repertoires through which care workers attend to, and enact different sets of differences between individuals: providing choice allows residents to express fleeting preferences; knowing residents places emphasis on care providers' familiarity with a person; and catering to identities brings to the fore the tastes which make up part of who someone is. The analysis brings attending to difference to the fore as a practical process and suggests that tailoring care requires sensitivity to the different kinds of individuals enacted when attending to difference. [ABSTRACT FROM AUTHOR]

Although sociological studies of quality and safety have identified competing epistemologies in the attempt to measure and improve care, there are gaps in our understanding of how finance and accounting practices are being used to organise this field. This analysis draws on what others have elsewhere called 'financialisation' in order to explore the quantification of qualitatively complex care practices. We make our argument using ethnographic data of a quality improvement programme for acute kidney injury (AKI) in a publicly funded hospital in England. Our study is thus concerned with tracing the effects of financialisation in the emergence and assembly of AKI as an object of concern within the hospital. We describe three linked mechanisms through which this occurs: (1) representing and intervening in kidney care; (2) making caring practices count and (3) decision‐making using kidney numbers. Together these stages transform care practices first into risks and then from risks into costs. We argue that this calculative process reinforces a separation between practice and organisational decision‐making made on the basis of numbers. This elevates the status of numbers while diminishing the work of practitioners and managers. We conclude by signalling possible future avenues of research that can take up these processes. [ABSTRACT FROM AUTHOR]

In this article, we situate the practices of health and physical activity in household collectives, and conceptualise everyday health 'behaviour' and lifestyle as complex, collective practices. Based on an ethnographic study on everyday family life and health practices, we provide a framework for understanding the household as a collective, where the household collective may take precedence over individual preferences, and individual behaviour has collective implications. We describe the household as a node for practices, gathered by the activities that draw together and align actors in collective practices of everyday life. In the everyday efforts of the households to live up to ideals and balance conflicting practices, healthy living is about more than simple, individual choices about whether to follow health recommendations or not. It is also dependent on pragmatic negotiations, the distribution of roles and tasks and conflicts between ideals and what is feasible in the everyday management and maintaining of the household. We suggest that engaging with these collectives could serve as a useful point of departure for health promotion activities, situating health promotion in the here and now of collectives, tinkering with their specific constellations, values and identities in the entangledness of multiple household practices. [ABSTRACT FROM AUTHOR]

A. L. Cochrane's Effectiveness and Efficiency frequently appears as a key reference in debates over, and a justification for, contemporary evidence‐based medicine. Cochrane's concern in this text with the equality of care as the ultimate rationale for why effectiveness and efficiency of cure are needed has, however, largely disappeared from debate. In this article, we reconsider Cochrane's approach through the use of case studies of plural forms of medicine in the Czech Republic, namely traditional Chinese medicine, homeopathy and spa care. In addition to bringing equality back into the picture, we also identify four expansions to Cochrane's original vision arising from the difficulties of separating cure from care; the overlap between prevention and cure; the complex actions of some multi‐faceted therapies; and recent reconceptualisations of the placebo effect. In conclusion, we suggest that instead of the widely used strictly vertical "evidence pyramid", a descriptor of the horizontal and additive ordering of evidence might be more appropriate. We also argue that in healthcare systems characterised by a multiplicity of approaches, if we want to truly benefit from this heterogeneity, we must take seriously each medical tradition's approaches to prevention, cure, care, as well as efficiency, efficacy and equality. [ABSTRACT FROM AUTHOR]

Telecare can offer a unique experience of trust in patient‐nurse relationships, embracing new standards for professional discretion among nurses, but also reflects an increasingly complicated relationship between nurses and doctors. The study uses ethnographic methodology in relation to a large 5 million euro project at four hospitals caring for 120 patients with COPD. Twenty screen‐mediated conferences were observed and two workshops, centring on nurses' photo elucidation of the practice of telecare, were conducted with a focus on shifting tasks, professional discretion, responsibility and boundaries between nurses and doctors. Analytically, the study draws on Star's notion of 'infrastructure' and Mol, Moser and Pols's ideas of care as 'tinkering'. Infrastructure is understood as human and non‐human conduct that is embedded into wider organisational conventions, sites and structures. The analysis demonstrates and proposes that, in telecare, greater accountability, discretion and responsibility are imposed on the nurse, but that they also have less access to the means of clinical decision‐making, namely, doctors. The article explores how relational infrastructures ascribe the professions they constitute (nurses and doctors) functions of power and accountability and highlights the ethical problem of the nurse being given greater responsibility while simultaneously becoming more dependent on the doctor. [ABSTRACT FROM AUTHOR]

Abstract: This article draws on ethnographic data from a UK Economic and Social Research Council (ESRC) funded study called ‘Buildings in the Making’. The project aims to open up the black box of architectural work to explore what happens between the commissioning of architectural projects through to the construction of buildings, and seeks to understand how ideas about care for later life are operationalised into designs. Drawing on recent scholarship on ‘materialities of care’ and ‘practising architectures’, which emphasise the salience of material objects for understanding the politics and practices of care, we focus here on ‘beds’. References to ‘beds’ were ubiquitous throughout our data, and we analyse their varied uses and imaginaries as a ‘way in’ to understanding the embedded nature of architectural work. Four themes emerged: ‘commissioning architectures and the commodification of beds’; ‘adjusting architectures and socio‐spatial inequalities of beds’; ‘prescribing architectures and person‐centred care beds’; and ‘phenomenological architectures and inhabiting beds’. We offer the concept prescribed personalisation to capture how practising architectures come to reconcile the multiple tensions of commodification and the codification of person centred care, in ways that might mitigate phenomenological and serendipitous qualities of life and living in care settings during later life. [ABSTRACT FROM AUTHOR]

Abstract: People diagnosed with brain tumours enter new and unfamiliar worlds in which they must make complex and previously unimaginable decisions about care, treatment and how to live their lives. While decisions are increasingly based around care pathways, these are embedded in values that often fail to accord with those of patients. In this article, we examine the cases of people with a brain tumour and how they, their families and healthcare professionals navigate and intervene in the course of life‐threatening disease. We use ethnographic data (2014–16) and modified social theory to highlight: (1) patients’ interpretations of disease and care and how they might differ from dominant biomedical logics; (2) complexity and contingency in care decisions; (3) rapid and unanticipated change owing to disease and bodily change; and (4) how people find ways through a world that is continually in motion and which comes into being through the combined action of human and non‐human agencies. Our modified ‘healthscapes’ approach provides an analytic that emphasises the constant precariousness of life with a brain tumour. It helps to explain the times when patients’ feel bumped off the pathway and moments when they themselves step away to make new spaces for choice. [ABSTRACT FROM AUTHOR]

Abstract: This article is part of a hospital ethnography that investigates healthcare architecture as an aspect of an increasingly large, complex, and urgent global health issue: caring for refugees and other immigrants. It argues that hospitals are nodes in transnational social networks of immigrant and refugee patients that form assemblages of human and non‐human objects. These assemblages co‐produce place‐specific hospital care in different hospital spaces. Place‐specific tensions and power dynamics arise when refugees and immigrants come into contact with these biomedical spaces. The argument is developed by analysing waiting rooms and exam rooms in two outpatient clinics in one US hospital. The article draws its analysis from 9 months of fieldwork in 2012 that included following 69 adult immigrant and refugee patients and observing their encounters with interpreters and clinic staff. Its inclusion of a transnational dimension for understanding place‐specific hospital care adds conceptual and empirical depth to the study of how place matters in 21st century hospitals. [ABSTRACT FROM AUTHOR]

This article examines how the amplified role of pharmaceutical substances in addiction treatment affects the everyday realisation of care, particularly the relationship between workers and patients, in so called austere environments. Theoretically the article draws firstly on the literature that links pharmaceuticalisation to the neoliberal undoing of central public structures and institutions of care, and secondly on Anne-Marie Mol's concept of the logic of care. Based on an ethnographic analysis of the everyday life at a Finnish opioid substitution treatment clinic we show the mechanisms through which the realisation of pharmacotherapy can, in the current political climate, result in a very narrow understanding of drug problems and minimal human contact between patients and professionals. Our analysis manifests an important shift in the logic of addiction treatment and health-care policy more broadly; namely, a growing tendency to emphasise the need for patients to care for themselves and make good choices with limited help from formal care institutions and professionals. We call this new ethos the logic of austerity. [ABSTRACT FROM AUTHOR]

'Quality of life' has become an important feature of research into patient outcomes, but an agreed definition of the term remains elusive. In order to empirically assess the meaning of quality of life for lay people, an ethnographic study was conducted using a sample of 22 patients suffering chronic, moderately severe asthma. The findings indicated that asthma was in general not considered to be important in the process of assessing or experiencing quality. The principal source of vaiue for respondents was described as the experience of happiness in the context of emotionally-significant social relationships. Sources of value appeared to be subject to variation between individuals and through time, implying that quality of life should be considered to be an existential concept. The process of attributing value to a subjective condition is best conceived of as an aesthetic one, involving an emotional engagement with (rather than rational evaluation of) everyday experience. [ABSTRACT FROM AUTHOR]

A paradox of the 1991 British NHS reforms is that increased central control over policy and strategy goes hand in hand with greater operational de-centralisation. Some commentators argue that market structures are leading to a dispersal of power, with local purchasers and providers assuming greater responsibility for the governance of their own relationships. Drawing inter alia on the Foucauldian concept of 'governmentality', they contend that 'action at a distance' or 'steering at a distance' is supplanting traditional bureaucratic regulation. Health authorities use contracts as a mechanism to constrain providers to deliver targets set by Government. We draw on a recent qualitative study of the NHS in Wales to examine the use of penalty clauses to enforce Patient's Charter guarantees for waiting times. This mechanism, which appears to govern the purchaser/provider relationship from within, turns out to be significantly con- strained by continuing central direction. Moreover, informal resistance strategies, similar to those used in the past to counter bureaucratic regulation, operate to limit the impact of de-centralised contractual governance. [ABSTRACT FROM AUTHOR]

The hospital is characterised by a dual orientation: being open to the heterogenous demands for medical care that are spontaneously directed to it, and selecting patients in terms of their match with medical specialties represented in its different services. This tension is at the heart of the functioning of emergency services. Based on ethnographic fieldwork in a French teaching hospital, the article examines the consequences of this duality on the concrete organisation of work. It shows the main dimensions that go to make up the patient's mobilising worth: closeness to the core of real emergencies; social demands; the intellectual interest of the case; questions raised by transfers of responsibility between doctors. For each dimension, it studies staff reactions and gives some indications about their complexity. Finally it suggests some comparisons between these results and the observations made by several studies conducted in American and UK hospitals since the 1970s. [ABSTRACT FROM AUTHOR]