Patient-involvement, governance and power in “patient-centred” health communication: A dialogic communication analysis of multi-actor meaning-making
The Ph.D. thesis is a collaborative research project between the Zealand Region (one of 5 administrative regions in Denmark) and Roskilde University involving patients and health-care professionals in Odsherred municipality in Denmark. According to the Zealand Region health-care-administration, the healthcare system faces serious challenges in relation to cross-sector collaboration and communication with respect to giving patients an experience of greater consistency and quality of treatment. Particularly patients with multiple diagnoses and patients in complex courses of treatment often have the experience of “falling between two stools”. This might be explained by the fact that they are simultaneously subject to several courses of treatment across healthcare sectors involving different health professionals such as the general practitioner, addiction centre, and community psychiatry. This increases the demand on cross-sectorial collaboration, dialogue and coordination between professions.
The research questions of the thesis are as follows:
How are patient voices – each constructing particular knowledge forms and subjectivities –articulated in inter-sectorial and inter-professional health care? What are the implications with respect to involving patients and their voices in the treatment?
The Ph.D. follows two research strategies, both based on an ethnographic, practice-oriented and participatory design. The theoretical framework is based on Mikhail Bakhtin, Dialogic self-theory and poststructuralism in order to analyse the multiplicity of the knowledge production and more specific the complexities of multiple voices.
The first is an approach that investigates how patients experience their course of treatment. Through the construction of narratives, this approach investigates how patient subjectivities are constructed through the positioning of self and other. Moreover, an effort is made to work on the basis of dialogic, relational research ethics and research narratives as a dialogic endeavour thinking with instead of about the stories.
The second approach focus on a “newer” dialogic approach towards treatment and network meetings called Open dialogue (see Jaakko Seikkula). Open dialogue creates a therapeutic dialogic setting inviting patient and relatives and the network of the health professionals to collaborate on the further coordination of the treatment. Telling stories is central to the Open dialogue approach. The Ph.D. project, is interested in how these stories become dialogic phenomena and how they can be analysed as performance in context. The Ph.D. investigates how patient subjectivities and knowledge are negotiated in the multiple-actors-dialogues and the implications with respect to patient-involvement, and governance and power.