Digital displacements in patient-professional relations.

Purpose The purpose of this paper is to examine the relational consequences of electronic patient records based on co-produced data from pregnant women's IT supported self-reporting. The analysis unfolds how the clinical encounter between patient and professional is reconfigured in the digitized society. Design/methodology/approach The paper provides a grounded theory analysis based on observations and interviews in an antenatal care unit. The study draws on empirical material generated through observations of the clinical encounters between pregnant women and midwifes, interviews with managers and midwifes, field notes and policy documents. Findings The author argues that the use of technology and co-produced data displace tasks and relations between healthcare professional and patient. The analysis shows that four modes of organizational patient involvement are enacted: involvement in administrative tasks, involvement in professional resistance, individualized involvement, and homogenized involvement of patients that tends to categorize the pregnancy roughly as either "normal" or "abnormal." Originality/value This study contributes to qualitative research in digitization and patient involvement in health organization studies by showing how digital technology distributes the midwife's autonomy, tasks and knowledge about the patient with both intended and unintended consequences. The argument goes beyond the prevalent prescriptive approaches to e-government and co-production, instead providing a critical analytical perspective on the promises of delivering efficient and patient-centered healthcare.

Constructions of the patient in healthcare communications: six patient figures.

PURPOSE: The purpose of this paper is to examine how strategic, patient-centred communication plays a part in the discursive management of expectations posed to patients and healthcare organizations. DESIGN/METHODOLOGY/APPROACH: The paper provides an analysis of four documents collected as part of an ethnographic case study regarding "The Perspective of the Patient" - a Danish Hospital's patient-centred communication programme. Mapping methods inspired by Grounded Theory are used to qualify the analysis. FINDINGS: The paper shows that strategic patient-centred communication addresses both a care-oriented approach to the patient and deploys market perceptions of patients. Market and care is seen as co-existing organizing modes that entail expectations to the patient. In the communication programme the patient is constructed in six information-seeking patient figures: affective patient; target group patient; citizen with rights; patient as a competent resource; user as active partner; and consumer. As a result, the patient-centred communication programme renders the patient as a flexible figure able to fit organizational demands of both care orientation and market concerns. ORIGINALITY/VALUE: This study contributes to qualitative research in organizational health communication by combining two subfields - patient-centredness and health communication - in an empirical study of how market and care are intertwined in a patient-centred communication programme. The argument goes beyond the prevalent prescriptive approaches to patient-centredness and healthcare communication, instead providing a critical analytical perspective on strategic communication and patient-centredness and showing how expectations are posed to both patient and organization.