All the good care: Valuation and task differentiation in older person care.

Abstract

Task reallocation is increasingly foregrounded as a promising solution for capacity problems. Numerous studies show, however, that task reallocation between medical professionals is a highly contested issue and difficult to institutionalise. Conflicts are omnipresent and often arise from 'intraprofessional competition': Zero-sum games between professionals from different disciplinary backgrounds where one party's gains require another party's losses. In this article, we build on calls to enrich the sociology of professions with new concepts and theories. We analyse a case of task reallocation between medical professionals in a nursing home using concepts from empirical ethics and valuation studies. We argue that modes of good care offer a valuable framework for analysing the reorganisation of professional work because they provide an empirically grounded and fine-grained conceptual toolkit for understanding the dynamics among professionals and between professionals and managers. Enactment of different modes of good care inspires innovation in service provision but at the same time creates new tensions between those involved. We show how, in times of scarcity, a dynamic emerges between professionals attempting to stave off and reallocate work, thereby restricting their professional domains.