Texts in action: how nurses are doing the fiscal work of health care reform

Abstract

Canada's publicly insured system of socialized health care is coming under intense scrutiny by governments firmly focused on the politics of national indebtedness and public spending. Contemporary health care reforms aimed at cutting costs and increasing productivity place new emphasis on “official knowledge” constituted through particular textual practices. Since 1994 the Canadian Institute of Health Information (CIHI) has become a powerful regulator of patient care. It has entered business-like accountability and rationing practices based on competitive, market-like comparisons into Canadian hospitals in order to “assist leaders in the health sector make informed decisions” (CIHI 2000). Using Canadian sociologist Dorothy E. Smith's (1987) Institutional Ethnography, with a specific focus explicating a Smithian textual analysis (1990a, 1990b, 1999), this paper explores, in depth, one feature of how a business genre is being inserted into the everyday practices of nurses and doctors who work with the frail elderly in a small community hospital in British Columbia.