War and peace in hospitals: Humans, objects and paradoxes

Abstract

Patient-centered care (PCC) in French hospitals has become highly topical. As it challenges people's roles and positions in the health care system, it generates tensions that can produce paradoxes when elements perceived as contradictory are both present and persistent. However, the actors most often learn to deal with them. The aim of this research is to examine how actors cope with the paradoxes created by PCC. Linking the theory of paradox to the concepts of situated action and object agency, this paper studies the orthopedics department of a major PCC public hospital in Paris based on shadowing, interviews and secondary documents. It highlights three ways in which technical objects play a key role in managing belonging, learning, organizing and performing paradoxes generated by PCC: enactment, mediation and interpretive flexibility. It thus extends the dynamic equilibrium model of organizing in the theory of paradox developed by Smith and Lewis (2011).