Innovation – inside out. Change and stability in social and health care education

Publikation: Bog/antologi/afhandling/rapportPh.d.-afhandlingForskning

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Resumé

Formål: Formålet med dette studie er at undersøge og udfordre kravet om innovation i offentlige velfærdsdomæner. Studiet spørger til hvordan sociale praksisser på tværs af grænser udfolder sig i social- og sundhedsuddannelserne i lyset af innovationsimperativer.
Metode: Studiet er designet som et tværorganisatorisk feltstudie af samarbejdspraksisser i social- og sundhedsuddannelserne i Danmark og undersøger aktiviteter mellem mennesker og de arbejdsopgaver og artefakter, som de interagerer med. Det tværorganisatoriske design er baseret på den teoretisk informerede hypotese, at grænsekrydsninger mellem forskellige
organisationer og professioner skaber potentiale for innovation.
Den empiriske praksis er en social- og sundhedsskole; de relaterede primærkommunale praktikpladser (plejehjem og hjemmepleje); kommunerne, der er elevernes ansættende myndighed; samt nationale interesseorganisationer og myndigheder, der udvikler og lovgiver i forhold til uddannelserne. Den empiriske praksis er således tværorganisatorisk og udfolder sig på tre niveauer: makro, meso og mikro. Lovgivningsmæssige forandringer og nationale
indsatsområder (makroniveau), ledelsessamarbejde og strategier (mesoniveau) og
hverdagspraksis blandt elever, undervisere, praktikvejledere, uddannelsesansvarlige og ledere (mikroniveau). Baseret på den pragmatiske forståelse af ’situationen’ som analyseenhed studeres innovation som indlejret i arbejde og studier - i situationer – hvor mennesker krydser grænser mellem skole og praksis og mellem niveauer, løser arbejdsopgaver, lærer nyt,
forandrer praksis, og hvor de møder forandrings- og innovationsimperativer.
Resultater: Afhandlingen består af 5 artikler indrammet af 7 kapitler. Den viser, hvordan innovation er uløseligt vævet ind i hverdagspraksisser, og hvordan innovationsimperativer påvirker og påvirkes af temaer i relation til professionelle kompetencer, arbejdsrutiner og værdier. Mange forskellige interessenter er direkte og indirekte involveret i samarbejde i det social- og sundhedsfaglige uddannelsesfelt, og aktørerne har forskellig adgang til beslutningsprocesser og dialog på tværs af organisatoriske grænser og mellem niveauer.
Innovationsimperativer og –initiativer involverer både epistemologiske og ontologiske processer af meningsskabelser men også tab af mening. Innovation konceptualiseres forsøgsvist som dynamikken mellem aktørers målrettede engagement på den ene side og forandret praksis på den anden. Innovation forstås således som ’intenderet forandring’ - menneskers bevidste og målrettede forandring af en social praksis. Studiet argumenterer for, at
innovation er en gennemgribende diskurs karakteriseret af ambivalens og modsætninger, som aktørerne i feltet både er modtagere og medskabere af. Innovation har tendens til at tage diskursive former, af og til på bekostning af handlinger, der fører til aktuel forandring. På den anden side er der masser af innovationsinitiativer blandt social- og sundhedsfaglige aktører på både makro-, meso- og mikroniveau. Studiet udvikler et begreb om ’hverdagsinnovation’
gennem ’boundary pushing’ (’skubbe’ eller ’flytte’ grænser). Disse begreber udfordrer fejringen af radikal innovation, og der argumenteres for, at innovation lettere opstår i situationer, hvor aktører er i stand til – og får mulighed for – at balancere forandringer med stabilitet. Rutiner, relationer og kompetencer udviklet over tid er vigtige stabiliserende faktorer, som er afgørende for at skabe holdbar og ønsket forandring.
Projektets bidrag og forslag til yderligere forskning: Når innovation betragtes som integreret i arbejdspraksisser og ikke kun som krav, der påføres fra politisk eller ledelsesmæssig side, så bliver undervisere, praktikvejledere, daglige ledere, elever og borgere centrale aktører i udviklingen af den social- og sundhedsfaglige praksis.
Studie argumenterer for, at innovation ikke er det eneste svar på fremtidens udfordringer.
Veletablerede ideer og konventionelle indsigter om uddannelse og menneskers behov for omsorg og pleje synes at være essentielle for en velfungerende velfærdssektor. Hvis innovationsbegrebet er kommet for at blive, er det måske nødvendigt med andre kriterier end ’nyhed’ og ’værdi’, som begrebet traditionelt defineres ved hjælp af. Kriterier der anerkender, at ønsket forandring er vigtigere end nyhed, og at værdi ikke kun må forstås som (økonomisk eller ikke-økonomisk) værdiskabelse, som medarbejdere og ledere skal bidrage til, men også som disse aktørers værdibaserede praksisser.
Afslutningsvist argumenterer studiet for, at social- og sundhedssektoren kan ses som en banebrydende sektor. Det banebrydende består i et muligt filosofisk bidrag til et bredere felt af offentlig innovation forankret i sektorens specifikke fokus på omsorg og pleje (engelsk: ’care’).
I arbejdet med at lindre smerte og hjælpe mennesker gennem eksistentielle spørgsmål, er problemer ikke altid noget, der kan løses. Der er ofte en mere ydmyg indstilling knyttet til ideer om ’godt og dårligt’, ’fremgang og tilbageskridt’. Forståelsen for, at fremskridt ikke er entydigt, kan inspirere den generelle debat om og forskningen i offentlig innovation. Når vi stiller spørgsmålet: ’Hvordan påvirkes social- og sundhedssektoren af innovationsimperativer’, må vi også vende det om og spørge: ’Hvordan kan innovationsimperativer påvirkes af socialog sundhedsfaglige begreber som fx omsorg?’
OriginalsprogEngelsk
Antal sider204
StatusUdgivet - 2013

Fingeraftryk

health care
innovation
education
macro level
meso level
welfare
Values
micro level
stakeholder
educator
innovation research
need for care
discourse
student
internship
earning a doctorate
interaction
field of study
home care
Denmark

Citer dette

@phdthesis{63400c8a32284a1b85cabba4d237838c,
title = "Innovation – inside out. Change and stability in social and health care education",
abstract = "Purpose: The purpose of this study is to scrutinize and challenge the call for innovation in welfare domains. The study asks how social practices across boundaries unfold in the field of social and health care educations under innovation imperatives.Methodology: The design is a multi-sited field study of collaborative practices in social and health care educations in Denmark, and it explores activities and interactions among people, the work tasks and the artifacts with which they engage. The multi-sited design is based on the theoretically informed hypothesis that crossing boundaries between different organizations andprofessions creates the potential for innovation.The empirical field is a social and health care college, the student internship facilities at elder care centers and home care departments, and the municipalities and national authorities that develop and implement social and health care education. The empirical practice is thus understood to be cross-organizational. The study was carried out on three levels, macro, meso and micro: Policy requirements for change (macro level), managerial strategies andcollaboration (meso level) and the daily work tasks in educators’ and students’ everyday practices (micro level). Based on a pragmatic notion of the ‘situation’ as the unit of analysis, innovation is studied as social practices, embedded in work and training activities and interactions -- in situations across sites where work tasks are performed, where change and innovation imperatives are encountered, and where knowledge and skills are learnt and transformed.Findings: The dissertation consists of five articles framed by seven chapters. It shows how innovation is intricately woven into everyday practices of work life, affected by and affecting issues of professional skills, work practices and values. Many different stakeholders are involved directly or indirectly in collaboration in the field of social and health care educations, and actors have varying access to decision-making and dialogue across boundaries. Innovation imperatives and initiatives involve epistemological and ontological issues of both meaningmakingand loss of meaning. Innovation is tentatively conceptualized as the dynamics between actors’ intentional engagement and actual change in practice. Thus, innovation is understood as ‘intended change’, i.e., individuals’ intentional remaking of the social practices. The study suggests that innovation is a pervasive public discourse characterized by ambiguity and contradictions, which the actors in the field are both subject to and co-creators of. Innovation tends to take discursive forms, sometimes at the expense of actions leading to actual change.There are, however, numerous innovation initiatives among social and health care actors taking place at macro, meso and micro levels. The study develops the notions of everyday innovation and boundary pushing. These notions challenge (what I argue to be) the celebration of radical innovation within discourses of public innovation, and I suggest that innovation is more likely to occur in situations where actors are able to -- and get the change to -- balance changeprocesses with a degree of stability. Routines, relations, skills and knowledge built over time are important stabilizing factors that are crucially necessary in order to create sustainable and desired change.Value and suggestions for further research: When innovation is regarded as emergent practices and not just as a set of demands imposed from policy and management levels, educators, students and care recipients can then become key stakeholders in the development of the social practices.The study argues that innovation is not the (only) answer to future welfare challenges.Established ideas and conventional insights about education and peoples’ needs for care seem just as essential for a well-functioning welfare sector. If innovation is here to stay, then other than the traditional defining criteria ‘novelty’ and ‘value’ might be needed. Criteria that acknowledge that desired change is more important than novelty, and that value must be understood not only in terms of the value creation (economic or non-economic), to which frontline actors are required to contribute, but also as these actors’ value-based practices.Finally, the study suggests that elder care and the social and health care education may also be regarded as a pioneering sector. It is pioneering in so far as it offers a philosophical contribution to a wider field of public innovation. This contribution lies in the specifics of the care sector, chose main concern is human care: death is inevitable, as we are dealing with relief of pain and existential questions. Accordingly, the care sector can propose a distinctly modestapproach about ‘good’, ‘better’ and ‘bad’ to the idea of innovation. This very modesty can inspire the general debate and research in the field on public innovation. When asking: ‘How is the social and health care sector affected by innovation imperatives?’ we may also ask the reverse question: ‘How are innovation imperatives affected by the notion of care?’",
author = "Charlotte Wegener",
note = "forsvar den 24.10.13 Bed{\o}mmelsesudvalget: Professor Svend Brinkmann (formand), svendb@hum.aau.dk Professor Terese Bondas University of Nordland, No, terese.bondas@uni.no Lektor Catharina Juul Kristensen, Ruc, DK, cjk@ruc.dk Vejleder: Lene Tanggaard Pedersen",
year = "2013",
language = "English",

}

Innovation – inside out. Change and stability in social and health care education. / Wegener, Charlotte.

2013. 204 s.

Publikation: Bog/antologi/afhandling/rapportPh.d.-afhandlingForskning

TY - BOOK

T1 - Innovation – inside out. Change and stability in social and health care education

AU - Wegener, Charlotte

N1 - forsvar den 24.10.13 Bedømmelsesudvalget: Professor Svend Brinkmann (formand), svendb@hum.aau.dk Professor Terese Bondas University of Nordland, No, terese.bondas@uni.no Lektor Catharina Juul Kristensen, Ruc, DK, cjk@ruc.dk Vejleder: Lene Tanggaard Pedersen

PY - 2013

Y1 - 2013

N2 - Purpose: The purpose of this study is to scrutinize and challenge the call for innovation in welfare domains. The study asks how social practices across boundaries unfold in the field of social and health care educations under innovation imperatives.Methodology: The design is a multi-sited field study of collaborative practices in social and health care educations in Denmark, and it explores activities and interactions among people, the work tasks and the artifacts with which they engage. The multi-sited design is based on the theoretically informed hypothesis that crossing boundaries between different organizations andprofessions creates the potential for innovation.The empirical field is a social and health care college, the student internship facilities at elder care centers and home care departments, and the municipalities and national authorities that develop and implement social and health care education. The empirical practice is thus understood to be cross-organizational. The study was carried out on three levels, macro, meso and micro: Policy requirements for change (macro level), managerial strategies andcollaboration (meso level) and the daily work tasks in educators’ and students’ everyday practices (micro level). Based on a pragmatic notion of the ‘situation’ as the unit of analysis, innovation is studied as social practices, embedded in work and training activities and interactions -- in situations across sites where work tasks are performed, where change and innovation imperatives are encountered, and where knowledge and skills are learnt and transformed.Findings: The dissertation consists of five articles framed by seven chapters. It shows how innovation is intricately woven into everyday practices of work life, affected by and affecting issues of professional skills, work practices and values. Many different stakeholders are involved directly or indirectly in collaboration in the field of social and health care educations, and actors have varying access to decision-making and dialogue across boundaries. Innovation imperatives and initiatives involve epistemological and ontological issues of both meaningmakingand loss of meaning. Innovation is tentatively conceptualized as the dynamics between actors’ intentional engagement and actual change in practice. Thus, innovation is understood as ‘intended change’, i.e., individuals’ intentional remaking of the social practices. The study suggests that innovation is a pervasive public discourse characterized by ambiguity and contradictions, which the actors in the field are both subject to and co-creators of. Innovation tends to take discursive forms, sometimes at the expense of actions leading to actual change.There are, however, numerous innovation initiatives among social and health care actors taking place at macro, meso and micro levels. The study develops the notions of everyday innovation and boundary pushing. These notions challenge (what I argue to be) the celebration of radical innovation within discourses of public innovation, and I suggest that innovation is more likely to occur in situations where actors are able to -- and get the change to -- balance changeprocesses with a degree of stability. Routines, relations, skills and knowledge built over time are important stabilizing factors that are crucially necessary in order to create sustainable and desired change.Value and suggestions for further research: When innovation is regarded as emergent practices and not just as a set of demands imposed from policy and management levels, educators, students and care recipients can then become key stakeholders in the development of the social practices.The study argues that innovation is not the (only) answer to future welfare challenges.Established ideas and conventional insights about education and peoples’ needs for care seem just as essential for a well-functioning welfare sector. If innovation is here to stay, then other than the traditional defining criteria ‘novelty’ and ‘value’ might be needed. Criteria that acknowledge that desired change is more important than novelty, and that value must be understood not only in terms of the value creation (economic or non-economic), to which frontline actors are required to contribute, but also as these actors’ value-based practices.Finally, the study suggests that elder care and the social and health care education may also be regarded as a pioneering sector. It is pioneering in so far as it offers a philosophical contribution to a wider field of public innovation. This contribution lies in the specifics of the care sector, chose main concern is human care: death is inevitable, as we are dealing with relief of pain and existential questions. Accordingly, the care sector can propose a distinctly modestapproach about ‘good’, ‘better’ and ‘bad’ to the idea of innovation. This very modesty can inspire the general debate and research in the field on public innovation. When asking: ‘How is the social and health care sector affected by innovation imperatives?’ we may also ask the reverse question: ‘How are innovation imperatives affected by the notion of care?’

AB - Purpose: The purpose of this study is to scrutinize and challenge the call for innovation in welfare domains. The study asks how social practices across boundaries unfold in the field of social and health care educations under innovation imperatives.Methodology: The design is a multi-sited field study of collaborative practices in social and health care educations in Denmark, and it explores activities and interactions among people, the work tasks and the artifacts with which they engage. The multi-sited design is based on the theoretically informed hypothesis that crossing boundaries between different organizations andprofessions creates the potential for innovation.The empirical field is a social and health care college, the student internship facilities at elder care centers and home care departments, and the municipalities and national authorities that develop and implement social and health care education. The empirical practice is thus understood to be cross-organizational. The study was carried out on three levels, macro, meso and micro: Policy requirements for change (macro level), managerial strategies andcollaboration (meso level) and the daily work tasks in educators’ and students’ everyday practices (micro level). Based on a pragmatic notion of the ‘situation’ as the unit of analysis, innovation is studied as social practices, embedded in work and training activities and interactions -- in situations across sites where work tasks are performed, where change and innovation imperatives are encountered, and where knowledge and skills are learnt and transformed.Findings: The dissertation consists of five articles framed by seven chapters. It shows how innovation is intricately woven into everyday practices of work life, affected by and affecting issues of professional skills, work practices and values. Many different stakeholders are involved directly or indirectly in collaboration in the field of social and health care educations, and actors have varying access to decision-making and dialogue across boundaries. Innovation imperatives and initiatives involve epistemological and ontological issues of both meaningmakingand loss of meaning. Innovation is tentatively conceptualized as the dynamics between actors’ intentional engagement and actual change in practice. Thus, innovation is understood as ‘intended change’, i.e., individuals’ intentional remaking of the social practices. The study suggests that innovation is a pervasive public discourse characterized by ambiguity and contradictions, which the actors in the field are both subject to and co-creators of. Innovation tends to take discursive forms, sometimes at the expense of actions leading to actual change.There are, however, numerous innovation initiatives among social and health care actors taking place at macro, meso and micro levels. The study develops the notions of everyday innovation and boundary pushing. These notions challenge (what I argue to be) the celebration of radical innovation within discourses of public innovation, and I suggest that innovation is more likely to occur in situations where actors are able to -- and get the change to -- balance changeprocesses with a degree of stability. Routines, relations, skills and knowledge built over time are important stabilizing factors that are crucially necessary in order to create sustainable and desired change.Value and suggestions for further research: When innovation is regarded as emergent practices and not just as a set of demands imposed from policy and management levels, educators, students and care recipients can then become key stakeholders in the development of the social practices.The study argues that innovation is not the (only) answer to future welfare challenges.Established ideas and conventional insights about education and peoples’ needs for care seem just as essential for a well-functioning welfare sector. If innovation is here to stay, then other than the traditional defining criteria ‘novelty’ and ‘value’ might be needed. Criteria that acknowledge that desired change is more important than novelty, and that value must be understood not only in terms of the value creation (economic or non-economic), to which frontline actors are required to contribute, but also as these actors’ value-based practices.Finally, the study suggests that elder care and the social and health care education may also be regarded as a pioneering sector. It is pioneering in so far as it offers a philosophical contribution to a wider field of public innovation. This contribution lies in the specifics of the care sector, chose main concern is human care: death is inevitable, as we are dealing with relief of pain and existential questions. Accordingly, the care sector can propose a distinctly modestapproach about ‘good’, ‘better’ and ‘bad’ to the idea of innovation. This very modesty can inspire the general debate and research in the field on public innovation. When asking: ‘How is the social and health care sector affected by innovation imperatives?’ we may also ask the reverse question: ‘How are innovation imperatives affected by the notion of care?’

M3 - Ph.D. thesis

BT - Innovation – inside out. Change and stability in social and health care education

ER -