Yves Habran - Two very different ways of providing care to patients, employees, children, etc. - ICN Business School

Yves Habran – Two very different ways of providing care to patients, employees, children, etc.

Based on the research article

Habran, Y., & Battard, N. (2019). Caring for or caring with? Production of different caring relationships and the construction of time. Social Science & Medicine, 233, 78-86.

 

Studies have shown that care can be delivered in different ways (to patients, employees, children, etc.). Based on a study of the development of a Service d’Education Renforcé A Domicile (home-based strengthened educational childcare service, SERAD) that aims at bringing children in institutions back into their families or avoiding putting them in new placements, Habran and Battard, (2019) compare two different care approaches. One follows a logic of substitution (caring for), while the other follows a logic of care (caring with). The authors show that not only does the relationship between caregivers and care recipients differ widely within the two approaches, but that they are also different in terms of time orientation and the design and use of tools.

Looking after individuals: “care for” approach vs. “care with” approach and implications for participants in the relationship  

The different types of relationships between a caregiver and a cared-for (care relationship) can be represented as shown below:  

This study by Habran and Battard (2019) looks at the shift from a logic of substitution (caring for families) towards a logic of care (caring with families). The work studies the change in social workers’ professional stance in families subject to parental dysfunctions (neglect, violence, incest, etc.).

Whereas at the start of the SERAD project, social workers followed a logic of substitution, they gradually developed a logic of care. In a logic of substitution, caregivers are, as social workers put it, in “high position” towards families. Because of their status, skills and knowledge, caregivers take over the responsibility of the situation and choses the best-suited solution. They re-educate. Although this does not mean that they lack compassion, it does not foster empowerment in the recipients. In comparison, a “care with” approach involves a more balanced relationship. The aim of the caregiver is to create emotional, physical and cognitive conditions that encourage families to develop and evaluate their own solutions. These different approaches therefore result in the caregiver and recipient occupying different places in care relationships. Moving from a role of evaluator, prescriber and controller, the caregiver becomes more of a partner in jointly constructing solutions, initiated by the family. These caregivers need to be adept at listening, questioning, reassuring and stimulating to give recipients space and allow them to make their own experiments. 

 

“Care for” approach vs. “care with” approach: implications for using and designing tools

Habran and Battard also illustrate that the design and use of tools differ in these two approaches. More specifically, they suggest that what differentiates the use of tools in “caring for” and “caring with” is the tools’ status. In a logic of substitution, tools are employed to diagnose the situation, prescribe action and monitor the effects. The tools are used by the caregivers, and care recipients are considered as “care objects”. In contrast, in a logic of care, the tools are used by both the caregiver and the care recipient to jointly build work objectives and action, and then evaluate them together. They thus encourage the active involvement of families in building solutions that correspond to their needs and situation. This use of tools therefore fosters the development of a responsibility stance from care recipients, who are considered as “care subjects”.

The authors identify three tool design characteristics that facilitate active participation and the development of a responsible role for care recipients. The first concerns the open design of tools. Families are invited to express their views on the objectives and appropriate action in a reflexive, forward-looking way. The second concerns the tools’ orientation towards the future. While a preoccupation with the past remains, the tools serve above all to project families into the construction of resources and their own solutions. Lastly, the tools are either shared, or owned by the recipients. This underlines the care worker’s “guest” status in the development of recipients’ capacities and empowerment.

“Care for” approach vs. “care with” approach: time conceptions and orientations

Lastly, Habran and Battard show that a substitutive and care logic have different conceptions and orientations regarding time[1]. In a logic of substitution, there is a strong focus on the past and the present. The caregiver works in the “here and now” and makes comprehensive diagnoses to attempt to reduce uncertainty and determine the future. Here, time is the time of the caregiver’s decision-making. In a logic of care, however, time concerns the contingent and specific process of developing the recipients’ situation. Time cannot be built for them, but rather with them, which makes their involvement so important. With this approach, uncertainty is accepted. Past and present are used to jointly build experiments, which have the fallible status of hypotheses and are subject to joint evaluation at a later stage; the future remains open and cannot be determined by present decisions.

A study with implications beyond its initial scope of application

Although it deals with childhood protection, this study has a more general scope. It raises reflections on different ways of developing care relationships, whether between social workers and families, doctors and patients, managers and those they manage [2], or even parents and children. It fundamentally raises the question of the type of care relationships that we want to develop with care recipients. While a “caring for” approach suggests that caregivers temporarily substitute to care recipients, either physically or in terms of decision-making, to help them tackle their difficulties, a “care with” approach aims to create the conditions to empower them. Care recipients play a more active role in building diagnoses and experiments and their evaluation. The type of tools and the ways of using them are also different in these two approaches. Rather than helping caregivers to make decisions for the recipients and then controlling the application (logic of substitution), in a care logic, tools are used to encourage recipients to express themselves and to develop and evaluate their own solutions. With this second approach, both caregivers and their tools therefore play a mediating role.

[1] Randall, J., & Munro, I. (2010). Foucault’s care of the self: A case from mental health work. Organization Studies, 31(11), 1485-1504

[2] Tomkins, L., & Simpson, P. (2015). Caring leadership: A Heideggerian perspective. Organization Studies, 36(8), 1013-1031.

Biography

Yves Habran is a research lecturer at ICN Business School. He also coordinates the “Health & Care” research pole at CEREFIGE, the management research laboratory of the University of Lorraine. He develops research on care in the domains of health and childhood protection. His studies focus on the organizational conditions that facilitate or prevent the development of care relationships, centered on patients or beneficiaries. They also incorporate multi-professional, intra- and inter-establishment coordination centered on the pathways of the care recipients.

 

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