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Title: Where three roads meet : triangulation in the care sector : a psycho-social view on caring & vulnerability
Author: Felix, Siebelien
ISNI:       0000 0004 7658 1585
Awarding Body: University of the West of England
Current Institution: University of the West of England, Bristol
Date of Award: 2016
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In this thesis I explore the effect on the lived experience of care workers and their managers in the residential elderly care sector of The Netherlands in relation to changes in and around the sector. Like in most western societies The Netherlands has to deal with ever increasing health costs. In 2006 the Dutch government opted for (semi-) privatizing the sector in the hope that competition would lead to more efficiency and reduction of costs. One of the major changes is the emergence of a powerful third party: the private insurance companies. As of 2006 healthcare and health cure providers have to negotiate with these companies about costs and services. The research perspective is a psycho-social approach, which aims to achieve a beneath the surface understanding of the interaction between macro and micro level phenomena. In doing so I wish to avoid approaching this issue from a single perspective such as organisational studies or social policy, in an attempt to adopt a more holistic understanding, viewing it both psychologically from 'inside' this experience and culturally/politically from outside. The data is collected through two case studies - two Dutch care homes for the elderly- where I applied three research methods: organisational observation, facilitated workshops and psycho-social interviews. The data was analysed by using a thematic, theoretical, deductive top down approach and with the help of reflection groups and postgraduate supervision. In this thesis I argue that macro level phenoma indeed are projected into the care sector and influence the running of the organisations and the lived experience of those working in the sector. The macro level phenoma are two feelings of anxiety in wider society: the fear of death and vulnerability and the fear that society can no longer afford the cost needed to care for vulnerable elderly. As such these feelings engender social defence like reactions and leads to 'as if' behaviour. It is as if good care is being delivered but in reality abuse is around the corner. I also argue that the sector has to learn to deal with thirdnes or a form of triangulation. By given a third stakeholder - the insurance companies - the task to reduce costs etc a form of triangulation is brought into the sector. However this form in practice turns out to create fear. Management constanctly focuses on the outside world and tries to comply with rules and regulations and leaves the carers to their own devices. The third party is regarded as a punitative superego, a negative third. I argue for a different form of triangulation in which the -one-in the third is allowed to be so that a true dialogue can emerge between the three partners concerned; the care recipient, the care provider and the financier. Acknolwedgements I am extremely gratefull to everyone who helped me to set up this research, to develop my thinking and to make it possible for this research project to have taken place • My director of studies professor Paul Hoggett and supervisior Matthew Jones, Associate Professor of Public Health, have been vital in this and have guided my through and have stimulated me to develop and use my creative thinking. • I foremost am very gratefeul to the two case studies. Both organistions gave me access to their inner worlds and created time to speak to and follow the management, the key workers, the carers and the facilitating staff. Without their valuable imput the data of this study would not have been able to emerge. • The existence of the centre of psycho-social studies founded by Paul Hoggett recently relaunched as the Centre for Understanding Social Practices, finding a home with Lita Crociani-Winland as new psycho-social team leader has been of the utmost importance. May the centre for a long time continue its creative thinking. All of the academic staff and my fellow researchers at the Centre for Psycho-Social Studies helped me to identify and explore unconscious dynamics that I might otherwise have overlooked. • Many among my friends and family supported me and had faith in my efforts. Foremost my husband Leo van de Valk who inspired me, stood by me through out and who supported me through thick and thin. • Throughout the course of this reseach my father died. I would like to dedicate this thesis to him, who was extremely proud of the fact that I undertook this effort and who would hopefully have been proud of the outcome of the thinking.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: care markets ; vulnerability ; elderly care