Klagomålshantering och lex Sarah-rapportering i äldreomsorgen. En institutionell etnografisk studie.

Abstract

The aim of this thesis is to increase the knowledge of how complaints and mandatory reports of mistreatments function in the care of old people. The objective is to make an analysis grounded in the experiences of the complainants to provide an analytic mapping where the experiences of the subject can be connected to social and ruling relations. The assumption guiding this objective is that local experiences are influenced, and to different degrees ruled, by other people’s activities elsewhere. The material consists of interviews with complainants, care staff, managers and officials, field-notes from observations in home care, special housing and service users’ councils, written complaints and mandatory reports collected from two urban areas in Sweden and from different municipalities as well as from regulatory authorities. The theoretical and methodological framework used in the study is institutional ethnography. An extended concept of work is employed as an orienting concept. Social and ruling relations are traced by identifying explanation repertoires. Part of the analysis is inspired by analytic induction. The method of ghostwriting is used in part to elucidate the dialogic process between the researcher and the researched. The results show that complaints have a limited significance for improvements in the care of individual care recipients and that complaints are often ignored. This is made possible due to a folk logic recognizing complainants as “annoying” people. In the complaining processes the caring work disappears and is replaced by a “documentary work,” which is in line with the reinforcements of quality assurance. The care recipients do not take part in this work, neither with an active voice nor as passive recipients of care. Many mandatory reports are initiated by complaints. From the care recipient's point of view, the mandatory reports have little value. Generally, mistreatments are not related to the consequences of abusive acts and neglect for the care recipient's health and well-being, but to systematic appearance of the mistreatment and whether intent can be established. Two prominent functions with the obligation to report are 1) finding systems of error and 2) that the conceptual framework following the act evokes a moral discourse identifying unsuitable care staff. Two main types of complaints processes are distinguished: a closed and an extended process. Three ideal-type models are delineated, showing the institutional practices that complainants and reporters meet in this context and their possibilities to make change through complaint procedures. None of these models seem to be of much help for the care recipient. A model where they can act and be treated as citizens is called for. The potential and drawbacks of institutional ethnography are discussed.