Saqqummersitaq

Since the 1990s, the provision of public hospital healthcare in Denmark has been under increasing pressure from neo-liberal managerial reforms that threaten the quality of health care. Following the idea of New Public Management – ‘value for money’, the aim of the reforms has been two-fold. First, to make public hospitals stand out as efficient providers of health services, while confronted with a small but still growing private market, and answering to classic economic calls for efficiency and ‘rationalisation’. Second, through the consumer-oriented service discourses of New Public Management, to attempt a new quality branding of the ‘healthcare services’. Regional, political and managerial bodies of healthcare have thus, through institutional and managerial reforms, endorsed the ‘new’ international standards of ‘patient safety friendly hospitals’ along with slogans such as ‘We are here for you!’ and policy calls for improved service orientation. The following chapter traces the consequences of the ‘value for money-reforms’, on the basis of an ethnographic study following the initial steps of newly qualified nurses, and the ways they must attempt to adapt to the pace and the established professional standards of practices at medical hospital units in Denmark. Based on observed experiences and practices of the care work of the nurses, we will discuss their challenges as a sign of the care crisis. This care crisis, which we argue is directly linked to the managerial reforms within the hospital sector, has the implication of individualising the responsibility for the quality of care, leading to the undermining the human prerequisites for care taught during nurse education.

I denne institutionelle etnografiske undersøgelse med analyser af deltagerobservationer, interviews og politiske dokumenter beskrives nyuddannede sygeplejerskers arbejde med at lære sig den ”rigtige” måde at tænke udskrivelse af medicinske patienter i Region Sjælland. Lægerne understreger, at patienterne skal tænkes udskrevet fra første indlæggelsesdag. Rationalet bag denne belæring af nyuddannede sygeplejersker er politiske bestemmelser, der sætter sig igennem i hverdagslivet. Region Sjælland har nemlig flest og Nordjyl¬land færrest akutte (gen)indlæggelser af borgere over 65 år med kroniske sygdomme, hvilket er en af de politiske bestemte indikatorer, der skulle definere kvaliteten af de regionale sundhedstilbud i Danmark. Men pointet i denne artikel er, at de politiske offentliggørelser med optællinger og sammenligninger af målindikatorer kun kaster spotlight på dele af arbejdsaktiviteterne i hverdagslivet. Et medicinsk afsnit, der er lokaliseret i Region Sjælland, skal rumme flere ældre patienter med kroniske sygdomme, som måske endog er demente, og som for¬årsager turbulente udskrivelser end f.eks. Nordjylland.