Vedi, Priyanka
(2021)
Emotional labour in medicine.
PhD thesis, University of Nottingham.
Abstract
The emotional workplace has been explored through several perspectives (e.g. Hochschild, 1983; Bolton, 2005) and within several different contexts (e.g. James, 1992; Ashforth and Humphrey, 1993; Morris and Feldman, 1996; Fineman, 2003; Ward and McMurray, 2016). Although several contributions exist on emotions within organisations, missing from these debates is the exploration of how institutional logics shape the performance and management of emotional labour on the frontline. There is also limited knowledge on how workers navigate their emotional labour process in light of heterogeneous logics. In this light, both Hochschild’s (1983) and Bolton’s (2005) analyses have been considered and extended in order to re-ignite debates of the emotional workplace. This thesis examines whether a lens provided by the institutional logics perspective develops our understanding of emotional labour by showing how competing institutional forces can be considered as shaping emotional aspects of work.
The empirical focus of this thesis is on the context of British medicine. Despite research evidence pointing towards the importance of health/wellbeing for healthcare professionals, emotional aspects of the medical labour process are worryingly overlooked for junior doctors (Boorman, 2009; Vijendren et al, 2015). A fundamental aspect of medicine is too often neglected by both academics and practitioners: the emotional labour in medicine. Accordingly, this thesis explores the emotional context of medical and surgical work as a means of extending theoretical debates and addressing an important empirical focus.
An ethnographic exploration into the work experiences of junior doctors offers a promising case study to explore theorising of emotional labour. An ethnographic case study approach, through an interpretivist philosophy, provides important insights into the medical labour process, allowing for immersion within the institutional context and the gathering of junior doctor narratives. I conducted 40 semi-structured interviews with junior doctors across the training grade spectrum practicing within both medical and surgical services – including a handful of consultants to help contextualise the junior doctor data. In addition to interviewing, I undertook ethnographic observations – within ward areas, training sessions/breakout rooms, specialist clinics and operation theatres. This allowed the space and scope to explore the institutional context, associated workloads and pace of work processes in medicine. Two hospitals and a treatment centre within Wilton Trust informed this PhD - constituting a rich and insightful dataset.
In this thesis, I first aimed to uncover how institutional logics can be understood as shaping the performance of emotional labour. Changes to the political economy of the UK and associated public service reforms have brought conflicting institutional logics into the frontline of public service work. Given the shift towards neoliberalism and the political focus on the efficiency of services (e.g. Bolton, 2002), I found that multiple, competing institutional logics shape important aspects of a junior doctors’ labour process, and thus the texture of their emotional labour with patients and related others. Logics of bureaucratic rationality, professionalism, consumerism and an orientation towards the community were navigated by the doctors routinely in this study – doctors were found to choose, resist and negotiate these influences depending on work contexts and situational demands. Understanding the significance of the institutional logics perspective offers the first contribution to knowledge. Secondly, I aimed to understand types of emotional labour performed by the doctors considering the identified institutional influences. This thesis, therefore, helps to bring recent work locating emotions within institutional theory (e.g. Voronov and Vince, 2012) and extant literature on emotional labour in order to examine characteristic forms of emotional labour within medicine – this offers the second contribution to knowledge. Thirdly, I aimed to explore the means by which emotions were managed on (and off) the job with patients, colleagues and others. I found that doctors tended to share work experiences and relied mainly on collective processes in order to manage the pains and pleasures of medical/surgical work. This offers the third (empirical) contribution of the thesis.
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