HEALTH STATES OF EXCEPTION: THE (INADVERTENT) PRODUCTION OF ‘BARE LIFE’ IN COMPLEX CARE TRANSITIONS: Justin Waring Professor in Organisational Sociology at Nottingham University Business School, 9th May 2019

Abstract: A growing number of reports and research studies show that people discharged from hospital often experience a sense of abandonment and stigmatisation, and that they all too often receive delayed, inappropriate or unsafe care. In many ways it can seem that these people are seen as less important or valuable to the care system. This paper draws upon the work of Giorgio Agamben to understand how the social organisation of care transitions can reduce people to their ‘bare’ life thereby making possible harmful and degrading treatment. The concept of ‘bare’ life is derived from classical Greek and Roman law, and describes a ‘life’ that is deprived or stripped of the safeguards and protections that are usually accorded to citizens in the form of a ‘qualified’ life.

The findings of a two-year ethnographic study are analysed to show how some people experience hospital discharge as a vulnerable, inhumane and unsafe process, as found in their lack of involvement in care planning, delayed discharge from hospital and inappropriate and unsafe follow-on care. This is shown to stem from the way patients are constituted as ‘unknown’ and ‘ineligible’ and, in turn, professionals become ‘not responsible’ for care during and after the discharge processes. The social production of ‘bare life’ is found to be an inadvertent feature of patients ‘falling between gaps’ of different professional practices and cultures within a complex care system.

Biography: I completed my doctorate in Sociology at the University of Nottingham (2004) on ‘The social construction and control of medical errors’. I am now Professor in Organisational Sociology at Nottingham University Business School. In 2013, I founded the Centre for Health Innovation, Leadership & Learning (CHILL), which leads the Business School’s research on health systems improvement, and in the same year was awarded a Health Foundation Improvement Science Fellowship to undertake research on major system change. I am currently Associate Dean for Research within the Business School, and also the Lead for the ‘Implementing Evidence and Improvement’ Theme for NIHR CLAHRC East Midlands, and the Lead for the ‘Safer Care Systems and Transitions’ Theme for the NIHR Greater Manchester Patient Safety Translational Research Centre.

Presentation slides available here.