Different kinds of gaps

Abstract

When observing the improvement of fall prevention in long-term care institutions, various types of ‘gaps’ will be encountered. Fall prevention is aimed at simultaneously diminishing risk and increasing freedom, two values that can contradict one another and thus require ‘groping for good care.’ This paper discusses care organizations that encounter a diversity of gaps while working on the improvement of the quality of care. The improvement takes place in the process of a national quality improvement collaborative. When using ethnographic research methods to evaluate the quality improvement collaborative and the participating care organizations, it became evident that, while managers worked hard to build a better place for their clients, professionals were confronted with a new reality – a considerable number of concrete gaps and holes – that increased rather than decreased the risks of falling incidents. Investigating the activities of the improvement team in an organization of care for mentally disabled people, a familiar issue gained prominence: the management professional gap. Marilyn Strathern’s work on partial connections was used to reframe this symbolic gap from dichotomy into complexity. Analyzing the empirical findings from the perspective of partial connections, it could be demonstrated how health care professionals and managers are complexly connected and how they both cope with the same contradictory values in providing ‘good care’. Consequently, this study shows that the use of a non-dualistic perspective can lead us beyond the management professional gap.