Rationalizing emotions and emotionalizing reason: The staging of decisions in the ED
2014 (English)Conference paper (Refereed)
In the setting of healthcare in general, and medical Emergency Departments (ED) in specific, decision-making is at the core of almost all activities—ranging from simple medical prescriptions to crucial decisions in life and death situations. Despite the far-reaching rational traditions and objective assumptions characterizing the ED, it has lately been acknowledged that the everyday decision-making involves much more than a simple analytical action-reaction sequences. In order to disambiguate symptoms, doctors need for example to balance on the one side, intuition and emotion-laden (non-reason based) decisions and on the other side, rational (reason based) decisions. For instance, to sensitize clinicians to non-verbal information, such as an odour, may provide an additional information that otherwise could have been overseen. The shifting between different modes (reason and non-reason based) also happens in interaction with others, through means of different channels, and in different locations. Decision-making in the ED therefore become staccato paced rather than distinct and flowing, which also implies that the decision-making skills do not take place in a vacuum, but are rather bound to restrictions of the context in which they take place. How the ED context as such, and the shifting between different modes, influences and shapes the enactment of medical decisions, is however less clear. Based on an in-depth qualitative study conducted at the Stanford Hospital and Clinics’ Emergency Department, the purpose is therefore to describe and analyze how the medical decision-making process unfolds, is staged, and shaped by contextual logics. Theoretically, the paper takes its departure in the psychological decision-making literature. Empirically, the paper is based on more than 200 hours of participant observation, document collection, and semi-structured interviews, which was analyzed using a template-based approach. Through the analysis, two different logics are identified—one ‘backstage logic’ and one ‘front-stage logic’—that both, but in different ways, shape how the decision-making process unfolds and the decisions are staged. The two logics have their underpinnings in dualistic assumptions of traditional decision-making literature, but are context dependent enactments rather than being based on information processing and individual capabilities. Through the logics we explain how Doctors may uphold a professional role, under both institutional and individual decision-making pressures, but also create a sense of public security to meet the widespread expectations of healthcare being a ‘precise science’. By that, we contribute with an enhanced understanding of how reason and non-reason based elements intertwine and serve a purpose for both caregivers and patients. In turn, this helps in bridging the caregivers’ and patients’ sometimes different perspectives by creating realistic assumptions about how medical decisions are made in practice. The study advances our understanding beyond a dualistic and personal emotion versus rationality dichotomy by emphasizing decisions as blends of non-reason and reason-based process by enclosing personal and relational conditions. Such a contextualization is valuable as it increases understanding of that decision-making processes is about more than providing ‘the right’ answer.
Place, publisher, year, edition, pages
Decision-making, logics, health care, emergency departments, process oriented
Business Administration Applied Psychology Social Sciences Interdisciplinary
IdentifiersURN: urn:nbn:se:bth-11745OAI: oai:DiVA.org:bth-11745DiVA: diva2:912584
Strategizing and Organizing in Extreme Contexts: Challenges and Opportunities for a Practice-based Perspective, Montreal, 15-16th of October