Don’t Pass Them By: Figuring the Sacred in Organizational Values Work

The health care system in the country of our case organization can be characterized as semi-decentralized. The responsibility for specialist care lies with the state since 2002, administered by four RHAs, whereas municipalities are responsible for primary care. Coverage is universal and automatic with some payment stipulations for patients. As of 2016, private providers accounted for less than 12% of overall services, mostly by not-for-profit institutions. Health care providers contracted by an RHA are typically paid a combination of annual lump sums based on the type of practice and number of patients on the list, fee-for-service payments, and patients’ copayments. The annual lump sum and the out-of-pocket fees are set by government, and the fee-for-service payment scheme is negotiated between government and medical associations.

The research project was approved by the National Center for Research Data and followed its guidelines for informed consent, anonymization, and other aspects of data handling. We also cleared the project with the hospital data protection officer and research manager, as well as the Regional Committee for Medical and Health Research Ethics (REC) because patient interviews were involved. REC waived the need for formal approval because our research focused on organizational processes rather than on patients’ health conditions.

We first asked open-ended questions about the activities, challenges, and charged concerns of leaders and employees: Can you tell me about the typical activities you engage in during a normal working day? What challenges do you face being a manager/employee in this organization? Can you tell me a story of when you made a difference for someone at work? At work, what are the most important and difficult discussions and decision situations that you meet? Next, we asked more directed questions about value orientations, value processes, and value priorities at work, including what the leaders thought might constitute violation of values.

The observation protocol involved the following questions: What were the expressed concerns and needs of people in treatment situations? How did staff respond to such concerns and needs in action? How were these events connected to ongoing value discourses? What kinds of contextual elements (e.g., time, place, history of treatment, staffing, regulations) influenced the observed situations?

Holy Bible, New International Version^® (https://​www.​biblegateway.​com/​passage/​?​search=​Luke+10%3A25-37): “A man was going down from Jerusalem to Jericho, when he was attacked by robbers. They stripped him of his clothes, beat him and went away, leaving him half dead. 31 A priest happened to be going down the same road, and when he saw the man, he passed by on the other side. 32 So too, a Levite, when he came to the place and saw him, passed by on the other side. 33 But a Samaritan, as he traveled, came where the man was; and when he saw him, he took pity on him. 34 He went to him and bandaged his wounds, pouring on oil and wine. Then he put the man on his own donkey, brought him to an inn and took care of him. 35 The next day he took out two denarii[c] and gave them to the innkeeper. ‘Look after him,’ he said, ‘and when I return, I will reimburse you for any extra expense you may have.’”

Much of the telling of the heritage of Maria Haven emphasizes dedication, the importance of quality in care, and the compassion for the whole person. At least two of the stories that are often told at The Deaconess have direct parallels to the Good Samaritan. One is a recurrent refrain referring to how Haven, upon entering the mother house of the organization, would always stop by and talk to and care for the poor people sitting by the stairs. The other, typically told during introduction seminars, is of a formative experience from when a young Maria Haven learned of the death of a homeless gypsy woman who used to roam the local farms asking for food. One winter morning, the woman was found frozen to death in a snowdrift, full of infected wounds. The event caused Haven to reflect on the travesty of humans freezing to death, being outside and alone. Caring for the outcasts, the ones everybody shies away from is so much harder than caring for one’s loved ones or those with means. Who cares for the hopelessly poor, the dirty drunks, the homeless, and the prostitutes with venerable diseases? A calling was seeded.

Our use of the triple mimesis framework involves two conventions to use in the empirical setting of organizational values work. First, we approached prefiguring and refiguring from the input side as stories to practice—the stories and figures of the sacred repeatedly told by leaders and others and that we have also observed as somehow mirrored in practice. The invocation of such stories during a specific act of care cannot be analytically determined with certainty. Organization members draw upon, explicitly or tacitly, a repertoire of such stories, corresponding to what Emirbayer and Mische (1998) called the iterative and retrospective dimension of agency. At work here is also a rehearsal of alternative possibilities for acting (Johnson 1993) in the projective dimension, and a practical evaluative resolution in the present of things present (Emirbayer and Mische 1998). Here, prefiguring and refiguring merge into configuring as organization members use elements from a prefigured repertoire that they enact prospectively or later rationalize as they narrate their experiences. Our second analytical convention is thus to approach configuring from the output side—stories from practice. The implicit complication is that researchers are not passive observers of such stories. Configuring may occur twice, first when doing and later as a performance when telling about the doing in an interview (Cunliffe et al. 2004). It is primarily that second moment we have empirical access to. The exception is when we are observing practice and assigning it meaning as belonging to this or that story. Then we as researchers are performing the configuring.