Expansive Concept Formation at Work: an Activity-Theoretical Analysis by PsyJournals.ru

EXPANSIVE CONCEPT FORMATION AT WORK: AN ACTIVITY-THEORETICAL ANALYSIS OF ANCHORING ACROSS ORGANIZATIONAL LEVELS YRJÖ ENGESTRÖM

Center for Research on Activity, Development and Learning CRADLE University of Helsinki

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Center for Research on Activity, Development and Learning CRADLE University of Helsinki

• “CONCEPTS AND THEIR MEANINGS DEVELOP AND EVOLVE IN SETTINGS OF PRACTICE AND ARE MAINTAINED IN PRACTICES BECAUSE THEY ARE USEFUL IN CONDUCTING THE COMMUNITY’S ACTIVITIES.” (Hall and Greeno, 2008, p. 213)

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Center for Research on Activity, Development and Learning CRADLE University of Helsinki

FIVE ARGUMENTS ABOUT THE NATURE OF COMPLEX WORK-RELATED CONCEPTS

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Center for Research on Activity, Development and Learning CRADLE University of Helsinki

1. COMPLEX CONCEPTS ARE EMBODIED, EMBEDDED AND DISTRIBUTED IN AND ACROSS HUMAN ACTIVITY SYSTEMS EQUIPPED WITH MULTI-LAYERED AND MULTI-MODAL REPRESENTATIONAL INFRASTRUCTURES OR INSTRUMENTALITIES

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Center for Research on Activity, Development and Learning CRADLE University of Helsinki

2. COMPLEX CONCEPTS ARE INHERENTLY POLYVALENT, DEBATED, INCOMPLETE, AND OFTEN ‘LOOSE’ DIFFERENT STAKEHOLDERS PRODUCE PARTIAL VERSIONS OF THE CONCEPT; THE FORMATION AND CHANGE OF COMPLEX CONCEPTS INVOLVES CONFRONTATION AND CONTESTATION AS WELL NEGOTIATION AND BLENDING 24.01.24

Center for Research on Activity, Development and Learning CRADLE University of Helsinki

3. COMPLEX CONCEPTS ARE FUTUREORIENTED, THEY ARE LOADED WITH AFFECTS, HOPES, FEARS, VALUES, AND COLLECTIVE INTENTIONS ‘POSSIBILITY CONCEPTS’ AND ‘PERSPECTIVAL CONCEPTS’ EXPLICATE TIMEBOUND COLLECTIVE INTENTIONS OR VISIONS OF FUTURE DEVELOPMENT AND CHANGE

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Center for Research on Activity, Development and Learning CRADLE University of Helsinki

4. COMPLEX CONCEPTS ARE FORMED AND CHANGED BY MOVEMENT AND INTERACTION IN TWO DIMENSIONS, VERTICAL AND HORIZONTAL

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Center for Research on Activity, Development and Learning CRADLE University of Helsinki

5. COMPLEX CONCEPTS EVOLVE THROUGH CYCLES OF STABILIZATION AND DESTABILIZATION THEY ARE STABILIZED BY MEANS OF NAMING, FRAMING AND ANCHORING THEM IN MATERIAL ARTIFACTS AND RULE-BOUND PRACTICES

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Center for Research on Activity, Development and Learning CRADLE University of Helsinki

THE HOME CARE PROJECT

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Center for Research on Activity, Development and Learning CRADLE University of Helsinki

PROJECT ’PREVENTING SOCIAL EXCLUSION AMONG THE ELDERLY IN HOME CARE IN THE CITY OF HELSINKI’ • GREYING OF THE POPULATION: RADICAL INCREASE OF THE ELDERLY IN FINLAND • WHOLESALE MOVE FROM INSTITUTIONALIZED CARE TO HOME CARE • INCREASING RISK OF SOCIAL EXCLUSION • QUICK FIXES, ABRUPT CHANGES • INCREASING PRESSURE TOWARD PRIVATIZATION OF SERVICES • PROJECT FUNDED BY THE CITY OF HELSINKI: SEARCH FOR NEW SOLUTIONS 24.01.24

Center for Research on Activity, Development and Learning CRADLE University of Helsinki

THE PRESENT CONTRADICTION IN HOME CARE DUTIES MEDICINE DISPENSATION, GARBAGE OUT, BREAKFAST, SHOWER, TIDY UP, ORGANIZE e.g. MEAL ON WHEELS... SERVICE / DUTY PLAN, SUPPLEMANTARY NO CARE PLAN, SERVICES NO PALETTE OF HC-SERVICES RAI...APPLICATIONS TOOLS BLOOD PRESSURE, PULSE...

OBJECT

PAYMENT ORDER, NO PALETTE OF HC-SERVICES TOOLS OBJECT

OBJECT

SUBJECT

RULES

LIFE LONELINESS, FUNCTIONAL CAPACITY, MOBILITY, DEMENTIA, RESOURCES

COMMUNITY

SUBJECT

OBJECT

DIVISION OF LABOUR

COMMUNITY

RULES

HOME CARE CLIENT

HOME CARE SHARED OBJECT

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Center for Research on Activity, Development and Learning CRADLE University of Helsinki

TWO LAYERS OF CONCEPT FORMATION CHALLENGE IN HOME CARE • FRONTLINE LAYER OF WORKERS AND CLIENTS: TO CONSTRUCT A NEW WORKING CONCEPT THAT ATTACKS THE NEGLECTED RISK OF CLIENTS’ LOSS OF PHYSICAL MOBILITY • MANAGEMENT LAYER: TO CONSTRUCT A NEW FUTURE-ORIENTED CONCEPT THAT OVERCOMES THE FRAGMENTATION AND ROUTINIZATION OF HOME CARE SERVICES

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Center for Research on Activity, Development and Learning CRADLE University of Helsinki

MATERIAL ANCHORING IN EXPANSIVE CONCEPT FORMATION

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Center for Research on Activity, Development and Learning CRADLE University of Helsinki

HUTCHINS ON MATERIAL ANCHORING “Blending with material anchors may increase the stability of conceptual structure, enabling more complex reasoning processes than would be possible otherwise. (…) In order to produce and manipulate a stable representation of the conceptual elements involved in such computations, the elements must be somehow held (or anchored) in place. The ‘holding in place’ is accomplished by mapping the conceptual elements onto a relatively stable material structure. This is how a material medium becomes an anchor for a conceptual blend. (…) If conceptual elements are mapped onto a material pattern in such a way that the perceived relationships among the material elements are taken as proxies (consciously or unconsciously) for relationships among conceptual elements, then the material pattern is acting as a material anchor.” (Hutchins, 2005, p. 1562) 24.01.24

Center for Research on Activity, Development and Learning CRADLE University of Helsinki

THE EXAMPLE OF A QUEUE “Consider a line of people queuing for theatre tickets. This cultural practice creates a spatial memory for the order of arrival of clients. The participants use their own bodies and the locations of their bodies in space to encode order relations. The gestalt principle of linearity makes the line configuration perceptually salient. (…) But seeing a line is not sufficient to make a queue. Not all lines are queues. (…) In order to see a line as a queue, one must project conceptual structure onto the line. The conceptual structure is the notion of sequential order. For our purposes, we will represent this directional ordering as a trajector (…). Conceptually blending the physical structure of the line with an imagined directional trajector turns the line into a queue.” (Hutchins, 2005, p. 1559) 24.01.24

Center for Research on Activity, Development and Learning CRADLE University of Helsinki

Research on Activity, Development and Learning CRADLE 24.01.24 HUTCHINS’ MODELCenter OFforMATERIAL ANCHORING (Hutchins, 2005, p. 161560) University of Helsinki

BUT A QUEUE IS NOT A COMPLEX CONCEPT TO BE FORMED TO MASTER CHANGES AT WORK IN THE HOME CARE CASE, THE INPUTS ARE NOT STABLE AND GIVEN THEMSELVES AT THE WORKER/CLIENT LEVEL OF HOME CARE, ONE INPUT IS THE CLIENTS’ IMMOBILITY AS A GROWING, YET NEGLECTED RISK: INPUT1 IS A PROBLEM, OR A THREAT – PERCEIVABLE BUT ALSO ELUSIVE THE OTHER INPUT IS THE MATERIAL-TEXTUAL DOCUMENT OF THE MOBILITY AGREEMENT, SUPPORTED BY AN EXERCISE BOOKLET; THIS INPUT2 IS A MATERIAL ANCHOR, BUT IT IS PERMANENTLY UNDER CONSTRUCTION, IT NEEDS TO BE NEGOTIATED AND ADAPTED TO EACH CLIENT’S PARTICULAR SITUATION FINALLY, THE EMERGING BLEND IS A NEW, AS YET UNKNOWN CONCEPT FOR HOME CARE CLIENTS’ MOBILITY; ONLY CONTINUED RUNNING OF THE BLEND OVER A NUMBER OF CLIENTS AND SUFFICIENT PERIOD OF TIME WILL EVENTUALLY GIVE RECOGNIZABLE SHAPE TO THE NEW CONCEPT

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Center for Research on Activity, Development and Learning CRADLE University of Helsinki

VYGOTSKY’S PRINCIPLE OF DOUBLE STIMULATION •

•

“In experiments involving meaningless situations, Lewin found that the subject searches for some point of support that is external to him and that he defines his own behavior through this external support. In one set of experiments, for example, the experimenter left the subject and did not return, but observed him from a separate room. Generally, the subject waited for 10-20 minutes. Then, not understanding what he should do, he remained in a state of oscillation, confusion and indecisiveness for some time. Nearly all the adults searched for some external point of support. For example, one subject defined his actions in terms of the striking of the clock. Looking at the clock, he thought: ‘when the hand moves to the vertical position, i will leave.’ The subject transformed the situation in this way, establishing that he would wait until 2:30 and then leave. When the time came, the action occurred automatically. By changing the psychological field, the subject created a new situation for himself in this field. He transformed the meaningless situation into one that had a clear meaning.” (Vygotsky, 1987, p. 356) 24.01.24

Center for Research on Activity, Development and Learning CRADLE University of Helsinki

VYGOTSKY’S PRINCIPLE OF DOUBLE STIMULATION

FIRST STIMULUS: PROBLEM SITUATION OR DOUBLE BIND AGENTIVELY TRANSFORMED SITUATION, NEW MEANING, NEW CONCEPT SECOND STIMULUS: MATERIAL ARTIFACT TURNED INTO MEANINGFUL SIGN 24.01.24

Center for Research on Activity, Development and Learning CRADLE University of Helsinki

DESIGN OF THE HOME CARE CONCEPT FORMATION STUDY INPUT/STIMULUS1 FRAGMENTATION AND ROUTINIZATION OF SERVICES BLEND; NEW CONCEPT, NEW AGENCY ? INPUT/STIMULUS2 MATERIAL ANCHOR SERVICE PALETTE

INPUT/STIMULUS2 MATERIAL ANCHOR MOBILITY AGREEMENT EXERCISE BOOKLET BLEND; NEW CONCEPT, NEW AGENCY ?

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INPUT/STIMULUS1 CLIENTS’ IMMOBILITY AS A NEGLECTED RISK Center for Research on Activity, Development and Learning CRADLE University of Helsinki

THE EXERCISE BROCHURE

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Center for Research on Activity, Development and Learning CRADLE University of Helsinki

PAGE FROM THE EXERCISE BROCHURE INSTRUCTIONS FOR STANDING UP FROM THE CHAIR

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Center for Research on Activity, Development and Learning CRADLE University of Helsinki

THE SERVICE PALETTE (INITIAL VERSION, 40 PAGES)

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Center for Research on Activity, Development and Learning CRADLE University of Helsinki

EXPANSIVE CONCEPT FORMATION IN PRACTITIONER-CLIENT ENCOUNTERS

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Center for Research on Activity, Development and Learning CRADLE University of Helsinki

INTERACTION IN THE STANDARD HOME VISIT: COORDINATION BY MEANS OF A QUESTION-ASKING SCRIPT

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Center for Research on Activity, Development and Learning CRADLE University of Helsinki

385 Mrs H: ... that I still hope to do some sort of, you know, small walking outside. That would be something I would like to get. I’m afraid that, to go out of the door, because it slams onto me. When I go with this rollator I’m there, pushing this door and I can’t go without it slamming onto me 386 Lisa: So. Or if that could be possible, if we could get some sort of, you know, those people who take you out, or kind of escort. Did you get the letter from social organisation which talks about these volunteers or about these people who escort? 387 Mrs H: No. 388 Lisa: Hmm. How didn’t you get that? 390 Mrs H: But how could I then, with that kind of escort, could go and have any kind of outing? I have, yes, sometimes... Lisa continued her work with the medicine doses for 30 minutes while Mrs H just sat and talked.

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Center for Research on Activity, Development and Learning CRADLE University of Helsinki

402 Mrs H: ... sometimes I forget that [rollator] and then I can walk, yes. Once I forgot that, there, and then I walked to watch TV, there [points further away]. And Timo [her son] was here then and he said ‘You forgot your rollator’, and brought it to me... Mrs H explained how she was not allowed to walk inside the house without the rollator. She has been told by several people that it is too dangerous for her to walk independently. 429 Lisa: There was a time when you had that training, that you wanted to train, but I didn’t give you permission to, without the rollator, all alone, to go.

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Center for Research on Activity, Development and Learning CRADLE University of Helsinki

*THE APPOINTMENT LASTED FOR 64 MINUTES *THE HOME CARE WORKER ASKED 79 QUESTIONS (OF A TOTAL OF 336 TURNS TAKEN BY THE HOME CARE WORKER) *IT WAS A SCRIPTED FLOW OF INTERACTION WHERE THE HOME CARE WORKER AND CLIENT WERE FOLLOWING THEIR ASSIGNED ROLES, CONCENTRATING ON THE SUCCESSFUL PERFORMANCE OF THEIR ASSIGNED ACTIONS *THIS SCRIPT IS CODED IN HOME CARE RULES AND ASSUMED TRADITIONS; IT COORDINATES THE PARTICIPANTS’ ACTIONS BEHIND THEIR BACKS WITHOUT BEING QUESTIONED

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Center for Research on Activity, Development and Learning CRADLE University of Helsinki

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Center for Research on Activity, Development and Learning CRADLE University of Helsinki

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Center for Research on Activity, Development and Learning CRADLE University of Helsinki

*THE CLIENT’S OBJECT WAS HER OWN MOBILITY *THE HOME CARE WORKER’S OBJECT WERE THE TASKS SHE WAS SUPPOSED TO COMPLETE DURING THE VISIT *THERE WERE HINTS GIVEN BY THE CLIENT THAT SHE WOULD LIKE TO BE MORE MOBILE… *BUT THE HOME CARE WORKER JUST WANTED TO COMPLETE HER TASKS

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Center for Research on Activity, Development and Learning CRADLE University of Helsinki

INTERACTION IN A HOME VISIT AFTER THE INTERVENTION: COOPERATION BY MEANS OF THE EXERCISE BROCHURE

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Center for Research on Activity, Development and Learning CRADLE University of Helsinki

INITIALLY THE EXERCISE BROCHURE IS THE SHARED OBJECT

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Center for Research on Activity, Development and Learning CRADLE University of Helsinki

AS THE HOME CARE WORKER STEPS BACK AND THE CLIENT BEGINS TO STAND UP FROM THE CHAIR (WITHOUT THE SUPPORT OF THE TABLE, AS INSTRUCTED IN THE BROCHURE), THE SHARED OBJECT BEGINS TO SHIFT FROM THE BROCHURE TO THE CLIENT’S MOVEMENT

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Center for Research on Activity, Development and Learning CRADLE University of Helsinki

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Center for Research on Activity, Development and Learning CRADLE University of Helsinki

EMBODIED REMEMBERING 119 Lisa: 4, 5, 6, 7, 8, 9, 10. Good. You can do this very nicely. What about dancing? Would you manage? 120 Mrs H: Dancing? How come? [laughing, Lisa shows ‘dancing steps’ in the brochure] 121 Lisa: Here are dancing steps, look at these – this kind of movement. 122 Mrs H: I’ve been dancing a lot when I was young. 123 Lisa: Well, then it will work very well. 124 Mrs H: But, it doesn’t work because... [laughs] 125 Lisa: It will work. So I mean – grab the chair there [shows]. 126 Mrs H: Ahaa. ... 130 Lisa: OK, try now... 131 Mrs H: In front, to the side, to the back. In front, to the side, to the back. [moves her legs]. Isn’t it like this also when you dance? [laughs]. My former husband was so eager to dance but I can’t do this all alone... ... 148 Mrs H: I’m imagining that my Matti is here now, like this...[laughs] 149 Lisa: Yes, good. Do you feel bad? 150 Mrs H: No. 151 Lisa: Nowhere? There’s no bad feeling? 24.01.24152 Mrs H: No.Center for Research on Activity, Development and Learning CRADLE University of Helsinki

AS THE CLIENT BEGINS TO TAKE THE DANCING STEPS, SHE EXPANDS THE OBJECT TO ENCOMPASS HER PERSONALHISTORICAL RELATIONSHIP TO HER BODY, FIRST BY MEANS OF THE CHAIR, THEN BY EMBODIED REMEMBERING OF HER DECEASED HUSBAND AS DANCING PARTNER

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Center for Research on Activity, Development and Learning CRADLE University of Helsinki

• THIS INTERACTION FIRST FOCUSED ON THE BROCHURE, THEN SHIFTED TO THE MOVEMENT AND EVENTUALLY EXPANDED TO THE CLIENT’S PERSONAL-HISTORICAL RELATIONSHIP TO HER BODY • THE EXERCISE BROCHURE MOVED FROM BEING THE OBJECT TO BEING A MEDIATING TOOL • THE EXERCISE BROCHURE ALSO FUNCTIONED AS THE SCRIPT OF THE ENCOUNTER; HOWEVER, THE COOPERATION MOVED BEYOND THE SCRIPT AT THOSE POINTS WHERE NEW FORMS OF AGENCY EMERGED

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Center for Research on Activity, Development and Learning CRADLE University of Helsinki

COMMITMENT TO ACTION 1 200 Mrs H: So, should I do these things by myself? 201 Lisa: Yeah, at least this getting up from the chair and if [shows the ‘dancing steps’] you can’t balance while you do these, we can do these together when we come to shower you, then... 202 Mrs H: Yes, then.

HERE THE CLIENT COMMITTED TO TRYING TO DO THE EXERCISES BY HERSELF MORE THAN THAT, THE HOME CARE WORKER COMMITTED TO INTEGRATING THE EXERCISES INTO HER ROUTINE CHORES (SHOWERING) IN FUTURE VISITS 24.01.24

Center for Research on Activity, Development and Learning CRADLE University of Helsinki

COMMITMENT TO ACTION 2 215 Lisa: But we just talked in the morning that however you move yourself so well in here with the rollator but if you could get some more muscle strength for your thighs. And I just looked up the number of this house manager and I will ask if there is any possibility to do something with that front door – so it would open easier. I will call them. 216 Mrs H: Yeah. 217 Lisa: Good.

IN TURN 215, THE HOME CARE WORKER MADE AN EXPLICIT COMMITMENT TO TAKE ACTION TO FACILITATE THE MOBILITY OF CLIENT SUCH COMMISSIVE SPEECH ACTS ARE STRONG INDICATIONS OF AGENCY IN TURN 216, THE CLIENT SUPPORTED THE COMMITMENT BY AN AFFIRMATIVE COMMENT, WHICH WAS FURTHER AFFIRMED BY THE HOME CARE WORKER IN TURN 217

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Center for Research on Activity, Development and Learning CRADLE University of Helsinki

STANDING UP FROM THE CHAIR: EXPANSIVE GERM CELL CONCEPT FOR HOME CARE CLIENT’S MOBILITY

IT IS SIMPLE, IT INCLUDES THE BASIC TENSION BETWEEN AUTONOMY AND DEPENDENCY (USE THE TABLE vs. USE YOUR OWN THIGH MUSCLES), IT IS PERVASIVELY PRESENT, AND IT IS A STARTING POINT FOR MORE COMPLEX ACTIONS OF MOBILITY… 24.01.24

Center for Research on Activity, Development and Learning CRADLE University of Helsinki

BEFORE

AND AFTER

USE YOUR OWN USE24.01.24 THE TABLECenter for Research on Activity, Development and Learning CRADLE University of Helsinki MUSCLES

EXPANSIVE CONCEPT FORMATION AMONG HOME CARE MANAGERS

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Center for Research on Activity, Development and Learning CRADLE University of Helsinki

CHANGE LABORATORY WITH HOME CARE MANAGERS 2008-09 • SEVEN AREA MANAGERS OF HOME CARE IN HELSINKI, PLUS THEIR DIRECTOR AND A PERSONNEL REPRESENTATIVE • MY GROUP OF FOUR RESEARCHERS • START: PARTICIPANTS FACED THE MIRROR: VIDEOTAPED CASES, INTERVIEWS, STATISTICS MANIFESTING TROUBLE • THEN ANALYSIS: WHERE DID WE COME FROM, WHAT ARE THE CONTRADICTIONS, WHAT ARE THE AVAILABLE DIRECTIONS • THE DESIGN: SERVICE PALETTE AS ’TROJAN HORSE’ 24.01.24

Center for Research on Activity, Development and Learning CRADLE University of Helsinki

FACING THE FIRST STIMULUS: DOUBLE BIND

Home care manager 3: I look at the future with great fear. Life and tasks there, that separation. I think it is a consequence of a failure of the whole society and the whole education system. (…) Many things kind of erode it [the principle of holistic care], so it becomes performing only minimum services. And then there is the client who has a life, and we only visit and take care of a wound or distribute medications and such, and we think that’s it. Home care manager 6: First they [practical nurses] read two years about life, then the last part of training they study the tasks. And it is the tasks in the end, so it does become centered on tasks. (…) And they do master them, there is no difficulty in taking out the garbage, they master it very well. They also master wounds and taking blood pressure, but … somehow the tasks do not connect to…the whole. (…) So how could that be fixed, I don’t know. Center for Research on Activity, Development and Learning CRADLE 24.01.24

University of Helsinki

Home care manager 10: Somehow I think we are not taking comprehensive responsibility. It is not clear. I mean, comprehensive responsibility for the situation of the client. Our services have been split into small pieces with all the support services. I am not criticizing them, we wouldn’t have managed without putting together those support services. But this has created a new need for us. To satisfy the client and to handle the totality in a manageable way with regard to our resources and the client’s needs, who has the responsibility for that? Home care manager 9: On the one hand, it takes away motivation from our workers, that they don’t have a holistic grasp of the patient, the client. And on the other hand, it is not possible for us because we have so little time per client, so that doesn’t make it possible for us to activate the client. So we function inefficiently in my opinion. I cannot say how we’d function better. I cannot say anything but that we’d need more time. But how? 24.01.24

Center for Research on Activity, Development and Learning CRADLE University of Helsinki

Home care manager 3: So it’s the basic level of coping with everyday life, if you can describe it this way. But are we so far down at the bottom that we don’t even have resources for anything else? Home care manager 9: The physiological functions, the lowest level of Maslow’s hierarchy is realized. Home care manager 3: Yes, right, right! Home care manager 2: We make the people passive there, when we serve them. I’m not saying that they are served helpless, but we are not giving them an opportunity during our visit to do the things they could still do. And from my point of view, this little by little pushes the people a bit too early toward their death. They are not so frail as we imagine. Center for Research on Activity, Development and Learning CRADLE 24.01.24 47 University of Helsinki

EQUALITY CENTRALIZED MASS PRODUCTION OF STANDARD SERVICES

THE SERVICE PALETTE FLEXIBILITY

CARE FOR THE POOR

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PRIVATIZED SERVICES

Center for Research on Activity, Development and Learning CRADLE University of Helsinki

STARTING TO ANCHOR: REDEFINING THE PROBLEM WITH THE HELP OF THE SERVICE PALETTE Home care manager 6: Well, we have experienced that the grannies know what their neighbors have gotten. We get phone calls, saying how come I have not been offered this service even though she [the neighbor] gets it and the caller knows that it is available. This makes me think that we cannot conceal our services. We have to show openly what we have, and that this may be good for you, but this is inappropriate for you. Researcher: Exactly. Home care manager 6: But… Researcher: When they are chosen by negotiation… Home care manager 6: …they know, and in the future they will know even more. Researcher: Yes. Then you cannot anymore give everybody the same. Home care manager 6: No, we can’t. 24.01.24

Center for Research on Activity, Development and Learning CRADLE University of Helsinki

Home care manager 9: How can we allow the client to decide: ”I take foot care, massage, cosmetological services, manicure, and preferably music therapy, but I certainly do not take anything that includes physical exercise, and I don’t bother to do much myself.” So this service palette requires that we know how to sell: ”Select from these, but do not select those because these are not for you, you can only choose from these!” Researcher: Surely the starting point must be that your professional competence emphasizes negotiation. Arguing why some services are useful for a client .(…) Home care manager 9: So here is an opportunity for us to create the job title of service councellor. 24.01.24

Center for Research on Activity, Development and Learning CRADLE University of Helsinki

Home care manager 4: This creates pressure to rethink how we approach the client and what kind of a repretoire we present to him or her. Often the client is dependent on relatives, and doesn’t understand his or her own state. This applies to physical mobility and other aspects, too. Home care manager 5: This is a huge challenge to management, because each one of us managers must know what our clientele is like, so that we can direct our workers to notice the deterioration of a client’s condition early enough. Now we just state that ”OK, they are in bad shape now”.

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Center for Research on Activity, Development and Learning CRADLE University of Helsinki

THE NEW CONCEPT BEGINS TO EMERGE: COLLABORATIVE HOME CARE Home care manager 9: So if home care concentrates on illness and physiological needs… Then, it could as its second task focus on the coordination of the whole. In that case, it doesn’t matter for the client who or which ones make the visits. It will be a known circle of people, not just one but maybe seven. If there are so many of them, we need a service coordinator who will manage the whole. I think this would give home care a reason to develop. Not just stick to illness, but focus on making agreements with different providers. Home care workers such as me will be motivated when we do not stop at the illness only. 24.01.24

Center for Research on Activity, Development and Learning CRADLE University of Helsinki

EQUALITY CENTRALIZED MASS PRODUCTION OF STANDARD SERVICES

COLLABORATIVE HOME CARE

THE SERVICE PALETTE FLEXIBILITY

CARE FOR THE POOR

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PRIVATIZED SERVICES

Center for Research on Activity, Development and Learning CRADLE University of Helsinki

ANCHORING THE MOBILITY AGREEMENT INTO THE SERVICE PALETTE Home care manager 2: The basic assessment is done in home care for those clients who can still get up from the chair. But I think that it is too demanding for home care to assess alone the mobility and functional capacity of those who are already tied to bed or wheelchair, those who cannot get up from the chair. (…) So here we need a physical therapist. We don’t need to do it alone. But we are responsible for those who still do get up from the chair. (…) So there are two services here [in the palette]. One is the assessment, multidisciplinary or multiprofessional assessment. The other one is the mobility agreement. And they are interconnected. There will always be assessment and mobility agreement. Mobility exercises at home are very good, but they must be included in the agreement. 24.01.24

Center for Research on Activity, Development and Learning CRADLE University of Helsinki

EMERGING EXPANSIVE CONCEPTS IN HOME CARE INPUT/STIMULUS1 FRAGMENTATION AND ROUTINIZATION OF SERVICES

BLEND; NEW CONCEPT, NEW AGENCY: COLLABORATIVE HOME CARE

INPUT/STIMULUS2 MATERIAL ANCHOR SERVICE PALETTE

INPUT/STIMULUS2 MATERIAL ANCHOR MOBILITY AGREEMENT EXERCISE BOOKLET

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BLEND; NEW CONCEPT, NEW AGENCY: STANDING UP FROM THE CHAIR

INPUT/STIMULUS1 CLIENTS’ IMMOBILITY AS A NEGLECTED RISK Center for Research on Activity, Development and Learning CRADLE University of Helsinki

CONCLUSIONS • EXPANSIVE CONCEPT FORMATION AT WORK IS A LONG PROCESS WHICH NEEDS TO BE ANCHORED IN MATERIAL ARTIFACTS • THE MEANING OF THE ARTIFACTS IS MOLDED IN THE PROCESS • EXPANSIVE CONCEPT FORMATION CAN PROCEED ON MULTIPLE LEVELS • ANCHORING ACROSS THE LEVELS CAN MAKE CONCEPT FORMATION MORE ROBUST

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Center for Research on Activity, Development and Learning CRADLE University of Helsinki