Creativity as openness: improvising health and care 'situations'

Clown's view as respiciō: looking respectfully to and after people with dementia

Clowns seem suspect when it comes to respect. The combination of clowning and people with dementia may seem especially suspicious. In this argument, I take potential concerns about clowning in dementia care as an opportunity to explore the meaning of a respectful approach of people with dementia. Our word 'respect' is derived from the Latin respiciō, meaning 'looking back' or 'seeing again', as well as 'looking after' or 'having regard' for someone or something. I build upon this double meaning of respiciō by examining how simultaneously we look to and after people with dementia. I do so empirically by studying how miMakkus clowns in their practice learn to look with new eyes to people and things around them. I call this clown's view and differentiate it from the predominant way of observing people in dementia care. I argue that respiciō comes in two guises, each of which merges specific forms of looking to and looking after the other. By making conventional, solidified ways of seeing the other fluid again, clowns remind us of the value that comes with a veiled way of paying respect to people with dementia.

“I don’t know why I’m here”: from knot-working to not-knowing

Purpose

– The purpose of this paper is to examine the idea of getting lost during field studies as a point of departure for reframing the initial research question.

Design/methodology/approach

– The paper presents field notes and reflections to illustrate the process of tracing innovation in the field by means of a theoretical concept – “knot-working” as proposed by Engeström (2008). By paying attention to seemingly irrelevant empirical data and experiences of being lost, the author infuses another theoretical concept – “not-knowing” as proposed by Lather (2007).

Findings

– By questioning research questions, it becomes possible to challenge conventional assumptions in the field under study as well as assumptions underlying existing theory. It is argued that good research questions evolve iteratively throughout a study and might be even more valuable than answers (Alvesson and Sandberg, 2013). The paper illustrates how not-knowing can serve as a methodological perspective from where ordinary held assumptions can be reconsidered, thus paving the way for novel research questions that can enhance established theory.

Originality/value

– The paper questions the initial research question: “How is the elderly care sector affected by innovation imperatives,” and ends up posing the reverse question: How are innovation imperatives affected – or how could they be affected – by the notion of care.

Ethnographic Evidence of an Emerging Transnational Arts Practice?: Perspectives on U.K. and Mexican Participatory Artists' Processes for Catalysing Change, and Facilitating Health and Flourishing

This article reports new ethnographic research exploring community-based, participatory arts practice in Northern England and Mexico City. Noting the value of an ethnographic approach, the study investigated whether commonalities discovered in practitioners' approaches are significant enough to constitute a generalisable participatory arts methodology, transcending significant contextual differences, and recognisable across national boundaries. Shared characteristics emerged in practitioners' modes of engagement with groups, and strategies for catalysing change; clear convergences from which a core methodology in community-based participatory arts for change is distilled. It suggests the opening of liminal spaces in which participants can reflect, rehearsing fresh ways of engaging in transformative dialogues in relation to the world in which they live. This article presents the study findings as a grounded characterisation of 'participatory arts practice': a complex but potentially powerful mechanism, in use within numerous community health projects, and evident in diverse settings, despite little or no exchange of ideas between practitioners.

A bricolage perspective on healthcare information systems design

Pressured by escalating costs, continual demand for high quality, and the speed of technological advances, the need for change and improvisation has become a critical priority for the healthcare industry. Now society demands that healthcare providers offer better patient care through the careful use of information technologies. For that, practitioners are urged to expand the boundaries of innovative IS design strategies. Unfortunately, research on healthcare information systems (HIS) improvisation remains relatively underdeveloped. Thus, this study uses the organizational improvisation and bricolage theoretical lenses, from the perspective of a case study, to examine how strategic improvisation might give rise to fruitful HIS novel design performances. Theoretically, we provide an inductively derived strategic conceptual model of improvisation that couples with network, structure, and institutional bricolage to execute a 'resource-time-effort' model. This enables us to improvise a superior HIS that offers quality patient-centric healthcare delivery and a valuable improvisation model. Professionally, this study contributes three key insights for IS improvisation in the healthcare industry.

A Hole in the Heart: confronting the drive for evidence-based impact research in arts and health

The field of arts and health, and associated academic discussion, is beset by a number of interlinked challenges which make it vulnerable to academic dismissal or, at best, poor visibility. One of these is a preoccupation with developing an evidence base of impact. This is compounded by resistance to definitions, disagreement over what constitutes appropriate evidence of success, and inadequate consideration of the mechanisms of arts and health practice, as opposed to outcomes. We argue that increased attention should be paid to the description, analysis and theorising of the practice itself as the basis upon which the findings of impact studies can be understood and accepted. A literature review identifies some important emerging themes in community arts and health practice, and some lacunae in need of further investigation. We conclude that an interdisciplinary theoretical framework for the practice could make a valuable contribution to the academic status of the field.