Technologies in caregiving: professionals’ strategies for engaging with new technology

• Date: 01 July 2020
• DOI: http://doi.org/10.1111/ntwe.12161
• Published date: 01 July 2020

178 New Technology, Work and Employment

New Technology, Work and Employment 35:2

ISSN 1468-005X

Technologies in caregiving: professionals’

strategies for engaging with new technology

Holger Højlund and Kaspar Villadsen

This article explores the adoption of new technology in organ-

isations that provide senior citizen care. Inspired by Niklas

Luhmann’s systems theory, we study how technology reduces

complexity by identifying client needs and ensuring predict-

ability in service delivery. However, how technologies are ad-

opted in practice is not determined by technology since it is

also structured by care-workers’ continuous decision-making.

Against this backdrop, we explore how technologies alter the

conditions for decision-making in two settings of elderly care,

and we describe how care workers seek to adapt technologies

to their practical needs as well as conception of care ethics.

Developing a systems theory approach, the article eschews a

priori assumptions of technological constraint on care-work-

ers’ professional autonomy, offering a more open-ended explo-

ration of diversied strategies for coping with new technolo-

gy. Our case studies show that employees develop diversied

strategies for technology adoption, including both non-usage,

heated resistance, excessive embrace, and creative adaption.

Keywords: new technology, elderly care, ethics of care, systems

theory, strategy.

Introduction

The growing prevalence of novel robot and information technologies in our lives and

workplaces has prompted scholars to focus greater attention on the relationship be-

tween technology and social practice, an enquiry they have conducted using a range of

theoretical approaches. Some researchers in elds like science and technology studies

(STS) and medical anthropology have conducted conceptual and empirical work on

the interplay between technology and the body (Mol, 2008), while others have exam-

ined the interplay between technology and caregiving practices (Grew and Svendsen,

2017). Critical agency theory (Rebughini, 2018) and practice theory (Corradi et al., 2010)

have also inspired a number of advances. In the realm of care provision, these contin-

ually emerging innovations include sophisticated alarm technologies built into toilets

and oors, devices for sensory stimuli, and technologies for surveillance and

documentation.

Inspired by systems theory, in this article we study technology adoption in organi-

sations that provide senior citizen care. Our approach differs from those of anthropo-

logical research, STS, and practice studies because we focus on decisions involving

Holger Højlund (hmeh@via.dk) is an Associate Professor at VIA University College, Aarhus, Denmark.

Kaspar Villadsen is a Professor (mso), Department of Management, Politics & Philosophy, Copenha-

gen Business School, Denmark.

Technologies in caregiving 179

© 2020 Brian Towers (BRITOW) and

John Wiley & Sons Ltd.

technology use in caregiving. At rst glance, one might not expect to see interactional

and compassionate practices of caregiving viewed through the somewhat ‘cold’ lens of

calculated decision-making. However, this perspective allows us to centre on the rela-

tionship between professional care and technologies, while also pursuing the premise

that professionalised caregiving entails continual decision-making. In line with Niklas

Luhmann’s systems theory, we view organisations as decision-producing systems

(Seidl and Becker, 2006; Luhmann, 2018). We further assume that caregiving in organ-

ised settings like residential elderly care and nursing homes is structured by profes-

sional decision-making as well as by the technologies adopted to support care-work

and inform such decisions. Against this backdrop, we explore how technologies alter

the conditions for decision-making in care-work in two organised elderly care settings

and how care workers seek to adapt the technologies to their practical needs and their

ethics of care.

Research questions

Our key research question concerns how care workers in elderly care develop strate-

gies for coping with novel technologies from the perspective of their care ethics. We

operate on the premise that care is provided in relationships of proximity, whereby

care workers pursue strategies aimed to help them make decisions using distinct inter-

ventions to meet client needs. Technologies thus help to stabilise decision-making in

care provision. Yet, as we shall see, technologies at times challenge the interactional

logic of caregiving.

In our approach to the research question of how care workers develop strategies for

dealing with technologies, we view technologies as an integral part of caregiving pro-

cesses. Eschewing the a priori assumption that technology constrains the possibilities

of interaction-based care, we pursue a more open-ended approach to how technologies

are handled in practice and become part of the organisation of care. Such an open-

ended approach resonates with recent research that strives to move beyond the duality

of human agency versus technological dominance (Bogost, 2012; Shaviro, 2014).

Theoretically, a clear division between the technological and the human is difcult to

defend, and empirical studies report that technologies are often appropriated in unex-

pected ways, thus blending with the strategies of their users (Helleberg and Hauge,

2014; Dupret, 2017). Professional users inevitably employ technologies according to a

variety of strategic choices made in the course of their organisational routines.

Systems theory offers a conception of strategy apt for describing the multifarious

ways strategies unfold empirically. In systems theory, strategy is closely associated

with the concept of programme, insofar as ‘programs are designated as strategies if

and insofar it is presupposed for them to change, on occasion, while being carried out.

The advantage of selections xed in advance is then replaced by specifying the infor-

mation that would cause for changes in the strategy’ (Luhmann, 1995: 317, n. 110). In

the context of our study, we thus view the strategies performed by care workers as

diversied adaptations of the new technology used in caregiving practices. Drawing

on two case studies, we demonstrate how care workers construct their professionalism

through strategies for coping with such care technologies. By studying how care work-

ers adopt technology in specic caregiving settings, we hope to contribute to broader

discussions concerning technology use in elderly care (Dahl and Eriksen, 2005) and

other social services in general (Sætnan, 1991; Glisson, 1992; Doolin, 2004).

The article is organised as follows. Section one reviews some predominant views of

technology held in care provision research. Section two presents Luhmann’s systems

theory as an alternative approach to analysing technology adoption in care-providing

organisations. Here, our premise is that technologies serve to reduce organisational

complexity, while care-workers’ reexive strategies mediate how technology is specif-

ically adopted in working routines. A third section describes the contexts and methods

used in our case studies of two elderly care settings: nursing homes and residential

care. Section four presents our ndings regarding care-workers’ coping strategies,