The performativity of the service management discourse: "value creating customers" in health care

The formation and spreading of market-, management- and individual-rights discourses into society, as well as the movement of consumerism, have paved the way for a transformation of the linguistic usage. The transformation suggests that the view of the care seeker has shifted from a waiting patient, via a consumer to a customer creating value. Another example of the process is that the former medical meeting between patient/doctor now is described as a service meeting. With this background, the purpose of this paper is to explore the transformation of linguistic usage and to analyse the performativity of the service management discourse in health care.

The concept of performativity (Butler) supported with discursive formation and subjectivization (Foucualt) is used as theoretical framework. The performativity of the discourse is understood as a vehicle within the discourse, which influences people on an ontological level that names and makes them active subjects in line with what the discourse is saying.

When the service management discourse travels into the world of health care, discursive tensions between medical-, care- and management discourses follow. These become apparent in the distinction between the different discursive constructions of patient--related to passivity, and customer--related to the performative image of active participation in value creating health. Even if the customer in service management discourse is imagined as an agent for himself with power and individual responsibility it is doubtful if people view themselves as customers. The dialectics between the use of the customer concept in commercial service meetings and the patient--doctor meeting, which is illustrated, point to unexpressed and implicit presumptions of an ontological kind in the ways service management researchers describe service meetings. Recent health care research can be interpreted as if a majority of patients have a desire to be part of their value creating processes. Since the responsibilities and tasks of the professions in health care however are regulated by law and institutionalised, the process of delegating tasks to patients seems not to be a matter of course.

It seems to be problematic to replace the patient concept with the customer concept in general. This concept gives hardly much room for the vulnerability that characterises a sick person. A reasonable approach would of course be to use the customer concept in a nuanced way.

The paper demonstrates that the performativity of service management theories, through the use of discursive analysis, is valuable in order to understand shifts in linguistic usage.