Dara Ivanova, Academic Researcher Erasmus School of Health Policy & Management Health Care Governance wrote a paper in which she further explores the effect of place on healthcare. This paper argues that the place in which health care is offered often has an effect on the quality of healthcare. New technologies like the Sensory Reality pod introduce 'post-place healthcare': Healthcare that is not bound to one particular place. Curious as to which exact effect technologies like these have, sDara Ivanaova studies the Sensory Reality Pod and its effects on the revolutionasition of health care.
You can find the full paper here, or read a shortened version below.
With the advent of telecare and the logic of information technologies in health care, the idea of placeless care has taken root, capturing imaginations and promising placeless caring futures. This ‘de-territorialisation of care’ has been challenged by studies of care practices ‘on the ground’, showing that care is always (materially) placed. Yet, while sociological scholarship has taken the role of place seriously, there is little conceptual attention for how we may think through immateriality and the changing nature of place in health care. Based on a case study of the introduction of a Sensory Reality technology into a care organisation, this paper argues that we need (1) to push the definition of placed care into new (digitally produced) landscapes and (2) a new vocabulary, with which to address and conceptualise this changing nature of care places.
The paper introduces the term post-place, as a first step in developing such a vocabulary. Post-place care, unlike the idea of placeless care or emplaced care, is an inclusive, open and generative concept. Its strength lies in its disruptive potential for challenging existing place-care ontologies and opening up productive space for thinking through the changing landscapes of health care.
The paper is based on qualitative interviews, document analysis and observations in the period between September and December 2018. Semi-structured formal interviews with the creator of the SRP and owner of Sensiks, neuroscientists at TNO involved in the Pod’s creation, an experience designer and IT support for Sensiks, the healthcare entrepreneur responsible for introducing the Pod into the Dutch healthcare market and managers in the healthcare organisation, where the Pod was introduced were conducted. More informal conversations with the Pod’s creator were held subsequently, which were followed by observations during three events, where he presented the Pod to a wider audience. Sensiks’s online presence, press interviews and releases, and promo videos were analysed.
In presenting the argument below, I first unravel the SRP as a layered place, answering the question where is place in this case? I then focus on how care is done through place, showing that the Pod is far from placeless. Finally, I argue that we need a different place-care vocabulary, with which to address the Pod’s new (digital, sensory, imagined) landscape of care. I thereafter introduce the concept post-place as a first step in building such a vocabulary.
Conclusion: Disruption as an opening
The nature of place in the SRP’s landscape is in how it is able to negotiate its layers (or not) – material, digital, caring. The sensory reality Pod only becomes a place of care when it is at once material, sensorial and digital; it is a care ecology, as opposed to different places – one digitalised/simulated and one ‘real’/material. A patient experiencing the Pod begins her journey in the corridor, aided by a nurse; enters the stuffy small room and then the black wooden cabin; her body has to fit the cabin’s affordances, she must place the goggles on her head. Then she is transported into a sensory place of virtual cues, only to find herself back on the wooden bench some time later. She then still has to exit the Pod and walk back through the corridor. The place of care in this story should be conceptualised wholly, as opposed to only a cabin or only a digital environment, emplaced in care practices. Any emphasis on a singular element in this care assemblage would not capture its nature.
Thirdly, the notion of unsettling through post-place is not only an analytical move towards a different ontology of place-care, but also a way of problematising (1) how ‘good care’ is imagined through place and (2) how power relations in health care are stabilised through place-making. The Pod as a place of care is wrought with problematic assumptions about what ‘good care’ is, about dealing with ‘difficult’ patients, about privacy, consent and manipulation.
Analysing the Pod through the lens of post-place allows one a deeper understanding of the case, as the term considers all care layers, and their interaction with/in power struggles. We see beyond the limitless possibilities of the cabin, observing instead how it structures hierarchies of care. The Pod becomes a spatial solution to a number of practical problems – patients who are emotional, depressed, difficult or bored can be placed inside, showing that the politics of care are just as much in need of unsettling as the concept of place. Nettleton et al.’s (2019) account of a top-down approach to personalisation, which they call prescriptive personalisation, parallels what the Pod exemplified: personalisation in health care is not only freedom of choice, but rather a particular way of structuring that freedom.
The ideology of autonomy is articulated through the idea that everything is possible (in the Pod, in post-place more generally), which reveals an urgency to make post-place care a matter of concern (Latour 2004). Finally, the concept of post-place may be helpful when dealing with ‘the sociological concern with the decline of place’ (Dyb and Halford 2009: 232). Post-place allows for working with the idea that places of care are changing without arguing that they are disappearing. Disrupting place-care may lead to conceptualisations of care places as experience, for instance, for patients with limited mobility or struggling with dementia. The dichotomy of place-full versus place-less is doing us a disservice. The place of care, understood as more than its location, will reveal itself.
The full research can be found here.