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Ethnographic reflections on access to care services

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Purpose: The purpose of this paper is twofold: to explore how gatekeepers’ ways of regulating the researchers’ access to knowledge in/about care services reflect the systemic and interpersonal values that inform Danish welfare systems’ daily workings at the street level; and also explore how the authors’ methodological experiences mirror the value-informed regulatory strategies that professionals and users themselves experience in their daily encounters in the same local practices that the authors have studied. Design/methodology/approach: The paper takes its empirical point of departure in a multisited ethnographic field study of the management of citizens with complex problems in Danish welfare systems. Findings: By means of Michael Lipsky’s outline of access regulation, the authors will analyze the following regulatory strategies that are identified during the fieldwork: “Gatekeepers’ sympathy and creaming,” “Queuing and delay,” and ‘Withdrawal of consent and “no resources.” The paper suggests that trust, shared goals and sympathy seem to be key to the process of getting access. Originality/value: Despite principles of neutrality, equal rights and access to services in welfare systems, the authors’ experiences thus tend to support other research within bureaucratic and care organizations, which has found that interpersonal relations, sympathy, dislikes, norms and values, etc., can heavily influence timely access to services, tailored information and support.

TidsskriftJournal of Organizational Ethnography
Sider (fra-til)279-297
Antal sider19
StatusUdgivet - 2019


  • Ethnography, Field work, Care values, Policy, Discretion, Organizational studies, Psychiatry, Drug Treatment, Employment services

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