When Life is at Stake

The PhD study at the University of Gothenburg in Sweden is performed as a collaborative project between the Academy of Music and Drama and University of Gothenburg Centre for Person-centred Care. The study holds the aim of exploring how particular techniques of acting and directing can contribute to person-centred health and care practice. In the study different methods of the theatre are applied to explore the process of partnership-creation between patients and health care professionals in clinical healthcare encounters.

The study make visible the practical knowledge and skills of actors and directors in a wider perspective, revealing how the methods and knowledge of the theatre create competence for analysing and handling complex situations. The thesis work also opens up for how perspectives from person-centred care practices can make visible and influence theatre-based thinking.

The PhD is within the field of artistic research and can also be framed as part of a new, but growing, field of Artistic Interventions in Organisations where artist-led initiatives help organisations to develop their activities or competencies. Artistic Interventions in Organisations is within the thesis work regarded as a strand within the field of artistic research (Lehikoinen 2013).

The playing field of the project

The field of person-centred health and care and the field of theatre are, within the project, acknowledged as two discursive realms where particular values, theories, ideas, rules and so on underpin procedures, practices and techniques. The project could be articulated as an artistic research project were the artist-researcher finds herself in an intervention process on the interface between these two realms. The idea is to tease out and expose specific practical knowledge and skills of the theatre artist as this knowledge is exposed in new ways in the encounter with another field of knowledge. By initiating a dialogue between, on the one hand, acting and directing practices within the field of theatre and, on the other hand, person-centred health and care practices and their philosophical foundations, the artistic intervention process opens up a third space for co-reflection and co-creation. The concept of performance operates within the thesis work as a tool for critical scrutiny, as it provides a means to frame and interpret social phenomena.

GPCC and person-centred care

The University of Gothenburg Centre for Person-centred Care (GPCC) is a research centre conducting clinical and applied research. GPCC was established in 2010, with support from the Swedish government's strategic investment in health and care research. The overarching objective is to support and carry out high quality research relating to person-centred care. This research aims to enhance knowledge surrounding how long term illness is experienced and handled by the individual, as well as to implement and evaluate person-centred care in practice.

Person-centredness is an ethical standpoint that may guide our practical actions as fellow human beings and professionals. All health care, care and rehabilitation can be person-centred. In person-centred care a patient is a person with needs but also resources and capabilities. Person-centred care is based on a partnership between patients and those working in health care, and it means that the patient is seen as a person who is an active part in the co-planned care.

Exploring co-creative partnerships within theatre and person-centred health and care practices

The theatre has developed techniques for establishing partnership and handling interaction in collaborative work on the stage. Interplay in a practical theatrical context builds on the actors ability to make themselves receptive to their fellow actors onstage. The actor needs to understand how they are affected by the onstage action, as well as how they are affecting the onstage action, when acting within the framework of the scripted role and/or the dramatic situation. This ability, or skill, which is trained during the actor’s education, can also be used by a director as an asset in their preparatory work with analysing and interpreting a play-script. During theatrical rehearsals this ability can also be an essential part of the actors and director’s collaborative work with creating the performance. (Brattström 2015)

Within the framework of the PhD study is developed a method of analysis highlighting co-creative and analytical aspect of the acting and directing professions. Central to the study are the concepts of the magic ‘If’ and ‘Given Circumstances’ which are part of the system of acting techniques developed by Russian actor and theatre director Konstantin Stanislavsky [1863–1938]. These theatrical concepts are in the study modified and elaborated in the context of person-centred health and care practice as a means to shed light on the phenomena of partnership, and partnership-creation.

Main study; questions, empirical data/material and analyses

In the main study audio recordings taken during observation of clinical health care encounters are transcribed. These transcripts are then taken through 3 levels of analysis that include:

(1) Interpretation of the transcripts as if they were scenes in a play, based on a director’s way of analysing and preparing a play script for a theatrical production.

(2) Investigation into the concept of partnership and partnership-creation between patients and care providers. Participants (patients and health care professionals) are observed in a workshop using the camera as a tool to generate images and discussions on partnership. To use the camera and the methods of filmmaking is applied as a way to bring forward another quality of data than if using interviews. When shooting images, participants need to discuss, interact and pose. Participants use body and mind in action, in a way that could be described as “brainstorming in
practice”.

(3) In “Rehearsal laboratories” the transcripts are explored together with actors in a co-creative and analytical process similar to a theatrical rehearsal. Selected acting and directing techniques are used to explore the transcripts from the point of view of the “characters” potential use of interactional strategies (physical, verbal and mental actions). With a starting-point in a theatrical exploration of the transcripts actual to the study, the aim here is to elaborate and make visible approaches and challenges in the process of partnership creation between patients and health care professionals in clinical healthcare encounters.

Specific questions explored within the main study are:

1. How do the patient and health care professionals co-create the role of the patient when both are considered an active expert and partner in a healthcare encounter? 
   1. By what means (physical, verbal and mental actions) are the patients during the encounters trying to position themselves as active partners and experts in their healthcare?
   2. By what means are the health care professionals during the encounters trying to support the patients to position themselves as active partners and experts in their healthcare?
2. In what ways are healthcare professionals and patients searching to overcome the obstacles or difficulties that arise in the situation and hamper the creation of a partnership-relation?
3. How is a "play-based approach" manifested, based on an exploration of the partnership process, in the interaction between patients and healthcare professionals in the transcribed encounters? What implications, in a broader perspective, may be indicated from analyses of a ‘play-based approach’ to the person-centred conversation?

References:

Brattström, Victoria. 2015. "Playing the ‘Magic If’ A theatre director’s perspective on intervening." In Artistic Interventions in Organizations: Research, Theory and Practice, edited by J Woodilla UJ Sköldberg, AB Antal - 2015, 184-162. Routledge.

Lehikoinen, Kai. 2013. "Artistic Interventions as a Strand of Artistic Research." The Impact of Performance as Research: CARPA3 Proceedings.

Merlin, B. (2014). The Complete Stanislavsky Toolkit, new edition, Nick Hern Books. (p. 19)