Narratives about negative healthcare service experiences: Reported events, positioning, and normative discourse of an active client

Abstract

Narratives about clients’ service experiences in healthcare organizations constitute a crucial way for clients to make sense of their illness, its treatment, and their role in the service process. This is important because the client’s role has recently changed from that of a passive object of care into an active responsible agent. Utilizing Bamberg’s narrative positioning analysis as a method, and 14 thematic interviews of healthcare clients with multiple health-related problems as data, we investigated the expectations of the client’s role in their narratives about negative service experiences. All the narratives addressed the question of the clients’ “activeness” in some way. We identified three narrative types. In the first, the clients actively sought help, but did not receive it; in the second, the clients positioned themselves as helpless and inactive, left without the care they needed; and in the third, the clients argued against having to fight for their care. In all these narrative types, the clients either demonstrated their own activeness or justified their lack of it, which—despite attempts to resist the ideal of an “active client”—ultimately just reinforced it. Attempts to improve service experiences of clients with considerable service needs require a heightened awareness of clients’ moral struggles.