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A long running discussion within the social sciences and humanities are if and how researchers should engage with an intervene in their fields of study. Some worry that by being engaged the researcher is compromising their “objective” position, while other warn that by being distant the researcher will fail to improve problematic or unethical conditions. However, in a quite recent book Zuiderent-Jerak (2015) suggests that a problem in these discussions is that the act of engagement is separated from the production of knowledge. “Twisting the lions tail” Zuiderent-Jerak thus suggests interventions as a generative mode of knowledge production. This edited volume will add to the understanding about interventions as generative mode of knowledge production by discussing the dilemmas involved in this process and the motivations to engage and intervene from a theoretical perspective of care. We find this increasingly important in a time where on the one hand many researchers want to be more engaged in a world that is increasingly polarized, and on the other many research grants come with stipulations about partnership with actors outside academia. We identify two main ways of approaching engagement from a perspective of care. The first approach to care can be called a “care in practice” – approach which understands care as persistent tinkering. The care in practice approach employs a form of empirical philosophy aiming to study facts, concerns, goods and values produced in situ. Much like Jensen’s (2007) call to sort attachments and Zuiderent-Jerak’s (2015) suggestion of situated interventions, care in practice scholars have emphasized the importance of studying goods and values within the setting under study, rather than engaging with and bringing in normativities from the “outside”. In this context, Pols (2008) stress the promises of being re-scriptive and suggestive by interfering “in the practices studied by opening implicit notions of good care for (self) reflection” (Pols 2008: 52). Drawing on in situ observations and situated analysis researchers can thus make suggestions for improvement and construct interventions. The second approach is often called critical care. A key issue in this approach is to draw attention questions of power, to care’s non-innocence and to the exclusions reproduced in and through care (Martin, Myers & Viseu 2015). In relation to engagement and interventions, critical care scholars emphasize commitment as an important aspect of care (Puig de la Bellacasa 2017). Care from this approach is not just something existing in the practices and situations we study, but instead Puig de la Bellacasa urges the researcher to think about their own cares and asks, “what we are encouraging caring for?” (2011: 92). She suggests that interventions can be ethically committed without being normative. An approach which is “More than following the actors, less than showing ‘the’ way” (Puig de la Bellacasa 2017: 143). Similarly, López-Gómez suggests to use care as a heuristic for “taking sides, participating, acting, making a choice, taking a position, but without taking for granted a general or fundamental principle on which these actions would safely and coherently be grounded” (López-Gómez 2019: 10). Thinking about engagement with care, a number of questions arise. How can we make careful engagements and interventions? How can we make re-scriptions? What inequalities do we risk producing especially when there is funding involved? How do we take sides without taking for granted a fundamental principle of action? What tensions and struggles do we meet while engaging with care in practice? How does this affect academic work and output? The book will provide empirical examples of careful engagement, as well as theoretical reflections about the issues and questions presented above.

Background The introduction of innovative models of healthcare does not necessarily mean that they become embedded in everyday clinical practice. This study has two aims: first, to analyse deliberate and emergent strategies adopted by healthcare professionals to overcome barriers to normalization of a specific framework of person-centred care (PCC); and secondly, to explore how the recipients of PCC understand these strategies. Methods This paper is based on a qualitative study of the implementation of PCC in a Swedish context. It draws on semi-structured interviews with 18 researchers and 17 practitioners who adopted a model of PCC on four different wards and 20 patients who were cared for in one of these wards. Data from these interviews were first coded inductively and emerging themes are analysed in relation to normalization process theory (NPT). Results In addition to deliberate strategies, we identify emergent strategies to normalize PCC by (i) creating and sustaining coherence in small but continuously communicating groups (ii) interpreting PCC flexibly when it meets specific local situations and (iii) enforcing teamwork between professional groups. These strategies resulted in patients perceiving PCC as bringing about (i) a sense of ease (ii) appreciation of inter-professional congruity (ii) non-hierarchical communication. Conclusion NPT is useful to identify and analyse deliberate and emergent strategies relating to mechanisms of normalization. Emergent strategies should be interpreted not as trivial solutions to problems in implementation, but as a possible repertoire of tools, practices and skills developed in situ. As professionals and patients may have different understandings of implementation, it is also crucial to include patients’ perceptions to evaluate outcomes.

This thesis examines a collection of cases and situations where efforts are being made to combine and unify the concerns of person-centred care, standardization and evidence-based medicine. Person-centred care is commonly associated with efforts to improve the quality of healthcare by catering for variation and difference while evidencebased medicine and standardized guidelines aim to assure quality by reducing difference and variation. Therefore, this thesis aims to investigate the paradoxes and tensions emerging as person-centred care is introduced as standard healthcare, and the actions taken by healthcare professionals to secure this healthcare reform in practice. The analysis builds on interviews with researchers working at a research centre where a particular standardized model of personcentred care has been developed; interviews with healthcare professionals working with and introducing this standardized model; observations of healthcare professionals applying this standardized model in practice, and related documents and written materials. The thesis builds on a practice oriented approach to person-centred care and adopts a material semiotic sensibility as a theoretical foundation. This approach enables detailed analysis of the messy, relational socio-material practices of person-centred care in action. Using the notions of tinkering and articulation work, the thesis extends the basic lessons of material semiotics by underscoring the importance of reciprocity - interrogating how inventive practices act back on and reshape tools, technologies and standards of person-centred care. Empirically the thesis encompasses four studies. Paper I examines the mundane technologies of person-centred care, the scripts and values inscribed in these technologies and the tinkering needed to balance and bring together potentially contrasting values in practice. Paper II investigates how person-centred care and evidence-based medicine are interwoven in practice and the tensions that emerge when a randomized controlled trial is used to evaluate personcentred care. Paper III draws on the notions of articulation work and invisible work to analyse the efforts involved in sustaining a particular standardized framework of person-centred care. Paper IV identifies the tenacious assumptions embedded in a standardized model of person-centred care and the challenges emerging when this model is introduced in diverse settings. Based on these studies I argue that while person-centred care is often advocated as the anti-thesis to standardized biomedicine this relationship is more complex. The studies in this thesis address attempts to develop a model of healthcare that is at once the same for all patients, yet also different by catering to each individual patient as a unique person. However, modelling care in this way is not without its challenges. One of the foremost challenges of making care recognizing the patient as a person into standard healthcare concerns how this person is actually imagined and enacted. By insisting on particular routines to be followed and specific values to be recognized particular versions of person-centred care risk embedding problematic assumptions of their own. These assumptions are very similar to those it aims to move beyond in the first place. The standardized model of person-centred care, as well as the tensions and challenges it gives rise to, are negotiated and managed in a variety of ways. Caregivers are obliged to make adaptions, translations and become creative mediators in order to enable the standardized model of person-centred care to hold together. They also have to coordinate different tasks, perform complex activities for which they have little prior training, and creatively interpret incomplete instructions in order to compensate for shortfalls in information. However, the thesis concludes that things could be otherwise if person-centred care was able to learn from material semiotics. Instead of conceiving person-centred care as something that has to be implemented and safeguarded in practice, an alternative vision would be to develop person-centred care in its local organizational complexity and thereby transform it from being something ready-made, which care professionals have to adhere to, to something that is an outcome of experimental interventions.