Work Knowledge as Improvisation: An Attempt to Create

Interviews with staff participants revealed contrasting narratives regarding the provision of the daily schedule, the implementation of the IPP, and the ways through which texts important to their work were taken up. The narratives demonstrated that the habilitation technicians’ work knowledge, at times, superseded ruling relations in the daily practices at Hope House. Smith (2005) described the aspects of work knowledge as a person’s “experience of and in their own work, what they do, how they do it, including what they think and feel . . . [and] the implicit or explicit coordination of his or her work with the work of others” (p. 151). Work knowledge orients the researcher to glean from participants details about their work including what they actually do, how their work is coordinated, and their feelings about it. Habilitation technicians spoke to how they followed the schedule, the moments when they deviated from the schedule, and how in many ways the daily schedule limited what they were able to do for and with the residents. When asked about her daily responsibilities Ann shared, “We just do what is expected of us…we know they have programming and goals they have to do…whatever is planned (by

“Now we all know that there are specific things that we have to do. You know, like active treatment and stuff like that; but the schedule is the schedule, and we follow it.”

It was clear there were habilitation technicians who followed the schedule as prescribed; however, there were also staff participants who stated they adapted the schedule. Specifically, Heather and others used their knowledge of the residents as well as knowledge related to how they could do work at other times as a means to deviate from the prescribed activities on the schedule. This deviation afforded the habilitation technicians the opportunity to incorporate activities that residents enjoyed, but also served as a way for staff to take breaks from work or get other things done (e.g., documenting in the medical chart and EMR, housekeeping, and doing inventory). For example, one morning following breakfast, habilitation technicians discussed among themselves which activities and time of day the residents should participate in them: Hab. Tech. 1: So what is the plan for today?

Hab. Tech. 2: This right here! <walks to the television and turns it to the Lifetime Movie Network>

Hab. Tech. 1: No. We don’t do that on this shift. Heather: Well, we could do arts and crafts.

Margaret: They (referring to the residents) have active treatment.

Heather: Yeah, but they can do this instead. You can put it on their checklist. Hab. Tech. 1: Does anybody need to go down?

Margaret: They all just got up.

Heather to Margaret: Well, I’m going to do arts and crafts. You can do what you want with your folks.

Heather: I know, but they just got up. They’re fine. We can do that later. . . when they have down time after lunch.

Hab. Tech. 2: Well my clients are watching TV.

This type of improvisation was not a source of frustration for the habilitation technicians, but rather an issue for administrators as this was perceived as habilitation technicians choosing not to follow the prescribed Active Treatment Plan. Although there were specific policies governing and organizing the daily practices of Hope House, Mary Ann provided the habilitation technicians opportunities to adapt and prioritize the daily schedule to suit the practicalities of managing personal care, habilitative programming, and social and leisure activities for the residents. Elijah confirmed, “We have rules that we need to follow according to the center, but we do what we need to do. We have to follow the programming, but we do it in our own way.” Another example of doing “it in our own way,” habilitation technicians occasionally used the afternoon rest time as an opportunity for residents to choose activities that were meaningful but outside the provision of the IPP (e.g., watch reality television, visit with residents in sister facilities, spend time in the garden):

Hab. Tech. 1 to other Hab. Techs: It’s time for everyone to go down (referring to resting in bed).

Mary Ann: Well Kevin wants to watch a movie. Tony (resident): I want to watch a movie too. Margaret: Well, I’m putting my folks down.

Mary Ann: Kevin and Tony are going to watch a movie. They’re good.

Hab. Tech. 1: Well Tony needs to get out of his chair and get in a “geri chair.”

comes. They can go down after that if they want.

This suggests that Hope House staff were able to bring to consciousness the ruling relations organizing their daily responsibilities, but utilized their work knowledge in order to perform those work duties within the confines of a prescribed schedule. Ruling relations were not disembodied. In other words, habilitation technicians were not completely freed from the regulations coordinating their daily work; rather, the replication of institutional practices mediated through those regulations were, at times, rejected.

Ruling relations are significant mediators of daily life activities. The habilitation technicians’ improvisation of the daily schedule at Hope House demonstrated how ruling

relations are taken up in ways that are local. Replicating and adapting ruling relations reinforces its power. Applying the rules in ways that are conducive to their work, habilitation technicians embodied the same institutional processes they claimed to reject. Decisions regarding how to address participation in meaningful occupations, when to perform the occupations, how to identify the available resources, and how to document data to show adherence to the schedule calls attention to the textual-coordination of institutional work. Work knowledge did not distance the habilitation technicians from ruling relations but rather allowed them to reproduce ruling relations in ways that benefited their work.