Axis 1 | Intangible value and utility of care

Keywords: relation, intangible value, pertinence of care

In the chronology of the formulation of patient-centred approaches, it was first of all the relational components that were highlighted. Better communication should make it possible to produce better results in terms of healing, at least in terms of the lived experience of the disease. Empathy must be pertinent from the point of view of moral philosophy, but even more importantly we put forward the hypothesis that there exists an “economy” in the relation of care. The time taken for meaningful interaction is an investment in the global health of the person. Relational skills are an integral part of medical knowledge and provide the finishing touches to a form of ethical leadership at the heart of healthcare organizations.

Contemporary society is marked by the predominance of utilitarian rationality, a tendency which some have qualified as “economism”. From this perspective, what makes something economically valuable is the capacity to generate a measurable economic benefit. The notion of performance pushes one to obtain the best results using minimal means. A “confidence in numbers” has spread to many sectors. But is this injunction effective in the health sector? The system of fee for service leads to a multiplication of services, and thus also cost inflation. This is why it is important to reflect on the pertinence of care. If an unnecessary service is generally associated with a service that is not medically justified, is it from the other points of view of the stakeholders of care? Is a non-indispensable service not a source of revenues for the care organization? Is it not also a form of reassurance for the anxiety of certain patients? This multiplication of points of view calls on us to rethink the notion of utility. What is useful to the person in itself sustains the constitution of the subject of care. To utilitarian rationality one may oppose a form of humanist reason. Medicine is no longer the only thing that may say what is of value in care. The costs of health, moreover, are also revenues… The value of care cannot be taken only at face value.

So how then can one tease out these other dimensions of value? With what tools can one bring to light the hidden values of care? Management sciences, and especially finance, offer tools for integrating the non-measurable into the strategies of a business. The quantification of intangible resources, such as persons, information, and client relations are at the heart of the “balanced scorecard” approach. This is a way of affirming that performance cannot be measured only by the yardstick of financial results. We consider extra-financial evaluation to go to the heart of what is at stake in economic evaluation. From this perspective, the “management of intangibles” can serve as a point of departure for identifying the most valuable resource of an organization, even as it makes us confront the “measure of the immeasurable”. The notion of intangibles was created in the field of finance to designate the organizational and relational mechanisms by which value is created in the market. The management of intangible activities could be a way to evaluate the relational value of care organizations, especially in a context where the managerial approach is dominant.

Despite its commodification, the care relation cannot be limited to the offer of a service. It takes place in the presence of another and cannot be reduced to communication techniques. The philosophical literature invites us to undertake a more profound reflection on the intangible dimensions of care. The issues concern even that which is unsayable in illness, and which plays out, ultimately, in the care relation. Non-technical gests add not only a supplementary dimension, but one that is essential to the effectiveness of care. Though marked by uncertainty, this very uncertainty can even generate its own added value. It is thus necessary to explore the motives and resources of an anthropology of vulnerability, which entertains a critical relation to an economism that reduces the values of care to the sole idea of price, and the gift to a simple exchange. The method of measuring added value that we envisage could take as its starting point the analysis of the value chain, the principles of which were set out by Michael Porter. It will require following a person over the long-term, in a trajectory which goes beyond the therapeutic.

Further reading