Andreas Wagenknecht¹, Julia Zielke¹

¹ Institute for Medical Sociology and Rehabilitation Science, Charité – Universitätsmedizin Berlin

The A&E department is regarded as a particularly time-critical part of the healthcare system. From determining the urgency of cases requiring immediate treatment to those involving waiting periods of several hours, and from patients’ satisfaction with their care – which is often linked to how long they had to wait – and, on the other hand, the staff who are under constant time pressure – the practice of care in the A&E department sets a precedent for reflecting on the relationship between time and ethics.

Drawing on the experiences of older patients in the A&E department, this paper develops a heuristic framework to understand and critically reflect upon the temporal aspects of healthcare, and to encourage time-sensitive care. To this end, a) the concept of chrono-normativity is elaborated for our context and based on empirical data, b) the concept of ‘imposed temporalities’ is developed to describe forms in which hegemonic temporal rationalities are imposed, and c) the temporal sovereignty of patients and staff is contrasted with this.

The data are based on 72 participatory observations of older patients’ stays in the A&E department. The observation logs cover all relevant events, including their timings, in chronological order. At a conceptual level, sociological concepts of time—namely rhythm analysis (Lefebvre) and the theory of practice (Bourdieu)—are linked.

Aspects such as events, duration, sequence, downtime and bodily time were identified in the analysis of the material in order to understand the temporal unfolding of treatment processes. Furthermore, the study describes the (contentious) decisions regarding urgency, the design of waiting areas, stressful waiting periods before and during treatment, communication about time, the unpredictability and lack of opportunities to anticipate the course of treatment, as well as temporal disorientation.

The loss of control over one’s own time and the unpredictability of the care process are used as a starting point for a concluding reflection on the ethics of care. If time is understood as an institutional form of governance that regulates the sequence, sequence, rhythm and pace of healthcare practices both normatively and organisationally, it becomes clear that and how time structures power relations and must therefore be understood as a central issue in questions of justice.