Tensions and Coherence in Balancing Risk in the Public Encounter – a case study of addressing antimicrobial resistance in healthcare

Drawing on an empirical comparative case study of antibiotic prescribing and stewardship in the UK and Nigeria, this paper seeks to demonstrate the value of bringing a risk work lens to our understanding of public encounters. Tensions, and the way actors cope with them, are consistent themes within public encounters research (Blijleven & van Hulst 2022). Often, tensions are understood as the result of antagonism between traditional bureaucratic values such as rule-following, standardisation, functional differentiation and expertise with contemporary values of experiential knowledge, collaboration, flexibility and responding to citizen demand. Competing values produce competing demands and public officials must find a way to cope when interacting with colleagues and citizens. In this article, we propose to reconceptualise tensions and coping in the public encounter through the lens of risk work theory (Brown and Gale, 2018). At the heart of risk work theory is the inherent tension between population-level risks and the individual with an uncertain future in the public encounter. Identifying the constituent dimensions of risk work, knowledge, interventions and relationality, and the inherent tensions between them, we move beyond a purely ideational account of tensions by locating them at the intersection of diverse affective and epistemic practices. Following on from this, we critique coping as a concept tied to individual actors with limited potential to explore the productive and inclusive dynamics of the public encounter. While maintaining focus on worker’s practices, we present a conceptual counterbalance to the notion of coping. We look to further develop the concept of ‘finding enough coherence to act’ (McKenna and Gale, 2022), which captures the emergent, fluid and dynamic ways in which actors navigate a multiplicity of practices in ways that allow them to act on the situation at hand. By bringing theories of public encounters and risk into dialogue with each other, we offer a more nuanced framework for the analysis of agency within a risk society. Exploring this conceptual argument through the empirical case of antimicrobial resistance (AMR), our proposal also aims to illustrate the value of studying real-world public encounters in a variety of contexts. Using a qualitative survey tool with frontline healthcare staff (antimicrobial prescribers) in England and Nigeria about how they understand, act and reflect upon AMR and its prevention, we uncover how the tensions inherent in risk work come to define and transform the practice of addressing AMR. Empirically, our contribution is to carry out a novel global north/global south comparison. Methodologically, we explore the contribution of survey methodologies to public encounters research and the benefits that they bring to complement participant-observation and other forms of research on practice. References: Brown, P. and Gale, N., 2018. Theorising risk work: Analysing professionals’ lifeworlds and practices. Professions and Professionalism, 8(1), pp.e1988-e1988. McKenna, M. and Gale, N., 2022. ‘Tensions within the public encounter: Balancing individual and population health risks.’ Peter Hupe (ed.) The Politics of the Public Encounter: What Happens When Citizens Meet the State, Edward Elgar, p.170.