Flexible Austerity: Negotiating the Unequal Effects of Resource Shortages in Racialized Organizations
American Sociological Review · 2024 · Alexandra E. Brewer
中文摘要
资源短缺以不平等的方式展开,往往影响社会处境最不利的人群,并加剧既有的不平等。鉴于大多数资源是通过组织获得的,组织过程在短缺期间放大不平等中扮演了什么角色?我认为,劳动者从事一种我称之为弹性紧缩(flexible austerity)的实践。弹性紧缩描述了资源短缺如何成为决策者更轻易地将不平等的资源分配合理化的机会。我通过对一所城市学术型医院开展民族志研究,并利用全国性静脉注射(IV)阿片类药物短缺之前及期间的数据,来发展这一概念。我表明,在此次短缺之前,临床医生不成比例地将黑人患者的疼痛评估为“不值得”使用静脉注射阿片类药物,但他们却宽松地分配这些资源,因为他们感到受到循证临床最佳实践指南的约束。在短缺期间,临床医生将资源稀缺建构为在治疗黑人患者时必须实行紧缩实践,却对白人患者行使灵活性。这以可能对黑人患者健康有害的方式扩大了照护差距。基于这些发现,我认为资源短缺之所以在组织中放大不平等,是因为它们为扣留资源提供了新的“色盲”式正当理由,使劳动者得以将应得性观念与分配决策联系起来。
Abstract
Resource shortages unfold unequally, often affecting the most socially disadvantaged people and exacerbating preexisting inequalities. Given that most resources are obtained through organizations, what role do organizational processes play in amplifying inequalities during shortages? I argue that workers engage in a practice I term flexible austerity. Flexible austerity describes how resource shortages become opportunities for decision-makers to more readily rationalize unequal resource allocation. I develop this concept by drawing on an ethnography of an urban academic hospital and leveraging data from before and during a nationwide shortage of medical intravenous (IV) opioids. I show that prior to this shortage, clinicians disproportionately assessed Black patients’ pain as “undeserving” of IV opioids, but they allocated these resources liberally because they felt constrained by evidence-based clinical best practices guidelines. During the shortage, clinicians constructed resource scarcity as necessitating austerity practices when treating Black patients, yet they exercised flexibility with White patients. This widened care disparities in ways that may have been detrimental to Black patients’ health. Based on these findings, I argue that resource shortages amplify inequalities in organizations because they provide new “colorblind” justifications for withholding resources that allow workers to link ideas of deservingness to allocation decisions.