Professional responses to post bureaucratic hospital reforms and their impact on care provision |
| |
| Institution: | 1. Department of Medicine, Mayo Clinic, Rochester, Minn;2. Office of Educational Innovations, Internal Medicine Residency Program, Mayo Clinic, Rochester, Minn;3. Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minn;1. Department of Radiology, Interventional Neuroradiology Service, Centre hospitalier de l''Université de Montréal, 1000 St-Denis D03.5362B, Montreal, QC, Canada;2. Department of Surgery, Health Sciences Centre, Division of Neurosurgery, University of Alberta Hospital, Mackenzie, 112 St NW Edmonton, 8440 Alberta, Canada;1. The University of Queensland, School of Population Health, Herston, Queensland 4006, Australia;2. The University of Queensland, School of Population Health, Queensland Alcohol and Drug Research and Education Centre (QADREC), Herston, Queensland 4006, Australia;3. Stellar Medical, Lowood, Australia;4. Mater Medical Research Institute, The University of Queensland, South Brisbane, Queensland 4101, Australia;5. The University of Queensland, Schools of Population Health and Social Science, Herston, Queensland 4006, Australia;1. Health & Education Services, Diabetes NSW, Glebe, NSW 2037, Australia;2. School of Health Sciences, Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia;3. Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada;4. School of Public Health, Western Australia Centre for Health Promotion Research, Curtin University, Perth, WA 6845, Australia |
| |
| Abstract: | BackgroundPost bureaucracy is increasingly shaping how health care professionals work. Within hospital settings, post bureaucracy is frequently connected to loss of professional autonomy and protocol-based care. However, this development also affects relationships between care providers and care receivers.QuestionTo explore experiences of post bureaucratic hospital reforms and their impact on care provision.MethodData builds on nine mini group interviews with midwives (n = three), nurses (n = three) and physiotherapists (n = three), in all thirty participants. Data was analysed using existing theories of professionalism and post bureaucracy.FindingsTwo overarching themes were identified: ‘Time, tasks and institutional duties’ which referred to transformations in care practices, increased use of screening procedures, efficiency requirements and matching linear time to the psychosocial needs of patients. ‘Managerial control of work’ which described rising administrative demands, engaging in protective measures, younger professionals pressured by documentation obligations and fear of disciplinary procedures.ConclusionThe institutional context appears to play a key role shaping care practices. Although midwives, nurses and physiotherapists share similar experiences of post bureaucratic hospital reforms, changes in care provision can impact these professions in different ways. As a discipline, midwifery is founded on relationships between women and midwives. Standardised clinical care, performativity demands, litigation risks and rising administrative obligations are liable to challenge the provision of woman centred care. These changes may also result in increased inequity in maternity care by affecting some groups of women more than others. |
| |
| Keywords: | Bureaucracy Managerialism Professionalism Protocol-based care Woman centred care |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
