Constructing the health care system in Greece: responsibility and powerlessness.

OBJECTIVES Based on health care professionals' (HPs) and patients' interviews about work demands and quality of care in hospitals, the study explores the way that patients and HPs constructed their identities to describe and construct the health care system in Greece. DESIGN This is a qualitative study using a focus group (FG) design. METHODS Seven FGs discussions were conducted: three FGs discussions were conducted for the assessment of job stressors (1 for doctors, 1 for nurses and 1 for residents) and four FGs discussions for the assessment of quality of care (1 for doctors, 1 for nurses, 1 for residents and 1 for patients). The sample consisted of health care professionals working in a teaching hospital in the region of Thessaloniki, Greece, and patients who had at least one experience of any kind in the same hospital. Transcripts of the FGs discussions underwent discourse analysis. RESULTS The results showed that both HPs and patients construct the health care system based on bipolar constructions of responsibility and powerlessness. In particular, participants use these constructions to allocate the responsibility to different levels of the health care system hierarchy or to the system per se constructing, at the same time, themselves as the 'viewers' of this system. CONCLUSIONS The study allowed a deeper understanding of issues related to quality of care in hospitals providing context-specific information. Identity in health care organizations was inextricably linked to power and responsibility. The need to deconstruct this responsibility/powerlessness ideology is discussed.

[1]  E. Panagopoulou,et al.  Improving quality and safety in the hospital: the link between organizational culture, burnout, and quality of care. , 2013, British journal of health psychology.

[2]  K. Vedhara,et al.  A 10 year (2000–2010) systematic review of interventions to improve quality of care in hospitals , 2012, BMC Health Services Research.

[3]  C. Vincent,et al.  An Examination of Opportunities for the Active Patient in Improving Patient Safety , 2012, Journal of patient safety.

[4]  Floyd J Fowler,et al.  Hospitalized patients' participation and its impact on quality of care and patient safety. , 2011, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[5]  N. Glaveli,et al.  Assessing hospitals' readiness for clinical governance quality initiatives through organizational climate. , 2011, Journal of health organization and management.

[6]  E. Panagopoulou,et al.  Connecting organisational culture and quality of care in the hospital: is job burnout the missing link? , 2011, Journal of health organization and management.

[7]  W. Murphy,et al.  Critical Theorist, Postmodernist and Social Constructionist Paradigms in Organizational Analysis: A Paradigmatic Review of Organizational Learning Literature , 2010 .

[8]  G. Ogunbanjo,et al.  Emotional reactions of medical doctors and students following the loss of their patients at the Dr George Mukhari Hospital emergency unit, South Africa , 2010 .

[9]  I. Holmström,et al.  The relation between patient-centeredness and patient empowerment: a discussion on concepts. , 2010, Patient education and counseling.

[10]  Victoria Bellou,et al.  Organizational culture as a predictor of job satisfaction: the role of gender and age , 2010 .

[11]  R. Iedema,et al.  Discourse research that intervenes in the quality and safety of care practices , 2010 .

[12]  J. Waring Constructing and re-constructing narratives of patient safety. , 2009, Social science & medicine.

[13]  Naresh Khatri,et al.  From a blame culture to a just culture in health care , 2009, Health care management review.

[14]  V. Bellou Identifying organizational culture and subcultures within Greek public hospitals. , 2008, Journal of health organization and management.

[15]  Timothy J Hoff,et al.  How Work Context Shapes Physician Approach to Safety and Error , 2008, Quality management in health care.

[16]  R. Marshak,et al.  Organizational Discourse and New Organization Development Practices , 2008 .

[17]  Victoria Bellou,et al.  Achieving long‐term customer satisfaction through organizational culture , 2007 .

[18]  J. Waring,et al.  Doctors' thinking about ‘the system’ as a threat to patient safety , 2007, Health.

[19]  David M Studdert,et al.  Defensive medicine among high-risk specialist physicians in a volatile malpractice environment. , 2005, JAMA.

[20]  J. Waring,et al.  Beyond blame: cultural barriers to medical incident reporting. , 2005, Social science & medicine.

[21]  Kevin Brazil,et al.  From theory to practice: improving the impact of health services research , 2005, BMC health services research.

[22]  Linda L. Putnam,et al.  Organizations as Discursive Constructions , 2004 .

[23]  R. Anderson Billions for defense: the pervasive nature of defensive medicine. , 1999, Archives of internal medicine.

[24]  N. Stanhope,et al.  Reasons for not reporting adverse incidents: an empirical study. , 1999, Journal of evaluation in clinical practice.

[25]  J. R. Wilcox,et al.  Understanding Organizational Culture , 1988 .

[26]  D. Morgan Focus groups for qualitative research. , 1988, Hospital guest relations report.

[27]  Nathanael J. Fast,et al.  Blame contagion: The automatic transmission of self-serving attributions , 2010 .

[28]  Sandra E. Spataro Diversity in context: how organizational culture shapes reactions to workers with disabilities and others who are demographically different. , 2005, Behavioral sciences & the law.

[29]  William R. Hendee,et al.  To Err is Human: Building a Safer Health System , 2001 .