Bureaucratization and medical professionals’ values: A cross-national analysis

Racko, Girts

doi:10.1016/j.socscimed.2017.03.027

Cited by 26 publications

(21 citation statements)

References 44 publications

(94 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The described trend of short-term treatment also seemed to challenge the autonomy, independence and judgement of some of the professionals, as well as inducing a risk of burnout for the professionals working in the general outpatient services. This is in line with previous research, suggesting that the regulation that lies within bureaucratization and national governance weakens medical professionals' autonomy [31]. Standardization of services, such as time limitations, can lead to professionals' skepticism and resistance [7,12].…”

Section: Discussionsupporting

confidence: 90%

Professionals’ perceptions of the establishment of a specialized brief therapy unit in a district psychiatric centre - a qualitative study.

Markussen

Aasdahl

Rise

2020

Preprint

View full text Add to dashboard Cite

Background: Increasing mental health problems and scarce treatment resources put pressure on mental health services to make innovations in service provision, such as developing differentiated services adapted to different needs. One innovation in differentiated service provision is brief or short-term treatment to patients with moderate mental health problems. Implementing a new unit in an organization usually faces many potential barriers and facilitators, and knowledge on how the professionals providing the services perceive the implementation of innovative approaches in mental health services is scarce. The aim of this study was therefore to explore the professionals’ perceptions of how the establishment of a specialized brief therapy unit had affected the organization, especially the everyday work in the outpatient clinics.Methods: Eleven professionals, five men and six women, took part in individual interviews. All participants were between 40 and 60 years old and had leading or coordinating positions in the organization. Their professional backgrounds were within psychology, nursing and medicine, most of them specialists in their field. Data was analyzed according to Systematic text condensationResults: The professionals’ experiences represented four main themes: (1) The brief therapy unit was perceived as successful and celebrated. (2) The general outpatient clinics, on the other hand, were described as “forgotten”. (3) The establishment process had elucidated different views on treatment in the outpatient clinics - and had set off (4) a discussion regarding the criteria for prioritizing in mental health services. Conclusion: Providing targeted treatment to patients with moderate mental health problems, while having a concurrent aim to solve broader problems in mental health services, entails a discussion regarding resource use and the appropriate level of treatment provision. Professionals should be more involved when innovative efforts are implemented, and the criteria for success must be conceptualized and evaluated. Longitudinal research on the implementation of innovative efforts in the services should include the professionals’ and the service user’s perspectives.

show abstract

Section: Discussionsupporting

confidence: 90%

Professionals’ perceptions of the establishment of a specialized brief therapy unit in a district psychiatric centre - a qualitative study.

Markussen

Aasdahl

Rise

2020

Preprint

View full text Add to dashboard Cite

show abstract

“…The 60-30-10 Challenge is ample warning against trudging along the same well-worn tracks to disappointment. Today's popular 'solutions' such as restructuring [38], constantly fiddling with policy settings [39], adding more and more bureaucracy [40,41], and introducing a new election manifesto or imposing fresh targets on the system every time a government changes [42] keep lots of people busy implementing 'change' but beyond superficialities; these measures conspire to constrain systems and contribute much inertia. In the end, all this top-down activity is not genuine improvement and just adds up to the same 60-30-10 gridlock.…”

Section: A Way Forwardmentioning

confidence: 99%

The three numbers you need to know about healthcare: the 60-30-10 Challenge

Braithwaite

Glasziou

Westbrook

2020

BMC Med

163

117

View full text Add to dashboard Cite

Background: Healthcare represents a paradox. While change is everywhere, performance has flatlined: 60% of care on average is in line with evidence-or consensus-based guidelines, 30% is some form of waste or of low value, and 10% is harm. The 60-30-10 Challenge has persisted for three decades. Main body: Current top-down or chain-logic strategies to address this problem, based essentially on linear models of change and relying on policies, hierarchies, and standardisation, have proven insufficient. Instead, we need to marry ideas drawn from complexity science and continuous improvement with proposals for creating a deep learning health system. This dynamic learning model has the potential to assemble relevant information including patients' histories, and clinical, patient, laboratory, and cost data for improved decision-making in real time, or close to real time. If we get it right, the learning health system will contribute to care being more evidence-based and less wasteful and harmful. It will need a purpose-designed digital backbone and infrastructure, apply artificial intelligence to support diagnosis and treatment options, harness genomic and other new data types, and create informed discussions of options between patients, families, and clinicians. While there will be many variants of the model, learning health systems will need to spread, and be encouraged to do so, principally through diffusion of innovation models and local adaptations. Conclusion: Deep learning systems can enable us to better exploit expanding health datasets including traditional and newer forms of big and smaller-scale data, e.g. genomics and cost information, and incorporate patient preferences into decision-making. As we envisage it, a deep learning system will support healthcare's desire to continually improve, and make gains on the 60-30-10 dimensions. All modern health systems are awash with data, but it is only recently that we have been able to bring this together, operationalised, and turned into useful information by which to make more intelligent, timely decisions than in the past.

show abstract

“…In addition to making them feel that their professional judgement and autonomy are challenged [25], they also perceive having less room for independence [6]. Research has suggested that the regulation that lies within bureaucratization and national governance weakens medical professionals' autonomy [40]. The medical profession has been described as founded on self-regulation and internally motivation, and not by external rewards [41].…”

Section: Therapist Autonomy In Mental Health Treatmentmentioning

confidence: 99%

Everyday work, working culture and patient care. A qualitative study on professionals’ perceptions of the establishment of a specialized brief therapy unit in a district psychiatric center.

Markussen¹,

Aasdahl²,

Rise³

2020

Preprint

View full text Add to dashboard Cite

Background: Increasing mental health problems and a scarcity of treatment resources put pressure on service innovation in mental health services. Innovative efforts include providing brief or short-term treatment to patients who have moderate mental health problems. So far, there is limited knowledge on how implementing brief therapy approaches in mental health organizations influence the professionals and their work. The aim of this study was to explore the professionals’ perceptions on how the establishment of a specialized brief therapy unit in a district psychiatric center had affected the work in the outpatient clinics, specifically the everyday work, working culture and patient care. Methods: Eleven professionals, five men and six women, took part in semi-structured individual interviews. All participants were between 40 and 60 years old and had leading or coordinating positions in the organization. Their professional backgrounds were within psychology, nursing and medicine, most of them specialists in their field. Results: The professionals’ experiences represented four main themes: (1) The brief therapy unit was perceived as successful and celebrated. (2) The general outpatient clinics, on the other hand, were by some, perceived as “forgotten”. (3) The establishment process had elucidated different treatment cultures in the outpatient clinics and had set off (3) a discussion regarding the criteria for prioritizing in mental health services. Conclusion: Implementation of new services calls attention to the distribution of scarce resources and differences in professional cultures. A strong focus on efficiency might challenge professionals’ perceptions of autonomy. Focusing on patients with moderate mental health problems can raise questions concerning resource use and the appropriate level of treatment provision. Before implementing new services, it is important to ensure information and, if possible, understanding for the process in the organization.

show abstract

Bureaucratization and medical professionals’ values: A cross-national analysis

Cited by 26 publications

References 44 publications

Professionals’ perceptions of the establishment of a specialized brief therapy unit in a district psychiatric centre - a qualitative study.

Professionals’ perceptions of the establishment of a specialized brief therapy unit in a district psychiatric centre - a qualitative study.

The three numbers you need to know about healthcare: the 60-30-10 Challenge

Everyday work, working culture and patient care. A qualitative study on professionals’ perceptions of the establishment of a specialized brief therapy unit in a district psychiatric center.

Contact Info

Product

Resources

About