Organizational hierarchies in Bulgarian hospitals and perceptions of justice

Abstract

What is already known on this subject? Health care organizations are hierarchically organized. Organizational injustice can contribute to burnout in health professionals. There is a high level of stress and burnout for health professionals in Bulgaria. What does this study add? This study adds understanding of changing hierarchies in hospitals during health care reform in the post-socialist period. Illuminates how health professionals' discourse sustains and resists hierarchical relationships in Bulgarian hospitals. Adds understanding of health professionals' perspectives on implications of injustice for their well-being.

Improving quality and safety in the hospital: The link between organizational culture, burnout, and quality of care

“…All the studies in the series lean towards a job demands/job resources model of occupational stress (JD‐R model, Demerouti, Bakker, Nachreiner, & Schaufeli, ). However, they go far beyond it, and it is obvious that issues such as blame (Lentza et al ., ), under‐appreciation (McGowan, Humphries, Burke, Conry, & Morgan, ), loose governance (Spanu et al ., ), justice (Todorova et al ., ), and gendered workplaces (Turk, Davas, Aksu, & Montogomery, ) do fit easily into demands and resources SEM variable boxes. The richness of the contextual information presented should remind us as to the dangers inherent in reifying variables.…”

“…Collectively, the studies challenge the popular IOM model of quality care: efficiency, efficacy, timeliness, patient-centredness, safety, and equitability. Both the Portuguese (Silva et al, 2013) and Greek studies (Lentza, Montgomery, Georganta, & Panagopoulou, 2013) directly challenge the validity of these categories, while the Bulgarian (Todorova, Alexandrova-Karamanova, Panayotova, & Dimitrova, 2012) and Romanian (Spanu, Baban, Bria, & Dumitrascu, 2013) experiences seriously question whether the ahistorical IOM model can sufficiently capture the legacy of the past. Patient experiences, collected from Greece (Lentza et al, 2013), Portugal (Silva et al, 2013), and Croatia (Fazlic, Milosevic, Mustajbegovic, & Montgomery, 2013), indicate the ways in which patients are concerned with and active participants within the organization of the hospital.…”

“…For example, the context in Romania is the fact that leaving the system has now become a career objective (Spanu et al ., ), while in Croatia, the background concerning the Croatian Act on the Protection of Patient Rights (CAPPR) is crucial to understanding the concerns of patients and HPs (Fazlic et al ., ). In Bulgaria, health reform is intensifying hierarchies (Todorova et al ., ), while in Greece, shrinking resources promote a defensive culture that results in a blame ideology (Lentza et al ., ). The article outlining the pressures on Irish junior doctors (McGowan et al ., ) is symptomatic of the impact of austerity in the health sector, while the importance of management issues as outlined in the paper from Portugal (Silva et al ., ) is rooted in the historical movement of public hospital to corporate entities.…”

“…While some of the occupational stressors identified by the health professionals are common for all countries, others are specific only to some of them. Continuous administrative reforms, the exclusive use of the top‐down decision‐making strategies, the chronic shortage of resources and supplies, and the migration of health workers have intensified the level of stress and lowered the quality of care in countries in transition, such as Bulgaria (Todorova et al ., ), Romania (Spanu et al ., ), and the former Yugoslav Republic of Macedonia (Karadzinska‐Bislimovska et al ., ). The tension between the demands of work and those of the family, gender stereotypes, and discrimination against women in their careers makes female health workers more vulnerable to professional stress in Turkey (Turk et al ., ).…”

Key worklife areas contributing to health care burnout: Reflections on the ORCAB project

“…Workers often find the procedures for making critical decisions to be obscure. As noted in the research articles (e.g., McGowan et al, 2014;Milosevic et al, 2014;Todorova, Alexandroa-Karamanova, Panayotova, & Dimitroa, 2014;Turk et al, 2013), tensions of workers with administrative employees become pervasive in times of limited resources. The two groups have contrasting views on the rationales for major decisions that shape their shared work setting.…”