Academic journal article The Qualitative Report

Fostering Change in Organizational Culture Using a Critical Ethnographic Approach

Academic journal article The Qualitative Report

Fostering Change in Organizational Culture Using a Critical Ethnographic Approach

Article excerpt

Over the past thirty years there has been a socially mediated paradigm shift to relocate the patient from that of a passive recipient of care to that of an active participant in their healthcare journey (Curran, 2007). Writings related to this philosophy permeate clinical (Bissell, May, & Noyce, 2004; Legare et al., 2011), consumer (Atkins, 2010; Conlon, 2007; Gerteis, Edgman-Levitan, Daley, & Delbanco, 1993) and health policy (Denis, Davies, Ferlie, & Fitzgerald, 2011; Romanow, 2002) literature, and are becoming more evident in recent legislation (Accessibility for Ontarians with Disabilities Act, 2005; Excellent Care for All Act, 2010) as well as current news media (Dan Sherman and the Canadian Press, 2011; Picard, 2011). There are many conceptual representations of a more customer-oriented healthcare, including collaboration (Curran, 2007; D'Amour, Ferrada-Videla, San Martin Rodriguez, & Beaulieu, 2005; Dalton, 2003), patient participation (Cahill, 1996, 1998; Eldh, Ekman, & Ehnfors, 2006; Martin, 2008), partnership (Casey, 2008; Coulter, 1999; Hinojosa, Sproat, Mankhetwit, & Anderson, 2002; Sahlsten, Larsson, Sjostrom, Lindencrona, & Plos, 2007), shared decision-making (Gravel, Legare, & Graham, 2006; Legare et al., 2008; O'Connor et al., 2003), patient/family centered care (Blickem & Priyadharshini, 2007; Dewing, 2004; Epstein & Street, 2007; Gerteis et al., 1993) and relationship centered care (Nolan, Davies, Ryan, & Keady, 2008).

These terms are inter-related, and at times are used interchangeably, but they do describe distinctly different concepts. Cahill (1996) conducted a conceptual analysis around patient participation and extended a hierarchical model based on this research. In her model, she represented the inter-related concepts of patient involvement, collaboration, participation and partnership in a pyramid. Patient involvement and collaboration were placed at the bottom of the pyramid, as foundational actions for patient engagement, but were described as limited to uni-directional, clinician to patient communication. These two concepts acted as precursors to patient participation, which depicted a two-way relationship with greater equality in power, and was positioned in the center of the pyramid. Patient participation required a narrowing of the knowledge gap between the clinician and the patient and enlisting the patient in activities that they saw as beneficial to their own care. All three concepts were precursors to the penultimate goal of patient partnership, defined as the productive association directed towards a joint venture and based on mutual trust, respect and equality.

Extending from Cahill's model (1996), other conceptual frameworks were considered. Shared decision-making warranted attention as it has been much examined in recent literature (Gravel et al., 2006; Legare, Stacey, & Forest, 2007). It is defined as a process whereby patients are supported to become involved in decision-making to reach healthcare choices together with their practitioners (Legare et al., 2008). Similar to partnership, it includes elements of mutual trust within a relationship where interactions influence each other; however, in practice, decision-making is often not equally shared. At best, practitioners will take a lead role based on patient needs, however, clinician-as-expert models of decision making still exist, so it is a goal to work towards (Makoul & Clayman, 2006). Patient and family-centered care has continued to demand much research in such areas as identifying its dimensions (Hobbs, 2009), values (Epstein & Street, 2011) and patient-centered practice attributes (Pelzang, 2010). A recent literature review determined the fundamental principles of patient-centered care as a patient-provider relationship that promotes patient involvement and the individualization of care (Robinson, Callister, Berry, & Dearing, 2008). It is frequently linked with shared decision making in its enactment (Pelzang, 2010). …

Search by... Author
Show... All Results Primary Sources Peer-reviewed

Oops!

An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.