ORCAB special series
Constructing the health care system in Greece: responsibility and powerlessness
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.
This is a qualitative study using a focus group (FG) design.
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.
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.
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.
Statement of contribution
What is already known on the subject? Relatively little is known about how both patients and health care professionals construct quality of care. Organizational cultures in health care settings are symbiotically linked with quality of care and medical errors.
What does this study add? The constructions of health care professionals and patients create and recreate the organizational culture organically. The present study illuminates how health care professionals and patients negotiate their identities based on passivity and rejection of accountability, which contribute to medical errors and passivity.