Sammendrag
Background:
There is little research comparing clinicians’ and managers’ views on priority settings in the
healthcare services. During research on two diffe
rent qualitative research projects on healthcare
prioritisations, we found a striking difference on how hospital executive managers and clinical healthcare
professionals talked about and understood prioritisations.
Aim:
The purpose of this study is to explore how healthcare professionals in mental healthcare and somatic
medicine prioritise their care, to compare different ways of setting priorities among managers and clinicians
and to explore how moral dilemmas are balanced and reconciled.
Research design and participants:
We conducted qualitative observations, interviews and focus groups
with medical doctors, nurses and other clinical members of the interdisciplinary team in both somatic
medical and mental health wards in hospitals in Norway. The interviews were recorded and transcribed
verbatim.
Ethical considerations:
Basic ethical principles for research ethics were followed. The respondents
signed an informed consent for participation. They
were assured anonymity and confidentiality. The
studies were approved by relevant ethics committees in line with the Helsinki Convention.
Findings:
Our findings showed a widening gap between the views of clinicians on one hand and managers
on the other. Clinicians experienced a threat to their autonomy, to their professional ideals and to their
desire to perform their job in a professional way. Prioritisations were a cause of constant concern and
problematic decisions. Even though several managers understood and empathised with the clinicians, the
ideals of patient flow and keeping budgets balanced were perceived as more important.
Discussion:
We discuss our findings in light of the moral challenges of patient-centred individual healthcare
versus demands of distributive justice from healthcare management.
Conclusion:
The clinicians’ ideals of autonomy and good medical and nursing care for the individual
patients were perceived as endangered.
Keywords
Areas of practice, clinical ethics, empirical approaches, ethics and leadership/management, ethics of care/
care ethics, intensive care, mental health/psychiatry, moral/ethical climate of organisations, professional
ethics, qualitative research, theory/philosophical perspectives, topic areas
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