1 University of Alabama at Birmingham, Birmingham, AL, USA.
J Health Soc Behav. 2019 Mar;60(1):3-17. doi: 10.1177/0022146518825379. Epub 2019 Jan 29.
There is no doubt that the organization of healthcare is currently shifting, partly in response to changing macrolevel policies. Studies of healthcare policies often do not consider healthcare workers' experiences of policy change, thus limiting our understanding of when and how policies work. This article uses longitudinal qualitative data, including participant observation and semistructured interviews with workers within hospice care as their organizations shifted in response to a Medicare policy change. Prior to the policy change, I find that the main innovation of hospice-the interdisciplinary team-is able to resist logics from the larger medical institution. However, when organizational pressures increase, managers and workers adjust in ways that reinforce medical logics and undermine the interdisciplinary team. These practices illustrate processes by which rationalization of healthcare affects workers' experiences and the type of care available to patients.
毫无疑问，医疗保健的组织形式目前正在发生转变，部分原因是为了应对宏观政策的变化。对医疗保健政策的研究通常没有考虑医疗保健工作者对政策变化的体验，从而限制了我们对政策何时以及如何发挥作用的理解。本文使用纵向定性数据，包括对临终关怀工作者的参与式观察和半结构化访谈，这些工作者的组织在应对医疗保险政策变化时发生了转变。在政策变化之前，我发现临终关怀的主要创新——跨学科团队——能够抵制来自更大医疗机构的逻辑。然而，当组织压力增加时，管理者和工作者以加强医学逻辑和破坏跨学科团队的方式进行调整。这些做法说明了医疗保健合理化如何影响工作者的体验和可向患者提供的护理类型的过程。
