The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, England, UK.
The Wellcome Trust Centre for Ethics and Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, England, UK.
Health Care Anal. 2019 Sep;27(3):171-184. doi: 10.1007/s10728-019-00373-x.
Efficiency is an important value for all publicly funded healthcare systems. Limited resources need to be used prudently and wisely in order to ensure best possible outcomes and waste avoidance. Since 2010, the drive for efficiency, in the UK, has acquired a new impetus, as the country embarked on an 'age of austerity' purportedly to balance its books and reduce national deficit. Although the NHS did not suffer any direct budget cuts, the austerity policies imposed on the welfare system, including social and mental healthcare, have had a direct and detrimental impact on the healthcare service. This paper draws from a qualitative study conducted in three A&E Departments in England to explore the effects of austerity policies on the everyday experiences of doctors and nurses working in Emergency Departments. It discusses the operationalisation of efficiency in A&E, in a climate of austerity, and its effects on the experiences and practices of healthcare professionals. It uses the empirical data as a springboard to highlight the role of structures and regulations, in this case targets and protocols, in how core healthcare ethical values, such as empathy, are exercised in practice. It provides an analysis of the normative role structures and regulations can play on the perception and practice of professional duties and obligations in healthcare.
效率对于所有公共资助的医疗保健系统都是一个重要的价值。为了确保获得最佳结果和避免浪费,有限的资源需要谨慎明智地使用。自 2010 年以来,英国的效率推动获得了新的动力,因为该国开始了一场“紧缩时代”,据称这是为了平衡账目并减少国家赤字。尽管国民保健制度没有遭受任何直接的预算削减,但强加给福利制度的紧缩政策,包括社会和精神保健,对医疗保健服务产生了直接和不利的影响。本文借鉴了在英格兰的三个急症部门进行的一项定性研究,探讨了紧缩政策对在急症部门工作的医生和护士的日常经验的影响。它讨论了在紧缩时期在急症部门中实现效率的问题,以及它对医疗保健专业人员的经验和实践的影响。它利用实证数据作为跳板,强调了在实践中行使核心医疗保健伦理价值观(如同理心)时,结构和法规的作用,例如目标和协议。它分析了规范结构和法规在医疗保健中对专业职责和义务的看法和实践可以发挥的作用。