Ideology in Organization Change (Healthcare)
- Darlene Edgar
Summary: "Ideological Tensions Amidst Organizational Change in Healthcare" (McMillan & Perron, 2020)
Managerialism in Organizations:
Managerialism aims to enhance efficiency through control in organizations.
Management is a social practice supported by institutions, evaluating performance for efficiency, productivity, profit, or service.
Shift to Business Language in Healthcare:
Healthcare adopts business language with terms like streamlining, efficiency, care production, care management, and healthcare consumer.
Factory and industry management models applied to healthcare create tensions with existing healthcare ideologies.
Culture of Service vs. Culture of Care:
Culture of Service:
Associated with streamlining, standardization, budget focus, and business efficiency.
Perceived at the cost of nurses' well-being and quality patient care.
Imposes a business model, pressuring nurses to do more with fewer resources.
Values initiative over key nursing process steps, leading to feelings of providing only "good enough" care.
Culture of Care:
Emphasizes patient advocacy, doing what's best for the patient, and high-quality care.
Supports exceptional nursing care, up-to-date nursing practices, and nurse well-being.
Allows for ample resources, leading to low stress levels and high morale.
Focused on patient contact, emotional connections, and building trust through bedside time.
Involves artful nursing practices often delegated to other roles in the culture of service.
Challenges and Distress:
Participants experience distress when unable to fulfill moral commitments to a culture of care.
Nurses are pressured to cope with increasing demands and limited resources in the culture of service.
Constructing a Bridge Between Ideologies:
Authors advocate for upholding a culture of care amid financial constraints and increasing complexities.
Nurses and their discipline-specific knowledge should lead organizational change processes.
A bridge between the two ideologies must be constructed, prioritizing a culture of care.