Abstract
BackgroundWith its emphasis on cost-reduction and external management, New Public Management emerged as the dominant healthcare policy in many Western countries. The ability to provide comprehensive and customized patient-care is challenged by the formalized, task-oriented organization of home-care services. The aim of this study is to gain deeper understanding of how nurses and the patients they care for, relate to and deal with the organizational systems they are subjected to in Norwegian home care.MethodsThe focused ethnographic design is based on Roper and Shapira’s framework. Data collection consisted of participant observation with field notes and semi-structured interviews with ten nurses and eight patients from six home care areas located in two Norwegian municipalities.ResultsFindings indicate cultural patterns regarding nurses’ somewhat disobedient behaviors and manipulations of the organizational systems that they perceive to be based on economic as opposed to caring values. Rigid organization makes it difficult to deviate from predefined tasks and adapt nursing to patients changing needs, and manipulating the system creates some ability to tailor nursing care. The nurses’ actions are founded on assumptions regarding what aspects of nursing are most important and essential to enhance patients’ health and ensure wellbeing – individualized care, nurse-patient relationships and caring – which they perceive to be devalued by New Public Management organization. Findings show that patients share nurses’ perceptions of what constitute high quality nursing, and they adjust their behavior to ease nurses’ work, and avoid placing demands on nurses. Findings were categorized into three main areas: “Rigid organizational systems complicating nursing care at the expense of caring for patients”, “Having the patient’s health and wellbeing at heart” and “Compensating for a flawed system”.ConclusionsOur findings indicate that, in many ways, the organizational system hampers provision of high-quality nursing, and that comprehensive care is provided in spite of - not because of - the system. The observed practices of nurses and patients are interpreted as ways of “gaming the system” for caring purposes, in order to ensure the best possible care for patients.
Highlights
With its emphasis on cost-reduction and external management, New Public Management emerged as the dominant healthcare policy in many Western countries
Rigid organizational systems complicating nursing care at the expense of caring for patients Home-care organization is perceived by nurses as increasingly complex, and many factors influence nursing practices
Interview responses and observational data indicate that lack of time, rigid organization, and focus on profitability may affect nurse-patient relationships (NPR) and restrict nursing care, having unfortunate consequences for patients
Summary
With its emphasis on cost-reduction and external management, New Public Management emerged as the dominant healthcare policy in many Western countries. The ability to provide comprehensive and customized patient-care is challenged by the formalized, task-oriented organization of home-care services. While the healthcare systems main task is to provide care for patients, it must be financially sustainable [6], and the introduction of New Public Management (NPM) into Norwegian healthcare can be seen in conjunction with financial challenges in the public sector. New public management in home care The term NPM is a common designation of various reforms and change-processes that have characterized public sectors worldwide. The public care sector in many countries, including in Nordic countries, has been subjected to organizational reforms and regulations based on NPM principles [1, 2, 9]. Despite the goals of enhancing quality and reducing costs, evaluations after 30 years of NPM-reforms in the UK public sector conclude that NPM has been unsuccessful and rather led to higher costs and more complaints [10]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
