Læger og sygeplejersker i krydspres mellem organisatoriske krav og ønsket om at levere høj faglighed

Abstrakt

The demographic development with more elderly people, more chronical diseases that requires treatment and higher demands on treatment from the population in general, increases the pressure on the healthcare system. All this together, makes the politicians demand more health care for the money spent. Due to this, it calls for higher efficiency and new ways of working in the public sector. A step toward reaching this goal is to build new hospitals and the new Norths Zealand hospital is one of them. When finished, the politicians expect that it will be possible to run the hospital more efficient, and that the budget will be decreased with 8%. At North Zealand Hospital today, there is significant focus on development of the organization to meet this demand. In this context, I was given the role to manage a project concerning management of the patient flow in the Acute Ward. In this project we are analyzing the opportunities to get a new IT-system, which is able to monitor and visualize the patient flow including key areas such as what diagnostics the patients are waiting for. Thus, it will be possible to allocate diagnostic examinations and other resources efficiently in order to decrease the length of stay for the patients. Moreover, this system will be able to suggest further treatments for the patient and visualize patients, which is in risk of harm. This challenges the doctors’ monopoly of knowledge. Today, the patient flow is highly influenced by the doctors and nurses on duty and their working preference. When implementing the new system, it will lead to new ways of working and do knowledge sharing. The work will be more standardized, and the demand for higher patient flow in the Acute Ward will play a bigger role. When planning the continuity of care for the patient, the doctors and nurses will have to take both a proper flow and the need for good treatment of the patient into account. Traditionally the expert knowledge of the doctors has played a pivotal role. For instance, they have had a high influence on which of the patients each of them were seeing, and how the patients were treated. The new system will change this way of working, and one risk is that it will decrease their motivation and they may even turn against it. Therefore, in order to create a positive implementation process, the present thesis examines how the professionals handle the defending interest of increased patient flow and still doing a professional job of high quality, and how balancing between the demands affects their motivation. The present thesis is based on observations of doctors and nurses doing their daily job in the Acute Ward at North Zealand Hospital, and interviewing them afterwards to cover their perspectives on the observations. This is discussed on the basis of Noordegraafs theory of professions, Thornthons theory of institutional logics and the Theory of Public Service Motivation. Observation and interviews of the professionals shows, that they today in different ways include both patient flow and their professional knowledge in their decision-making. Especially for the younger doctors and the nurses it seems natural to include them both in the continuity of care for the patient, whereas especially the chief physicians seem to be a bit more reluctant about this perspective. Concerning how to create a good implementation process and avoid crowding out, it will be important to take the institutional logics, which are at stake in the organization today, and redefine them to include patient flow more naturally. Thereby the professionals will be inspired to work as “beyond hybrid professionals”. It´s is extremely important to include the chief physicians in defining a new role for them in the collaboration. For instance, the younger doctors and the nurses take care of the main part of the patients, and the chief physicians take care of the more complicated patient cases. Then their expert knowledge will be acknowledged. It should lead to higher motivation and the patient flow will be increased as well. 4 Concerning the nurses, the new system will make it easier for them to have a bigger role in treatment of the patients, and thereby to work more equally with the doctors. Today the nurses act like “beyond hybrid professionals”, and that increases the chance for crowding in with the implementation of the new system.