health care organization

8/11/2019 Health Care Organization

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A. History

“A health care system is the totality of services offered by all health disciplines”

(Berman, Snyder, Kozier, & Erb, 2 !"# $t incl%des people, or anizations, facilities and reso%rces

to meet the needs of the pop%lation#

A health care or anization m%st be concerned 'ith doin the ri ht thin s thro% h efficacy

and appropriateness and doin the ri ht thin s 'ell thro% h availability, timeliness,

effectiveness, contin%ity, safety, efficiency and respect and carin ( e )a%ne & )adner, 2 **"

+hro% ho%t the cent%ries, a lot of chan es have occ%rred in the field of health care# +he

primitive system of health care years a o has evolved to today s advanced and improved health

care#

%rin the fifth and si-th cent%ries, .hristianity s early years, ch%rches and monasteries

'or/s not only incl%de providin of food, clothin shelter and spirit%al s%pport to those in need

b%t also, servin the sic/# $n the middle a es, several reli io%s orders of men provided n%rsin

care to both 'estern and eastern health instit%tions# Also at this time, instit%tions 'ere

established to ho%se patients 'ith comm%nicable disease li/e leprosy (0all,n#d#"#

$n the ei hteenth cent%ry, hospitals increased in size and foc%sed more on the medical

aspect than the reli io%s side# $n America, isolation hospitals and almsho%ses 'ere b%ilt for the

sic/ and for the poor as 'ell# Ben1amin ran/lin and r# +homas Bond spearheaded the

establishment of 3ennsylvania 4ospital in *56* (0all, n#d#"#

$n the nineteenth cent%ry, 7apoleon b%ilt bi hospitals 'ith more than a tho%sand beds in

rance to accommodate his 'o%nded troops from the 'ars (0all, n#d#"# $n *!68, lorence

7i htin ale, the fo%nder of modern n%rsin created the 7i htin ale +rainin School for 7%rses

at St# +homas 4ospital in )ondon# 7on9profit hospitals s%pported by reli io%s ro%ps, p%blic



hospitals and proprietary hospitals 'ere also established d%rin these times# $n :nited States,

hospitals became more modern and e-pensive d%rin *!;69*826#$n *!!5, <rs# Bedford

en'ic/, a 'ell9/no'n leader in En land campai ned for n%rse re istration# After a year, she

fo%nded the British 7%rses Association 'hich later became the =oyal British 7%rses

Association# $n *!8>, professionals and artists attended the 0orld s air and .ol%mbian

E-position in America# +he atherin of n%rses, mostly directors of n%rsin paved the 'ay to the

event%al formation of American Society of S%perintendents of +rainin Schools for 7%rses# +he

standard of n%rsin ed%cation 'as their foc%s# $n *8 5, .anadian n%rses also created the

.anadian Society of S%perintendents of +rainin Schools# +he American or anization 'as later renamed to the 7ational )ea %e for 7%rsin Ed%cation in *8*2 and event%ally to 7ational

)ea %e for 7%rsin in *862 (Ellis & 4artley, 2 !"#

$n *8* s, American hospital became more scientific, emphasized the val%e of antiseptics

and cleanliness and %sed pain medications (3%blic Broadcastin Service, n#d#"# %rin the ?reat

epression in *8> s9*8@ s, patients t%rned to p%blic health instit%tions instead of privately9

o'ned hospitals# $n April 5, *8@!, the 0orld 4ealth r anization 'as formed by the :nited

7ations# <edicare and <edicaid 'ere created in *8;6 to provide financial s%pport to the a ed

and people in need especially those 'ith lo' income (Berman et al#, 2 !"# $n *85 s,

comm%nity hospitals offered comple- and advanced services s%ch as open9heart s%r ery,

radioisotope proced%re and in9ho%se psychiatric facilities#4ospital costs escalated d%e to some

factors s%ch as hi h <edicare e-penses, rapid inflation of the economy, increase of hospital

e-pendit%res and profits and advancement in technolo y, medication and treatments (3%blic

Broadcastin Service, n#d#"# $n *8! s profit and non9profit health instit%tions started formin

bi er hospital systems# “A system 'as a corporate entity that o'ned or operated more than one



hospital” (0all, n#d#"# .ost control 'as the foc%s of hospitals in the *88 s# <edicare and

<edicaid contin%ed to be infl%ential and ins%rance companies became more active in mana in

hospital costs#

$n the 3hilippines, ray %an .lemente, a ranciscan friar established a dispensary in

<anila in *655# $t later became the San %an de ios 4ospital in *;68 ( epartment of 4ealth,

2 **"#Aside from San %an de ios 4ospital, the San )azaro 4ospital is also one of the old

hospitals in the co%ntry# n September 2, *822, Anastacia?iron9+%pas fo%nded the ilipino

7%rses Association 'hich became the 3hilippine 7%rses Association in *8;;# +he epartment of

4ealth 'as separated from the epartment of 3%blic 4ealth and 0elfare as an individ%al entityin *8@*# rom the *86 s on'ards, there 'as a steady improvement in patient care, medical

ed%cation, and p%blic health comparable to other developin co%ntries(=om%aldez, et al#, 2 **"#

$n *8;8, the 3hilippine <edical .are Act approved hospitalization, medical and s%r ical e-pense

benefits for ilipinos# 4ealth care services 'ere classified into primary, secondary and tertiary

levels in *85 # 3rivate sector health services, free9standin hospitals, physician9r%n individ%al

clinics, and mid'ifery clinics, have mainly follo'ed the 7orth American models of independent

instit%tions 'hich 'ere based on fee9for9service payments# rom *88 s on'ards, health pro1ects

s%ch as 7%trition 3ro1ect, +raditional <edicine and octors to the Barrio 'ere p%shed f%rther

( epartment of 4ealth, 2 **"# $n *886, the 3hil4ealth 'as established as the national health

ins%rance corporation (=om%aldez, et al#, 2 **"#

B. Structure and Organization of Health Care1. Primary, Secondary and Tertiary

$nnovations in biomedical science have almost eradicated sco%r es s%ch as polio and

measles and have allo'ed s%ch marvels as or an transplantation, “/nifeless” amma ray s%r ery

for brain t%mor, and intensive care technolo y that saves the lives of children 'ith asthma



complicated by pne%monia# $n cases s%ch as the fail%re to prevent severe asthma flare9%p is not

related to financial barriers, b%t rather reflects or anizational problems, partic%larly in the

delivery of primary care and preventive services (Bodenheimer & ?r%mbach, 2 8"#

+he or anizational tas/ facin all health care systems is one of “ass%rin that the ri ht

patient receives the ri ht service at the ri ht time and in the ri ht place” (=od'in, *8!@"# An

additional criterion co%ld be “# # # and by the ri ht care iver” (Bodenheimer & ?r%mbach, 2 8"#

0ho is responsible for plannin and ens%rin that every child receives the ri ht service at the

ri ht timeC .an an %r ent care center or an in9store clinic at 0atson s desi ned for episodic

needs be held acco%ntable for providin comprehensive care to all patients passin thro% h itsdoorsC Sho%ld parents be e-pected to ma/e appointments for ro%tine visits at medical offices and

clinics, or sho%ld p%blic health n%rses travel to homes and day9care centers to provide preventive

services o%t in the comm%nityC 0hat is the proper balance bet'een intensive care %nits that

provide life9savin services to critically ill patients and primary care services eared to'ard less

dramatic medical and preventive needsC

Primary Health Care

+he first level of contact bet'een individ%als and families 'ith the health system refers

to the 3rimary 4ealth .are (Kareem, *88;"# Accordin to the Alma Atta eclaration of *85!,

3rimary health care is essential health care based on practical, scientifically so%nd and socially

acceptable methods and technolo y made %niversally accessible to individ%als and families in

the comm%nity thro% h their f%ll participation and at a cost that the comm%nity and co%ntry can

afford to maintain at every sta e of the development in the spirit of self9reliance and self9

determination# $t incl%ded care for mother and child 'hich incl%ded family plannin ,

imm%nization, prevention of locally endemic diseases, treatment of common diseases or in1%ries,



provision of essential facilities, health ed%cation, provision of food and n%trition and adeD%ate

s%pply of safe drin/in 'ater ( epartment of 4ealth, 2 **"#

$n the 3hilippines, the oal of 3rimary 4ealth .are is “4ealth for All ilipinos by the

year 2 and 4ealth in the 4ands of the 3eople by the year 2 2 ”# +here are t'o levels of

3rimary 4ealth .are 'or/ers, the Baran ay 4ealth 0or/ers, 'ho are trained comm%nity health

'or/ers r health a%-iliary vol%nteers or traditional birth attendants or healers, and the

$ntermediate )evel 4ealth 0or/ers, incl%des the 3%blic 4ealth 7%rse, =%ral Sanitary $nspector

and mid'ives (3rimary 4ealth .are (34.""#

Elements of Primary Health Care Education for Health

$t is one of the potent methodolo ies for information dissemination# +his helps promote the

partnership of both the family members and health 'or/ers in the promotion of health as 'ell as

prevention of illness (3rimary 4ealth .are (34.""#

Locally Endemic Disease Control

+his foc%ses on the prevention of occ%rrence of endemic disease to prevent morbidity rate

(3rimary 4ealth .are (34.""#

Expanded Program on Immunization

+his pro ram controls the occ%rrence of preventable illnesses especially of children belo' ;

years old# $mm%nizations on poliomyelitis, measles, tetan%s, diphtheria and other preventable

disease are iven by the overnment and on oin pro rams of the 4 for free#



Maternal and Child Health and Family Planning

As the name implies, this pro ram foc%ses on the most delicate members of the comm%nity, the

mother and child# +he oal of amily 3lannin incl%des spacin of children and responsible

parenthood (3rimary 4ealth .are (34.""#

Environmental anitation and Promotion of afe !ater upply

Environmental Sanitation is the st%dy of all factors in the man s environment, 'hich e-ercise or

may e-ercise deleterio%s effect on his 'ell9bein and s%rvival# As a basic need for life, 'ater is

necessary for the maintenance of healthy lifestyle# +his pro ram is necessary for basic promotion

of health (3rimary 4ealth .are (34.""#

"utrition and Promotion of #de$uate Food upply

+here are many food reso%rces fo%nd in the comm%nities b%t beca%se of fa%lty preparation and

the lac/ of /no'led e re ardin proper food plannin , maln%trition is one of the problems that

'e have in the co%ntry (3rimary 4ealth .are (34.""#

%reatment of Communica&le Diseases and Common Illness

<ost comm%nicable diseases are preventable# +he ?overnment foc%ses on the prevention,

control and treatment of these illnesses (3rimary 4ealth .are (34.""#

upply of Essential Drugs

+his foc%ses on the information campai n on the %tilization and acD%isition of dr% s# $n response

to this campai n, the ?E7E=$. A.+ of the 3hilippines is enacted (3rimary 4ealth .are (34.""#

Secondary Health Care

$f a person has been referred to a specialist by the primary care provider, then he she has

been referred to secondary care# Secondary care simply means bein ta/en care of by someone

'ho has more specific e-pertise in 'hatever problem a person is havin (+orrey, 2 **"#



Secondary 4ealth .are incl%des smaller, non9departmentalized hospitals incl%din district

hospitals and r%ral hospitals# Services offered to patients 'ith symptomatic sta es of disease,

'hich reD%ire moderately specialized /no'led e and technical reso%rces for adeD%ate treatment

(3rimary 4ealth .are (34.""# Secondary care is 'here most of %s end %p 'hen 'e have a

medical condition to deal 'ith that canFt be handled by primary care# Sometimes, problems 'ith

specialty care develop beca%se 'e have been referred to the 'ron /ind of specialist (+orrey,

2 **"#

Tertiary Health Care

+ertiary health care lies at the ape- of the or anizational pyramid 'hich involves themana ement of rare and comple- disorders (Bodenheimer & ?r%mbach, 2 8"# Specialized

cons%ltative care is provided %s%ally on referral from primary and secondary medical care

(Kareem, *88;"# +ertiary healthcare services are specialised and are a hi hly technical level of

healthcare, 'hich involves dia nosis and treatment of disease and disability# +hese services

involve the specialised intensive care %nit, hi hly trained doctors and health 'or/ers, 'hose

main role is to offer healthcare (Bodenheimer & ?r%mbach, 2 8"#

2. Profit !on"Profit

+he health care system is composed of different health care providers, cons%mers and

settin s# A health care or anization can either be a profit or non9profit or anization# “7o sin le

a ency or ro%p controls the entire health care system”( e )a%ne & )adner, 2 **"#

Profit Health Care Organization

+hro% ho%t the history of the health care ind%stry, a lot of non9profit or anizations have

been created, providin services to those in need of medical attention# 4o'ever in the last 2



years, several for9profit or anizations s%ch as hospitals and dialysis centers have also been

established (Andre & GasD%ez, 2 * "#

3rofit or anizations are said to provide D%ality service and benefits at affordable costs beca%se of

their efficiency, cost9c%ttin and innovations# “+his cost9c%ttin trend 'as attrib%ted to mana ed

care, 'ith the percenta e of hospitals participatin in mana ed care pro rams almost do%blin

bet'een *88> and *88@” (Sac/man, n#d#"# <ost non9profit or anizations 'or/ independently# n

the other hand, for9profit or anizations are %s%ally connected to each other, allo'in for

economies in financin and mana ement, centralized services and shared eD%ipment, thereby

leadin to lo'er costs (Andre & GasD%ez, 2 * "# +hey also have easy access to capital 'hich isnecessary to replace o%tdated materials and machine 'ith ne' and improved ones, %nli/e non9

profit health care or anizations# or9profit instit%tions pay ta-es and by doin so, they believe

that they can contrib%te to society s 'elfare thro% h these remittances#

4o'ever, there are also disapprovals thro'n to profit or anizations# +hey are said to

serve only those 'ho are rich and avoid receivin %nins%red patients# $n addition, they co%ld

promote hi hly9l%crative dr% s, tests and treatments instead of the cheaper and traditional ones#

!on"Profit Health Care Organization

7on9profit or anizations are important part of the p%blic health sector# +hese are

vol%ntary a encies that are f%nded thro% h different 'ays s%ch as individ%al contrib%tions,

corporate philanthropy and membership d%es( e )a%ne & )adner, 2 **"#As a non9profit health

care or anization, they aim to provide care and services 'itho%t re ard of the patient s capacity

to pay ()ayne, n#d#"# +hese or anizations are responsible to the comm%nities and pop%lations

they serve# +he earnin s of non9profit health care or anizations are reinvested to benefit the

comm%nity (Alliance for Advancin 7onprofit 4ealth .are, n#d#"# +heyr%n health care



instit%tions 'hich are %s%ally operated by reli io%s or anizations or other comm%nity

ro%ps(?overnment of Sas/atche'en, 2 *2"#

.onsideration of 1%stice is the concern of non9profit or anization# “All persons have a

ri ht to live their lives 'ith di nity” (Andre & GasD%ez, 2 * "# +hey believe that every member

sho%ld be iven the ri ht to health care access, 'hether they are rich or poor, partic%larly in

'ealthy co%ntries s%ch as America#

.ontrary to for9profit or anizations 'hich have ample so%rce of capital, non9profit

or anizationshave diffic%lty attractin f%nds beca%se they depend on donations and s%pport#

Some people don t consider oin to them beca%se of the sti ma that these are “p%blicinstit%tions” and that some of their facilities are a in and o%tdated (Andre & GasD%ez, 2 * "#

7on9profit hospitals are either operated as a charitable or ed%cational instit%tion or both#

Some charitable hospitals incl%de faith9based hospitals and comm%nity hospitals# +here are also

other non9reli io%s affiliations that offer help# Ed%cational hospitals are also prevalent# +hey are

%s%ally %niversity9affiliated and foc%s on st%dent ed%cation and research# +hese hospitals %s%ally

%se ne' technolo y and e-perimental techniD%es# +here are also research instit%tions 'hich

cond%ct research b%t are not %niversity9affiliated# E-amples of these research instit%tions are the

<ayo .linic, Scripps $nstit%te and .ity of 4ope in %arte, .alifornia# Apart from hospitals, there

are also other non9profit health care a encies ( ei enba%m, 2 *>"#

<ost p%blic health pro rams are considered non9profit or anizations# =ecipients of these

pro rams %s%ally pay a little amo%nt or none at all# ree clinics, imm%nization clinics, hospice

care for the indi ent and A$ S prevention pro ram are some of the services they provide

( ei enba%m, 2 *>"#



E-amples of not9for9profit or anizations in :#S# are the American 7%rses Association and

the American <edical Association# +here are also or anizations 'hich provide ed%cational

reso%rces to health care providers and eneral p%blic# +hese incl%de :#S# a encies li/e the

American .ancer Society and the American 4eart Association( e )a%ne & )adner, 2 **"#

Aside from the aforementioned ro%ps, there are more p%blic health service

or anizations# +he 4ealth =eso%rces and Services Administration (4=SA" provide the p%blic

'ith health9related information and spearhead pro rams abo%t health care to the homeless, or an

transplant, 4$G9infected and A$ S patients, and impart /no'led e abo%t r%ral health care and

employee occ%pation health# +he ood and r% Administration ( A" protects the p%blic fromthe %se of %nsafe dr% s, food and cosmetics# +he .enter for isease .ontrol and 3revention

(. ." assists in preventin the transmission of comm%nicable diseases# +he 7ational $nstit%tes

of 4ealth (7$4" cond%cts research and ed%cation abo%t specific diseases# )astly, the Alcohol,

r% Ab%se and <ental 4ealth Administration (A A<4A" tac/les on information abo%t

s%bstance ab%se and other mental health iss%es# +hese instit%tions are some of the or anizations

s%pported by the :#S# 3%blic 4ealth Service( e )a%ne & )adner, 2 **"#

+here has been a reat iss%e bet'een non9profit and for9profit or anizations, on 'hether

'hich type benefits the society more or 'hich a ency delivers the better health care service than

the other# $n the end, these or anizations are all %nder the health care system# +hey o% ht to

provide care to those in need to elevate the standard of health in any society# +r%ly, as previo%sly

mentioned, neither of them controls the entire health care system#



C. CHA!#$!# %&'O#(APH$CS A!% H&A)TH CA(&

+he variation of different demo raphics has constantly affected health care 'orld'ide#

$ncreased n%mber of elderly, eo raphical location and economics are 1%st some of the factors

involved#

#ging Population

By 2 2 , it is estimated that people over the a e of ;6 years old in America 'ill be more

than 6> million H * million more than the c%rrent pop%lation (;6 years old and above"# +his

statistics is alarmin considerin that the elderly reD%ire close attention# +hey are %s%ally

affected by lon 9term illnesses and reD%ire special ho%sin , treatment services and financial

s%pport# Since only 6I of the elderly are instit%tionalized, home mana ement and n%rsin

s%pport services 'ill be essential for these patients# $n addition, health care or anizations sho%ld

not only foc%s on the elderly s health b%t consider their 'orth and prod%ctivity as 'ell, thro% h

special pro rams (Berman, et al#, 2 !"#

“$f health care cons%mption patterns and physician prod%ctivity remained constant over

time, the a in pop%lation 'o%ld increase the demand for physicians per tho%sand pop%lation

from 2#! in 2 to >#* in 2 2 # emand for f%ll9time9eD%ivalent ( +E" re istered n%rses per

tho%sand pop%lation 'o%ld increase from 5 to 5#6 d%rin this same period” (.han in

emo raphicsJ $mplications for3hysicians, 7%rses, and ther 4ealth 0or/ers, 2 >"#

'neven Distri&ution of ervices

:rban and r%ral areas have different health care opport%nities# =%ral areas enerally have

shorta e of health care services compare to %rban areas 'ith adeD%ate health instit%tions,

personnel and services# 3atients in r%ral areas often travel lon distance in order to access health

care services# “Efforts to increase the s%pply of health professionals in these areas m%st deal 'ith



economic, c%lt%ral and lan %a e considerations (.han in emo raphicsJ $mplications

for3hysicians, 7%rses, and ther 4ealth 0or/ers, 2 >"#

An increasin n%mber of health care 'or/ers provide specialized services# +his

specialization can ca%se fra mentation of services and increased e-penses#

'r&anization ( #dvances in %echnology

%e to the modernization, health care delivery has constantly improved# 4i h9end and

sophisticated dia nostic proced%res have helped in early detection of diseases# <ore medicines

have also been prod%ced to treat different diseases and even the more complicated ones# Also, a

lot of s%r ical proced%res, 'hich 'ere non9e-istent 2 years a o have already been performed#%e to the modernization of technolo y, the p%blic are becomin a'are of their health sit%ation

thro% h the %se of comp%ters and internet# 4o'ever, beca%se of the escalation of health care

standards, these treatment and proced%res entail hi her costs for the people#

Economics

3ayin for health care services is becomin a reat concern# A co%ntry s economic stat%s

affects the delivery of health care# Berman et al# (2 !" indicated the ma1or reasons for the

escalation of costs# 4ealth care instit%tions contin%e to improve their facilities and eD%ipment in

order to /eep %p 'ith the pace of modern health# +he increase in pop%lation, especially the

elderly and %nins%red has also ca%sed the increase of costs# %e to improved technolo y, more

people are becomin a'are ca%sin them to see/ for health assistance# +here is also an increase

in the n%mber of health care providers# And lastly, medicines are also becomin more costly#



Poverty

+he health problems of homeless and poor are %s%ally e-acerbated d%e to their inability

to avail of health care services# 3hysical, mental, social, and emotional factors create health care

challen es for them (Berman et al#, 2 !"#

!omen)s Health

0omen s movement has ca%sed health care or anizations to ive attention to 'omen s

needs# .hildbirth services have been improved# 0omen s health iss%es s%ch as osteoporosis and

heart disease are addressed# +here is also an increased emphasis on the psychosocial aspects of

'omen s health#

Family Fragmentation

Sin le9parent families and alternative family str%ct%res have been prevalent# 0omen are

%s%ally the head of these sin le parent families# +hey often are 'or/in individ%als and need

s%pport in providin care for their children, especially 'hen they are sic/#

Cultural and Ethnic Diversity

4ealth care or anizations ive emphasis on patients differences in c%lt%re# +o address

this problem, instit%tions employ personnel 'ho can comm%nicate in En lish#

%. TH& C*)T*(& O+ H&A)THCA(& O(#A!$ AT$O!S

.%lt%re is the characteristics of a partic%lar ro%p of people, defined by everythin from

lan %a e, reli ion, c%isine, social habits, m%sic and arts ( immermann, 2 *2"# $t is “ho' and

'hy yo% do 'hat yo% do” (0iseman & Kaprielian, 2 6"# Accordin to 0iseman and Kaprielian

(2 6", “c%lt%re is made %p of the overarchin themes 'ithin an or anization %s%ally made %p of

stories and %n'ritten r%les overnin behavior 'hich mi ht be clearly stated or merely implied,

intentional or %nintentional”#



.%lt%re is not necessarily %niform 'ithin a sin le or anization# or e-ample, in a

hospital, each healthcare 'or/er may have a different c%lt%re# +hese differences may either

benefit or impede the patient care# +he latter is more li/ely, as c%lt%ral differences freD%ently

res%lt in comm%nication differences (0iseman & Kaprielian, 2 6"#

$n the healthcare environment, the c%lt%re of an or anization has many competin

variables# +he conflictin needs of patients, families, providers, instit%tions, re %lators and

others create many discrepancies and mi-ed messa es (0iseman & Kaprielian, 2 6"# <any

have said that a c%lt%re of blame has been pervasive in healthcare# Beca%se medicine 'as often

vie'ed as the 'or/ of a sole physician (or other professional" 'or/in 'ith an individ%al patient,'hen somethin did not o 'ell the a%tomatic reaction 'as to try to determine 'ho 'as at fa%lt

and, often, to discipline them# +his “shame and blame” approach leads to hidin rather than

reportin of errors, and th%s is the antithesis of a c%lt%re of safety# =ecent efforts have tried to

chan e thisLto enco%ra e people to report problems rather than hide them, so they can be

addressed# or'ard9thin/in healthcare or anizations remember that their primary reason for

e-istence is to ta/e care of patients, and they 'ant to /eep them as safe and healthy as possible#

+here are formal and informal c%lt%res in an or anization# ifference bet'een the formal

operational style stim%lated by the mana ement and the style demonstrated and felt by staff

members may be evident# +his can res%lt in an incompetent or anization# +herefore, the c%lt%re

of an or anization definitely affects D%ality of care# A positive c%lt%re prod%ces tr%st, information

sharin , collaboration and ris/ ta/in # n the other hand, a ne ative c%lt%re promotes

divisiveness, resistance and a desire to maintain the stat%s D%o leadin to employees lac/in

creativity and self9direction ( e )a%ne &)a%dner, 2 **"#



4ere is an e-ample of t'o different c%lt%res in a health care or anizationJ

+im reco nized the %niD%e 'ay the teams at 4ospital A 'or/ed 'hen d%rin a fairly

serio%s proced%re a n%rse spo/e %p and as/ed for a proced%ral stop# +he physician had iven a

verbal order for an antibiotic in con1%nction 'ith the proced%re# She D%estioned this beca%se of a

recollection that the patient had several dr% aller ies# +he team held the proced%re %ntil the

record 'as revie'ed, and it 'as confirmed that the patient 'as indeed aller ic to the medication

that 'as ordered# +he physician ladly chan ed the order, an alternative medication 'as

administered, and the proced%re 'as then performed# After'ards, the doctor act%ally than/ed the

n%rse for her 'illin ness to as/ the D%estion#+im realized this 'as tr%ly a different 'orld than he had lived in at 4ospital B# 4e

recalled n%rses avoidin raisin D%estions abo%t doctors orders beca%se of the conseD%ences# 4e

specifically remembered one physician “dressin do'n” a n%rse ri ht o%tside the e-am room,

f%lly 'ithin earshot of the patient and a n%mber of other 'or/ers# +here had been some

mana ement intervention and a 'or/shop on team'or/ as a res%lt, b%t it 'as common

/no'led e that the n%rse received a 'ritten 'arnin 'hile the doctor ot only a mild verbal

reprimand#

$n the above e-ample, 4ospital A e-emplified a positive or anizational c%lt%re as

evidenced by open comm%nication bet'een the members of the health care team# +he n%rse 'as

not afraid to spea/ %p 'hile the physician 'as open to corrections# $n the end, they 'ere able to

identify and correct the error and promote the 'elfare of the patient# n the other hand, n%rses in

4ospital B 'ere afraid of raisin D%estions beca%se of fear of ettin reprimanded by the

physician#

health care organization

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