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Defensive work in nursing homes: accountability gone amok
1Department of Physiological Nursing, School of Nursing, University of California, San Francisco 94143.
Social Science & Medicine (1982)
|January 1, 1989
Summary
Defensive work, focused on protecting institutions and staff, dominates nursing homes, leading to substandard care for the elderly. Re-channeling this energy towards therapeutic work is recommended for improved patient outcomes.
Area of Science:
- Healthcare Management
- Organizational Behavior
- Geriatric Care
Background:
- Nursing homes often face challenges in evaluating and treating acute illnesses.
- Organizational functioning in these facilities can impact patient care quality.
- Comparison with intensive care nurseries highlights specific nursing home dynamics.
Purpose of the Study:
- To identify dominant organizational processes in nursing homes.
- To examine the influence of defensive work on decision-making and care delivery.
- To propose strategies for improving therapeutic work in nursing homes.
Main Methods:
- Qualitative study of organizational functioning in three American nursing homes.
- Focus on decision-making processes related to acute illness evaluation and treatment.
- Analysis of 'defensive work' as a key organizational process.
Main Results:
- 'Defensive work' (institution-protective/self-protective) emerged as a dominant process.
- Avoidance strategies within defensive work led to counterstrategies and skewed priorities.
- Consequences included acceptance of substandard care and diversion from therapeutic work.
Conclusions:
- Defensive work negatively impacts the quality of care for sick elderly patients.
- Organizational structures can inadvertently foster suboptimal care delivery.
- Recommendations focus on redirecting energy from defensive to therapeutic work for better patient outcomes.