Heirarchical vs Decentralized Workplace Structure in Healthcare

It seems as though every workplace has its own unique set of stressors. Workplace stressors can impact employee satisfaction and health, but can also impact the company by reducing productivity, morale, and resulting in more employee sick days. As a medical sociologist I study the structure of the healthcare workplace, and much of the research in this field is focused on the heirarchical nature of physican-nurse-patient relationships, and conflicts among staff. Take the example of a hospital where the doctors are talking down to the nurses, and since the nurses cannot retaliate, they may take out this stress on their fellow nurses. Another stressful aspect of healthcare work, particularly for nurses, is the negotiation of relations with their patients and their patients' doctors, where the nurse may be put in the position to advocate for their patient and potentially go against a doctors' opinion.

With this in mind, I was interested and suprised at what I gathered from my fieldwork here in Denmark I visited a Hospice Center, a Community Health Center, a Hospital, and a Center for Autism, all located in southern Zealand. Although the institutions provide different services and have unique attributes, they all shared a culture of decentralized power and more fluid relationships among management, staff, and clients. This looked very different from the heirarchical American structure. To give a few examples....The manager or CEO's office was in a sort of clear glass box--while the staff and middle management had somewhat private workplaces with no differentiation, I was told that the boss's office was physically transparent and thus the employees could see if they were working or not. Whether this was a joke or not, the structure provides for this kind of check and balance system with upper managment. The structures of each workplace were decentralized, meaning team leaders had full autonomy over how their team was run, as long as they held the company's values in mind and met institutional goals. These goals were always focused on the quality of care, since the profit motive was not as present as in the American system. When a CEO has to make more money, they need to control their workers. When the goal is quality, you want to empower your workers to get the job done. Even the cafeterias did not separate each level of employee, or separate the employees from the clients. That is, the employees and patients ate all meals together. In the case of the hospice center, it motivated elderly adults to eat more...the difference between being told to do something, and being invited to be part of something social. This was the case with the Center for Autism as well. No client was told to do something unless it became a serious situation. The rule was for the employees to simply emulate the behavior expected from the clients.

It is unclear if many of these principles could be implemented in American healthcare centers because the nature of the business of medicine differs so greatly from the Danish context. However, it is certain that creating a culture within an insitution that all involved can get behind, can increase efficiency, effectiveness, and employee morale by relying more on trust and togetherness than punishment and competition.