SYSTEM OF INQUIRY
Introduction
Professional services provision principally involves problem solving for the customer (2006). The service provider uses his/her professional knowledge to make a diagnosis of the problem and suggest a solution (2006). The core service offering is intangible; it may be advice, a professional opinion, or information that contributes to the resolution of the client’s problem (2000).
For instance, management consultants, accountants, financial advisors, architects, lawyers and medical doctors make purchasing and investment decisions, financial recommendations, design choices or treatment determinations (1998). The problem resolution may also have tangible outcomes, such as blueprints, plans, reports, prescriptions for pharmaceuticals, or surgical procedures.
In the hospital setting, there is a need to delve into the situation that affects those working in the hospital. Thus a system of inquiry is needed. This paper attempts to develop a system of inquiry to be used in evaluating decision-making, problem solving, and behavior in the hospital setting. This model includes a basic framework as well as a discussion of why, how, when, and by whom it is used. This system of inquiry will focus on the problem of privacy of the patients brought about by gossiping between healthcare professionals, specifically nurses.
Background
Both the American Nurses Association Code of Ethics (1985) and the International Council of Nurses Code for Nurses (1973), as well as various other professional codes, address confidential information. There is no doubt that confidentiality is a professional obligation. It is a central ethical concept in the professional-client relationship along with veracity, integrity, fidelity, charity, and compassion. Challenges periodically emerge to force us to reexamine virtues like confidentiality. One of those challenges is the problems brought about by gossip between health care professionals.
From the patient’s perspective, confidentiality generally is addressed as a right. The right requires protection, and various professional activities can be examined to determine strategies that will ensure confidentiality. Some particularly sensitive areas involving confidentiality include media inquiries, donor names for transplants, cases of violence or abuse, posting assignments and schedules, and the use of patient materials for presentations and publications. Strategies to protect confidentiality may be developed through peer-review procedures, various shift report modalities, ethics committee advice, quality-assurance measures, and professional review organization’s standards. Institutional policies are sometimes devised to protect confidentiality, or broader legislation is enacted at a state or federal level ( 1997).
However, confidentiality is generally a problem when health care professionals talk to each other about their patients through gossip. The concept of gossip, unlike that of emotion and stress, has received relatively little attention in organizational research. However, gossip is not an easy phenomenon to research. It is difficult to define and conceptualise, a situation further complicated by multidisciplinary perspectives that hold different views regarding the characteristics and function of gossip (2005).
The operationalization of gossip as a prototypical category was a key conceptual feature of this research, as was the use of multiple methods of inquiry in order to try to capture the complexity of the phenomenon under investigation. A pragmatist paradigm (2002) was adopted, rejecting “either/or” and “incommensurate paradigm” arguments, adopting instead an inclusive and holistic position. The research design combined and integrated qualitative and quantitative approaches to data collection, analysis and inference. This was an ambitious research agenda, the overall aim of which was to investigate the characteristics and function of gossip at work, using nursing and health-care organizations as information-rich sources of data (2005).
Method of Inquiry
Following the general logic of professional services research, this paper argues that the special features of professional services should carry implications for the problem solving that forms the core of the professional services provision. The purpose of this inquiry is thus to test the validity of the presumed characteristics of professional services by studying their manifestation in the problem solving that occurs in the hospital setting.
This will be achieved by investigating the factors that influence problem solving in one professional service sector and by comparing these factors with the commonly accepted characteristics of professional services. Through this comparison this inquiry will be able to provide empirical support for the validity of the presumed characteristics and also to identify other factors that influence problem solving but have thus far received less attention in the professional ethics research.
This trust is supported by another proposed professional attribute, namely self-regulation. Because the work demands a high degree of skill and expertise, only other professionals can accurately judge the quality of a professional’s work. This is why society accepts professional associations taking charge of peer reviews, licensing, and the sanctioning of inappropriate behavior ( 2000). The profession defines and shares certain rules of conduct, traditions, or a code of ethics (1999), which can be considered as manifestations of self-regulation. Particularly the existence of ethical codes is associated with professional services; “nearly all professions have some kind of formal ethical code” ( 2000). Hence, one can assume that problem solving within professional services is influenced by collegial control, typically manifested in codes of ethics defined and shared by the profession.
Another professional feature is the autonomous status that professionals attach to their work (Harte & Dale, 1995). Autonomy refers to professionals’ freedom to exercise individual judgement to define problems and the means for their resolution without external pressures from clients, non-members of the professions, or the employing organisation (1995). Autonomy can also be considered as a requirement of objectivity; professional service providers are expected to be independent of suppliers of other goods and services. Often the autonomy and objectivity of the professional is the very reason why the client acquires the service; and it may even be required by law. For example, corporations must use independent auditors to approve annual accounts. In sum, professionals are expected to solve problems autonomously, free from the influence of non-members of the profession (2006).
It has been suggested that health-care workers, including nurses, experience different stressors to other occupational groups ( 1998). Ironically, it has also been suggested that health and social care professionals who deal with distress in others may find themselves working in organizational environments where it is difficult to express their own emotions ( 2000). There is also the “stress trap of professionalism” (2003), where professional mystique is to be preserved regardless of personal cost. Feelings of vulnerability, stress or incompetence are shielded, certainly from clients, but also from friends and colleagues, and often from oneself. The trap is reinforced by social expectations: certain professionals are to appear invulnerable, founts of wisdom, and rarely beset with the same problems experienced by ordinary mortals, such as their clients, patients, or consultees.
Inquiry Proper
Because of the contested and prototypical nature of gossip, maximum variation sampling will be the overall strategy to be adopted, in order that the data reflected the “messiness” of reality (1999). The rationale is also to enable a broad range of information and perspectives to be obtained from multiple samples in order to document diverse variations and identify common patterns (2002). Participants will all be qualified nurses working in a wide range of organizational settings, and include newly qualified nurses, nurse managers at ward/team level, senior nurses working at directorate level, and nurses with specialist roles such as cancer care, hospital-community liaison or education. The length of time working in health-care organizations should range from six months to 30 years.
Gossip is a sensitive area of inquiry, particularly with regard to the rights and confidentiality of the third parties who are the subject(s) of gossip. Individuals and organizations are therefore not identified by name, and in the reporting of the findings, on occasions, some details will be slightly modified in order to maintain the confidentiality of third parties and participants.
The investigation as a whole, will address the following areas of inquiry:
1. individual differences relating to gender and position in the organization;
2. sensemaking and socialization processes;
3. organizational factors relating to size, change and methods of formal communication; and
4. emotion.
Data relating to participants’ experiences of gossip, emotion and stress will be collected. Multiple methods of data collection can result in complicated and diverse findings (2002), and to some extent this is intentional, given the nature of the phenomenon under investigation. An analytical framework is developed, incorporating three styles of analysis:
In-depth interviews will be carried out with ten clinical nurse specialists working in a large tertiary hospital. Their roles will cross a range of organizational and professional boundaries, and encompass a range of clinical specialities. A semi-structured interview guide will be used to explore issues and critical incidents relating to gossip and emotion, and the interviews will all be tape-recorded and transcribed. The coding template relating to the theme “Emotional expression and outcome” arising from preliminary data analysis will be used and developed further in the analysis and interpretation of this interview data.
Conclusion
Organizations may develop good communication strategies, and effective formal communication methods, potentially reducing the need for gossip about the organization. However, this does not necessarily stop gossip; it merely tends to shift the topic from organizational issues to individual issues. Organizations may also develop and implement policies and procedures to try to reduce or eliminate damaging, negative gossip ( 2001), in order to protect individuals, and this is sound ethical and professional organizational practice (1998).
It may be difficult to develop a policy to deal with gossip and rumour, particularly that which occurs “behind closed doors”, in the informal “emotionalised zones” and unmanaged spaces of organizations (2003). Nevertheless, it is important to reflect upon what the emotions expressed through gossip might represent or reveal, in terms of underlying issues relating to organizational health, communication and change. This is, however, contingent upon an awareness of gossip and emotion for individual practitioners, managers and health-care organizations. Individuals may not be aware of what emotions gossip as a defence might be shielding, and managers and the organization may be unaware of the nature of gossip and emotions that occur in “unmanaged spaces.
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