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Identifying disrespect and abuse in organisational culture: a study of two hospitals in Mumbai, India

This paper draws on findings from a qualitative study of two government hospitals in Mumbai, India, which aimed to provide a better understanding of the institutional drivers of disrespect and abuse (D&A) in childbirth. The paper describes the structural context, in which government hospital pro...

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Autores principales: Madhiwalla, Neha, Ghoshal, Rakhi, Mavani, Padmaja, Roy, Nobhojit
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Taylor & Francis 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6178091/
https://www.ncbi.nlm.nih.gov/pubmed/30102132
http://dx.doi.org/10.1080/09688080.2018.1502021
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author Madhiwalla, Neha
Ghoshal, Rakhi
Mavani, Padmaja
Roy, Nobhojit
author_facet Madhiwalla, Neha
Ghoshal, Rakhi
Mavani, Padmaja
Roy, Nobhojit
author_sort Madhiwalla, Neha
collection PubMed
description This paper draws on findings from a qualitative study of two government hospitals in Mumbai, India, which aimed to provide a better understanding of the institutional drivers of disrespect and abuse (D&A) in childbirth. The paper describes the structural context, in which government hospital providers can exercise considerable power over patients, yet may be themselves vulnerable to violence and external influence. Decisions that affect care are made by a bureaucracy, which does not perceive problems with the same intensity as providers who are directly attending to patients. Within this context, while contrasting organisational cultures had evolved at the two hospitals, both were characterised by social/professional inequality and hierarchical functioning, and marginalising women. This context generates invisible pressures on subordinate staff, and creates interpersonal conflicts and ambiguity in the division of roles and responsibilities that manifest in individual actions of D&A. Services are organised around the internal logic of the institution, rather than being centred on women. This results in conditions that violate women's privacy, and disregards their choice and consent. The structural environment of resource constraints, poor management and bureaucratic decision-making leads to precarious situations, endangering women’s safety. With the institution's functioning based on hierarchies and authority, rather than adherence to universal standards or established protocols, irrational, harmful practices endorsed by senior staff are institutionalised and reproduced. A deeper focus on organisational culture, embedded in the discourse of D&A, would help to evolve effective strategies to address D&A as systemic problems.
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spelling pubmed-61780912018-10-22 Identifying disrespect and abuse in organisational culture: a study of two hospitals in Mumbai, India Madhiwalla, Neha Ghoshal, Rakhi Mavani, Padmaja Roy, Nobhojit Reprod Health Matters Research Articles This paper draws on findings from a qualitative study of two government hospitals in Mumbai, India, which aimed to provide a better understanding of the institutional drivers of disrespect and abuse (D&A) in childbirth. The paper describes the structural context, in which government hospital providers can exercise considerable power over patients, yet may be themselves vulnerable to violence and external influence. Decisions that affect care are made by a bureaucracy, which does not perceive problems with the same intensity as providers who are directly attending to patients. Within this context, while contrasting organisational cultures had evolved at the two hospitals, both were characterised by social/professional inequality and hierarchical functioning, and marginalising women. This context generates invisible pressures on subordinate staff, and creates interpersonal conflicts and ambiguity in the division of roles and responsibilities that manifest in individual actions of D&A. Services are organised around the internal logic of the institution, rather than being centred on women. This results in conditions that violate women's privacy, and disregards their choice and consent. The structural environment of resource constraints, poor management and bureaucratic decision-making leads to precarious situations, endangering women’s safety. With the institution's functioning based on hierarchies and authority, rather than adherence to universal standards or established protocols, irrational, harmful practices endorsed by senior staff are institutionalised and reproduced. A deeper focus on organisational culture, embedded in the discourse of D&A, would help to evolve effective strategies to address D&A as systemic problems. Taylor & Francis 2018-08-13 /pmc/articles/PMC6178091/ /pubmed/30102132 http://dx.doi.org/10.1080/09688080.2018.1502021 Text en © 2018 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group http://creativecommons.org/licenses/by/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Articles
Madhiwalla, Neha
Ghoshal, Rakhi
Mavani, Padmaja
Roy, Nobhojit
Identifying disrespect and abuse in organisational culture: a study of two hospitals in Mumbai, India
title Identifying disrespect and abuse in organisational culture: a study of two hospitals in Mumbai, India
title_full Identifying disrespect and abuse in organisational culture: a study of two hospitals in Mumbai, India
title_fullStr Identifying disrespect and abuse in organisational culture: a study of two hospitals in Mumbai, India
title_full_unstemmed Identifying disrespect and abuse in organisational culture: a study of two hospitals in Mumbai, India
title_short Identifying disrespect and abuse in organisational culture: a study of two hospitals in Mumbai, India
title_sort identifying disrespect and abuse in organisational culture: a study of two hospitals in mumbai, india
topic Research Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6178091/
https://www.ncbi.nlm.nih.gov/pubmed/30102132
http://dx.doi.org/10.1080/09688080.2018.1502021
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