The primary independent variable was Medicaid enrollee status. We studied 4 outcomes using the 2017 National Health Interview Survey: patient-provider concordance on racial/sexual/cultural identity, respectful provider attitude, solicitation of patient opinion/beliefs during the care encounter, and patient-centered communication (PCC). However, we know little regarding Medicaid patients' experience with their doctors along several key dimensions of patient-centered care, and how their experience compares with Medicare and privately insured patients. Patient-centered care is at the nexus of several overlapping institutional reforms to improve health care system performance. The structural competency approach can be applied to increase awareness of the role of social determinants in shaping patients’ ethnic-based treatment refusals and to improve the handling of such incidents. Refusals are often initiated by the patients’ relatives and occur more frequently during periods of escalation in the conflict.
Refusals are usually directed toward nurses and junior medical staff members, especially if recognizable as religious Muslims. Most refusal incidents recorded are unidirectional: Jewish patients refusing to be treated by Arab practitioners. Fifty in-depth interviews were conducted with 10 managers and 40 health care professionals, Jewish and Arab, employed at 11 public hospitals. Taking the Israeli–Palestinian conflict into account, this article aims at examining Israeli health care professionals’ points of view concerning patients’ refusal of treatment because of a practitioner’s ethnic identity. Patients’ refusal of treatment based on the practitioner’s ethnic identity reveals a clash of values: neutrality in medicine versus patient-centered care. Immigrant background did not receive adequate support. OneĮxplanation could be limited knowledge of the scope, due to lack of reporting. Role not to react, and they would not risk losing shifts.Ĭonclusion: The nursing homes’ efforts to prevent harassment, discrimination, and racism lacked structure.
#Tor publishing discriminatory professional#
Results: Two categories of incidents were identified: hateful speech and preference for healthcare staff with a majorityīackground.Managers trusted established routines would counter harassing, discriminatory and racist incidents.Įmployees refrained from reporting because they internalized the incidents, they considered it in line with their professional
Of 200 hours of observation and 27 qualitative interviews with managers and employees. Methods: The study is a qualitative case study with three nursing homes as embedded units.
Handle incidents and weigh up the consideration for residents’ right to healthcare and self-determination against The study analyzes how managers and employees This process stresses dialogue, assessment of clinical feasibility, and empowerment and support for affected care providers.īackground: The purpose of the study is to shed light on managers and employees’ experiences of harassment, discriminationĪnd racism fromresidents and relatives in nursing homes. A Caregiver preference guideline developed and used at University Health Network, Toronto provides a standardized way for the organization to decide when it will honor patient requests for providers of a particular background. In a context of patient-centered care, harm principle-based boundaries of respect for autonomy must be defined. Providers need to be clear that their organization will not be complicit in discrimination against them, instead supporting their needs and preferences for management of the situation. Protecting healthcare providers from harm while maintaining obligations to patients requires unambiguous messaging to both parties. On the other hand, providers have legal, professional, and organizational assurances that they should not suffer workplace discrimination. On the one hand, providers have a duty to deliver clinically indicated care consistent with patient preferences. Patient requests for a healthcare provider of a particular race or sexual orientation create a conflict of obligations.
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