Year

2005

Degree Name

Master of Midwifery - Research

Department

Department of Nursing

Abstract

Health and consumerism is a partnership featured in many Western developed countries. Nearly a decade ago, the National Quality Taskforce and Advisory Council recommended the adoption of a consumer oriented approach as being fundamental to providing safer services, minimising preventable adverse health outcomes, whist also improving healthcare quality. In accordance with this recommendation, it is now commonplace for healthcare organisations to incorporate the consumer oriented philosophy into their mission statements. In addition, healthcare recipients tend to be referred to as consumers in preference to the traditional term patient. Despite organisational commitment for change and reports of consumer satisfaction with acute care services in Australia (AIHW 2000), the findings from the Bristol Inquiry (2001) and the King Edward Memorial Hospital Inquiry (2001) suggests that there is an absence of consensus as to the impact of these initiatives on the delivery or quality of frontline healthcare. This study aims to determine indicators of consumer participation in the planning and delivery of healthcare in an Australian context. The practice of consumer participation at the individual level of frontline healthcare is examined specifically for indicators of active participation in both decision making and information sharing. This study is complimentary to Phase Two of a Commonwealth funded project designed to explore clinical teams and the organisation of care related to the clinical condition, elective caesarean section. The study’s participants have been determined by the Commonwealth project, with the study’s samples being drawn from the recipients and providers of elective caesarean section healthcare, in three Queensland public hospitals over a three month time frame. A multi-method approach is utilised to navigate the complex social and professional constructs that impact on the organisation and recording of elective caesarean section healthcare. Triangulation of the environmental, clinician, consumer and medical record data from the three study sites allows for a greater understanding of the relationships between and within the data sets. The medical record audits tendency to lack evidence of consumers actively participating in information sharing and decision making is shown to be a reliable representation of the environments inability to support participation, and the clinician and consumer samples passive view of participation at the frontline of healthcare. The triangulated data also clearly demonstrates the diversity of views and behaviours that clinicians hold in relation to the involvement of consumers in healthcare and that in the main consumer involvement is not valued. In relation to the quality and safety of healthcare, aside from the clinician’s views on consumer participation, the absence of accountability to utilise standardised forms, function collaboratively or communicate clinical care effectively suggests that the study sites have numerous professional and governance issues that have yet to be effectively addressed. In focusing on the individual aspects of the healthcare experience this study demonstrates that collection and aggregation of consumer satisfaction data to be an unreliable indictor of healthcare quality. This study demonstrates a potential relationship between expectations of healthcare and satisfaction with healthcare. Women who felt fully involved in decision making often claim to be dissatisfied with that level of involvement and women who felt uninvolved are often satisfied with not being involved. In order to satisfy consumers and secure a positive health outcome measure, the study findings suggest matching expectations with experience, and this would involve an active level of participation. However, meeting the consumer’s expectations and generating satisfaction should not be interpreted as representative of meeting the technical quality or service delivery standards. This study contributes to the limited body of research relating to consumer participation at the individual level of healthcare. The study demonstrates that overall the level of consumer involvement in healthcare is marginal. Inconsistency in beliefs and behaviours and an ad hoc approach to organising and communicating clinical care ensures the passivity of the healthcare recipients and brings into question the true quality and safety of Australian healthcare.

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Unless otherwise indicated, the views expressed in this thesis are those of the author and do not necessarily represent the views of the University of Wollongong.