Health Sare as a System

Health care can be thought of as a system having various subsystems, for example, hospitals, neighborhood health centers, clinics, home health agencies.

The goal of any health care agency is to provide medical and nursing care and services related to health for a specifically defined population. How this goal is achieved depends on how the agency is organized.

In a highly organized system such as a hospital, what one department does is crucial to another department. Action in a neighborhood health center may have little effect on any other health agency. In some agencies, hierarchy is obvious and rigid. For example, a staff nurse cannot take certain actions without obtaining permission from the head nurse. In other agencies, the nurses are peers.

Social controls exist in each health agency, and these controls create either coercion or cooperation. For example, a nurse may enlist the cooperation of a patient in establishing an oral drug routine or the nurse may quickly inject a medication when the patient refuses the oral medicine-a form of coercion.

Since each agency serves a specifically defined population, the subject of boundary becomes significant. Sometimes the environment is distinct : The neighborhood center services the northwest section of the city. Or the environment may be diffuse: Patients may come for hundreds of miles to a hospital for open-heart surgery. The hospital or home health agency may also relate with other health care subsystems in the environment, such as a nursing home, mental health association, Alcoholics Anonymous, or the Red Cross. Maintaining communication with and obtaining feedback from the community served are essential in serving the people`s needs-the goal of the system.

 

Health care agencies may be categorized as being either (1) authoritarian or democratic or (2) Gemeinschaft or Gesellschaft. In the authoritarian system, one person is in charge; other people follow. Ideas originate with the person at the top, flow down, and go unquestioned. People who are lower in rank have no power and little room for creativity. In the democratic system, members are peers and all members are involved in decision making. Members arrive at solutions by discussion and consensus. Anyone may originate in idea, and that person will be given either negative or positive feedback about his or her ideas and behavior. All relationship in an agency are effected by the dominant pattern.

 

A health care agency may be one or the other of these, but typically it combines characteristics of these two ends of the continuum. Some nurses like to work in the informal but nonchanging Gemeinschaft atmosphere; they like feeling a part of a big, happy family. Other nurses are frustrated in the Gemeinschaft system; they enjoy the formal, efficient atmosphere of the Gesellschaft agency. They feel that they should concentrate on nursing as a job; they are not especially interested in the personal problems or joys of other workers.

An understanding of your own basic preference and a careful study of the philosophy and characteristics of the agency you plan to work for are useful in selecting a satisfying work position. Much of the mobility in nursing may be the result of a Gemeinschaft personality being employed by a Gesellschaft agency, so that the person`s emotional and social needs cannot be met. Economic rewards are always important, but some people also have strong needs for peer approval, individual recognition for a job well done, or an affectionate relationship with the person in charge.