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Institutional Decision Making: Empowering of Health System and Economic Transformation

机译：机构决策：卫生系统的赋权与经济转型

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Organized medicine (OM) is an institution built to defend the American health care system of the 20th century. The institutional structures that it employed, however, operated mechanically and independently of its practitioner base, which drew from physician and nonphysician health professions. This article suggests that OM's institutional structures were founded and defended by a "logic of confidence," which initially served as a buffer against external socioeconomic pressures. The institutional structures of OM came to be treated systemically as rules (e.g.," Trust me, I'm a doctor" and "The doctor knows best"), biasing and guiding organizational decision making and activities. Such rules were inculcated through professional education and clinical practice and were promulgated to the public by OM's practitioner and consumer base. OM so effectively promoted its rules that they were installed as powerful myths in the American psyche. So powerful were these myths that even OM was prevented from updating its identity to match its changing socioeconomic context. Instead, OM compartmentalized and sequestered its operational components from the public and from one another, effectively decoupling its identity from its activities and its context. In this manner, OM maintained an outmoded status quo when confronted by changing socioeconomic circumstances. The author explains how OM's failure to adapt has impelled the strongest representatives of all health professions to resist top-down decoupling in favor of bottom-up identity maturation, applying a new " logic of appropriateness." The logic of appropriateness is offered as a framework to guard against biased decision making and to ensure that institutional and individual identity, context, and decision making are coordinated and relevant. A new, public health-led, American health system is described in which the family physician and family nurse practitioner co-lead primary care practice and in which professional psychology has a vital role at every level.
机译：有组织医学（OM）是为捍卫20世纪美国医疗保健体系而建立的机构。但是，它采用的机构结构是机械地运作的，并且独立于其从业者的基础，而这是由医师和非医师的健康专业人士提供的。本文认为，OM的制度结构是由“信任逻辑”建立和捍卫的，而“信任逻辑”最初是抵御外部社会经济压力的缓冲。 OM的机构结构已被系统地视为规则（例如，“相信我，我是医生”和“医生最了解”），从而偏向和指导组织的决策和活动。这些规则是通过专业教育和临床实践制定的，并由OM的从业者和消费者群体向公众发布。 OM如此有效地推广了其规则，以至于它们成为美国人心中强大的神话。这些神话是如此强大，以至于甚至无法阻止OM更新其身份以适应其变化的社会经济环境。取而代之的是，OM隔离了公众和彼此隔离的运营组件，从而有效地将其身份与活动和环境脱钩。以这种方式，OM在面对不断变化的社会经济环境时保持了过时的状态。作者解释了OM的不适应如何促使所有卫生专业的最坚强代表采用自上而下的身份成熟，抵制自上而下的脱钩，并应用了新的“适当性逻辑”。提供适当性逻辑作为框架，以防止偏倚的决策制定，并确保机构和个人的身份，环境和决策制定相互协调和相关。描述了一种新的，以公共卫生为主导的美国卫生系统，其中家庭医生和家庭护士从业人员共同领导初级保健实践，并且职业心理在每个层次上都起着至关重要的作用。

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