Summary:
Aim: In this study, the exploration of healthcare professionals' perceptions (mainly doctors and nurses) regarding the type of approach in their relationship with patients -either physician-centered or patient-centered- was attempted. Additionally, the role of communication skills in shaping these perceptions was examined as a factor influenced by professional training. Simultaneously, the level of professional satisfaction was determined, correlating it with the dominant organizational culture and commitment of healthcare professionals in the Attica Hospital, as well as with the type of approach (physician-centered vs patient-centered) and healthcare model prevalent in the patient-doctor relationship in Greece, based on the participation of healthcare professionals in the research. Furthermore, the perceptions of patients regarding the dominant approach in their relationship with doctors, the assessment of autonomy in healthcare matters, opinions on medical errors, the attribution of health control to God, and the levels of their support network were investigated. Finally, another objective was to explore the role of digital storytelling in empowering and self-expression of healthcare professionals and "patients," as well as its contribution to the patient-centered approach within the framework of narrative medicine.
Material and Methods: The study was mixed-methods and consisted of both quantitative and qualitative aspects. In the quantitative section, a total of 273 subjects participated, including 192 healthcare professionals and 81 healthcare service recipients. Out of the 192 healthcare professionals,100 came from the Attikon hospital, which was the hospital under study, and 92 from other public hospitals and facilities. Of the 121 healthcare professionals, 51 were nurses, 13 were other healthcare specialties, and 7 were other hospital services. Of the 81 healthcare service recipients,18 were patients with chronic or non-threatening diseases,17 were caregivers and relatives of patients, and 46 were general population utilizing health services for prevention and diagnostic examinations. The sample was asked to respond to demographic, educational, and professional data, as well as to the OCAI (Organizational Culture Assessment Instrument), OCQ (Organizational Commitment Questionnaire), JSQ (Job Satisfaction Questionnaire), GNJSS (General Nurses Job Satisfaction Scale), PPOS (Patient-Provider Orientation Scale), and PBS (Bio-Psycho-Social) scales to investigate dominant organizational culture, organizational commitment levels, healthcare professional job satisfaction levels, nurses’ job satisfaction levels, human-centered and doctor-centered approaches, and the extent to which the biopsychosocial approach is applied in clinical practice.
Results: Among the 100 healthcare professionals surveyed at the Atticon Hospital, the dominant type of organizational culture was found to be the culture of hierarchy, and the desired type of culture for the next five years was the culture of innovation according to the Cameron & Quinn model. Organizational commitment was at moderate levels, and the factors positively associated with it were training in communication skills with patients, the status of the nurses or doctors in charge versus the trainees, over 11 years of experience at the Attica Hospital, a higher salary, examining a higher number of patients weekly, and professional satisfaction. Regarding the professional satisfaction of healthcare professionals, no differences (p>0.05) were observed between Atticon hospital healthcare professionals and those of other hospitals on both the JSQ and GNJSS scales. The results revealed a positive, statistically significant correlation (p<0.05) between the satisfaction of healthcare professionals and gender (male), coming from the middle socio-economic class, lack of training in communication skills, the status of the nurses or doctors in charge, over 11 years of experience within the organization, and a low number of patient examinations per week. Similarly, regarding the satisfaction of nurses, the factors that positively influenced their satisfaction were older age, additional education beyond the basic undergraduate degree, working in surgical versus other departments, morning work shift, previous work experience in the facility up to 10 years, and higher salary. Concerning the adoption of the person-centered and biopsychosocial (PPOS & PBS) versus the physician-centered and biomedical model, it was found that the person-centered approach was identified however the medico centric health model prevails. The main influencing factor being previous training in patient communication skills, additional education (postgraduate, second degree, doctoral, postgraduate training), good communication between healthcare professionals and patients, and middle class. Additionally, medical residents showed higher levels of person-centered approach compared to attending physicians, while the surgical specialty had the highest adoption of the physician-centered approach. The control conducted did not find a statistically significant (p>0.005) correlation in the adoption of the person-centered approach and the biopsychosocial health model among healthcare professionals working in Attica Hospital compared to other hospitals. Patients adopted and desired a more human-centered approach, an active role, information, decision-making, and full participation in their health situation to a greater extent. Patients with high levels of desire for a human-centered approach had high levels of autonomy preference for their health, did not attribute control of their health to God but to doctors, had a strong support network, desired full information in case of medical error, and had low levels of desire to lodge complaints. In comparison, caregivers and relatives of patients adopted a less human-centered approach, showed a higher attribution of control of health to God, did not desire valid and comprehensive information for patients' relatives, and had higher levels of desire to lodge complaints in case of medical error.
Regarding the qualitative research aspect and the use of digital storytelling as a means of empowerment and self-expression, issues were raised by patients regarding the limited time their doctors had to spend with them, the lack of active listening and guidance following the diagnosis. Doctors referred to their experience with patients more abstractly and generally, with some exceptions. The digital narratives of the nurses were of particular interest, as they were stories about patients that raised issues of connection, grief, and patient and caregiver care. The digital narratives were analyzed along three communication axes: explanatory, transactional, and authoritative, and two types of interactions: two-way "person-to-person" and one-way "authority-to-symptom". The process of digital storytelling functioned redemptively and reflectively as a good practice.
Conclusions: Patients, in comparison to professionals and caregivers, expressed a greater willingness for participation, an active role, decision-making, information, and engagement in the therapeutic process. Simultaneously, the tendency towards a patient-centered approach with the comprehensive involvement of the patient was adopted by the entire healthcare workforce. Organizational commitment and prevailing culture were found to be influenced by the professional satisfaction of healthcare professionals. Regarding digital storytelling, it was found to function educationally in cultivating empathy and communication skills. It served as a good practice for expressing emotions, sharing and coping with difficulties (human pain, grief for patients), organizing thoughts and emotions, and transforming experiences into universal ones through sharing beyond the individual realm.
The above highlights the necessity for reform changes in favor of workers, organizational changes, and training in communication skills of healthcare professionals.
