How medical dominance and interprofessional conflicts undermine patient-centred care in hospitals: historical analysis and multiple embedded case study in Morocco

Abstract

BackgroundIn Morocco’s health systems, reforms were accompanied by increased tensions among doctors, nurses and health managers, poor interprofessional collaboration and counterproductive power struggles. However, little attention has focused on the processes underlying these interprofessional conflicts and their nature. Here, we explored the perspective of health workers and managers in four Moroccan hospitals.MethodsWe adopted a multiple embedded case study design and conducted 68 interviews, 8 focus group discussions and 11 group discussions with doctors, nurses, administrators and health managers at different organisational levels. We analysed what health workers (doctors and nurses) and health managers said about their sources of power, perceived roles and relationships with other healthcare professions. For our iterative qualitative data analysis, we coded all data sources using NVivo V.11 software and carried out thematic analysis using the concepts of ‘negotiated order’ and the four worldviews. For context, we used historical analysis to trace the development of medical and nursing professions during the colonial and postcolonial eras in Morocco.ResultsOur findings highlight professional hierarchies that counterbalance the power of formal hierarchies. Interprofessional interactions in Moroccan hospitals are marked by conflicts, power struggles and daily negotiated orders that may not serve the best interests of patients. The results confirm the dominance of medical specialists occupying the top of the professional hierarchy pyramid, as perceived at all levels in the four hospitals. In addition, health managers, lacking institutional backing, resources and decision spaces, often must rely on soft power when dealing with health workers to ensure smooth collaboration in care.ConclusionThe stratified order of care professions creates hierarchical professional boundaries in Moroccan hospitals, leading to partitioning of care and poor interprofessional collaboration. More attention should be placed on empowering health workers in delivering quality care by ensuring smooth interprofessional collaboration.

Understanding the Nature and Sources of Conflict Among Healthcare Professionals in Nigeria: A Qualitative Study

“…Findings suggest that a lack of proper communication structure can result to practitioners encroaching beyond their scope of practice whilst being oblivious to the disposition of other professionals. 53 In similitude to other reports, 54 compartmentalization was seen to have resulted in poor communication and a consequent lapse in patient care. A defunct inter-professional communication or deficit in leader to member communication channel has been shown to breed conflict in different sectors of healthcare practice.…”

Nursing students' perceptions and experiences of learning and using nursing theories: A qualitative study

“…A study of interprofessional interactions in Moroccan hospitals revealed marked conflicts between doctors and nurses that may be detrimental to patients. The researchers believed that soft power can help nurses resolve these challenges 52,53 . A study analyzed the concept of power in nursing and reported that knowledge and information, expertise, communication, purposefulness, taking responsibility, and intention to do or to affect something provide power to nurses 54 .…”

“…The researchers believed that soft power can help nurses resolve these challenges. 52,53 A study analyzed the concept of power in nursing and reported that knowledge and information, expertise, communication, purposefulness, taking responsibility, and intention to do or to affect something provide power to nurses. 54 In a qualitative study on the concept of power in nursing, it was reported that being purposeful, providing high-quality care, improvement of communication, leadership, scientific knowledge and skills of nurses, application of nursing knowledge in practice, and adherence to human values in nursing practice would lead to acceptance of the fundamental role of the nursing profession and increase the power of nurses in the healthcare system.…”

Professional qualifications of medical affairs pharmaceutical physicians and other internal stakeholders in the pharmaceutical industry

“…The idea that organisational survival is predicated on commercial success is a well-established business principle within and beyond the pharmaceutical industry; however, the nature and importance of pharmaceutical medicine expertise is less well-recognised, 1 which may have problematic implications for interprofessional collaboration 2 and patient-centricity. 3 The International Federation of Associations of Pharmaceutical Physicians and Pharmaceutical Medicine and other leading experts 4,5 have advocated for the role of medical affairs pharmaceutical physicians (MAPPs) and defined its competencies, activities and importance to drug development, adoption and post-adoption and launch processes. 6,7 MAPPs aim to identify gaps between practice and evidence-based guidelines, [8][9][10][11][12][13] improve patient outcomes and decrease healthcare costs.…”