Members of this culture value technical expertise and specialized technical language. They are fully committed to the preservation of professional autonomy and have established quasi-political governance processes to insure this autonomy. These processes have enabled health care professionals, over the past hundred years, to strongly influence or even dictate the policies, procedures and missions of the health care system. Members of this culture hold assumptions about the dominance of rationality and technically based procedures in hospitals and other health institution.
Health care professionals have the rights and hold the responsibilities associated with physically touching people. This is not a trivial point, for these are among the only people in contemporary society, other than hairdressers, masseurs and a few other members of the touching professions, who hold the power to physically touch another person with whom they are only professionally affiliated. The capacity to touch and comfort may be one of the most powerful and even magical ways in which people help one another in coping with the anxiety associated with physical and psychological pain.
Cure (amelioration) is highly valued in the professional culture. Prevention is also important. Any nurse or physician would prefer to prevent an illness or injury than treat it; however, professionals must often assign secondary status to prevention. These health care workers are often overwhelmed with the demand for treatment and are usually being paid primarily to cure rather than prevent. This emphasis on cure is intended in part to reduce the anxiety of both providers and patients. When the emphasis on cure is dominant, there is a tendency for members of health care systems to defer or deny issues associated with death and dying and to collude with patients in the avoidance of pain.
The professional culture also highly values competency. This emphasis helps to reduce the anxiety of both providers and patients. This emphasis, unfortunately, also tends to perpetuate the myth of medical infallibility and can block public access to the secrets of the inner temple of professional health care. Members of the professional culture value hierarchy and believe that a clear and stable hierarchy can effectively reduce the anxiety of both providers and patients.
This does not mean that the professional culture values bureaucracy—a hallmark of the second, managerial, culture. Members of the professional culture instead value clarity regarding whom is in charge in any given instance. Physicians, nurses and a host of other players in a busy Emergency Room often are dealing with highly chaotic and emotionally charged situations. They value hierarchy from the perspective of identifying power and responsibility so that effective decision making occurs. This emphasis on hierarchy can, in turn, lead to major status differences among health care providers—and is a source of considerable wounding among many members of the health care community.
The Managerial Culture: This culture also brings much that is of value. It builds on the dichotomy between control and chaos. Members of this culture fear their loss of organizational control and are anxious about organizational chaos. They resolutely hold theories about how to organize for maximum effectiveness that have to do with predictability regarding the outcomes of any change effort. They look for continuity and for planned change.
