Today, this assurance is no longer warranted. Americans can no longer trust that they will receive adequate treatment—unless they are wealthy. Health care managers also no longer can feel comfortable in counting numbers of patients served. They now must take costs more fully into account and often seek less rather than more patient-contact. When access is valued, it is sometimes presented in a very condescending manner on the part of the health care managers: “be glad you’re getting something!”
Accountability is also valued by the managerial culture. This emphasis is intended to reduce anxiety for both manager and clients. Taken to the extreme, however, this emphasis on accountability can produce a bean counter mentality. Furthermore, for many members of the managerial culture, accountability primarily relates to another managerial value, namely profit. This emphasis on profit and efficiency, in turn, is intended to reduce only the anxiety of managers.
Patients typically could care less about profit. In fact, they often take great offense when they discover that their illness, injury or health is a source of profit for another person or institution. The managerial culture’s emphasis on profit creates a climate of indifference when taken to an extreme, People in the managerial culture sometimes lose touch with the real reason for engaging in the business of health care. A dominant concern for profit leads eventually to indifference about the primary customer: the patient. Many people from the management culture, including accountants, information services technicians, insurance agents, and members of the human resource staff, have little contact with patients.
The Advocacy Culture: Representatives of this culture view their world primarily through the prisms of revolution, war and peace. This is the orienting dichotomy of the advocacy culture. We propose that advocates are primarily anxious about disruption in the social system. Just as members of the managerial culture are fearful of organizational chaos, advocates are fearful of societal chaos. In the United States, advocates try to thwart societal disruption by placing a great deal of emphasis on individual rights. They defend the rights of the underdog, ensuring that each citizen receives his rightful access to health care services.
In devoting their primary attention to individual rights, American advocates are sometimes inclined to forget or downplay the other half of the equation: collective responsibility. In their attempts to avoid the death of their society, advocates often fail to recognize the responsibility that all members of society must assume in sustaining this society. On the other hand, advocates provide an invaluable role to the social systems they serve by seeking compromise and by ensuring that there is equitable distribution of those resources that are most central to the pursuit of life, liberty and the pursuit of happiness.
