Who is Wounding the Healers: The Four Cultures of Health Care
Authors: William Bergquist, Suzan Guest and Terrence Rooney
Those who are providing health care and those running health care organizations are themselves wounded. As a result, they can’t fully attend to the needs of those who seek their wisdom and assistance. We should be worried about the wounded healers, for if they are not well, then how can they help the rest of us? If hospitals, clinics, managed care systems and governmental processes are unhealthy places in which to work, then how can these institutions promote health and offer viable solutions to our pressing health care problems?
Three critical questions evolve from this concern regarding the wounded healers. The fundamental question is: “who is wounding the healers?” The second, accompanying, question is: “how do we help the healers and prevent the wounding?” The third question follows naturally from the first and second: “how do we make the health care industry healthier so that it might more effectively address the major health-related challenges now facing our societies?” The answers to these three questions are not easily provided. The health care industry holds a unique place in all our various societies. It is complex. It has an enormous impact on our lives. We are already trying to change it, in order to make it healthier and more effective. Yet, most of the time we tinker with the system without really understanding how it all works.
In Who is Wounding the Healers, we examine the basic reasons why health care systems exist and operate as they do. We propose that the key to understanding these reasons resides in the phenomena of pain and anxiety within health care, and the role played by distinctive organizational cultures in addressing this pain and anxiety. We more specifically propose that there are four dominant organizational cultures operating in contemporary health care systems, and suggest that each of these cultures have contributed both to the growth and accomplishments of health care and to the wounding of those who currently serve in the health care industry.
We identify these four cultures of health care as professional, managerial, advocacy and alternative. These four cultures are to be found in all types and at all levels of health care systems: primary care, hospitals, rehabilitation centers, health-related insurance companies, public health agencies, naturopathic and wellness offices. Furthermore, the current trends and crises in health care that center on managed care (in the United States) and national public health care (in Canada) involve significant realignments in recent years of the power and modes of collaboration among these four cultures.