'Should it fit? Yes. Does it fit? No': Exploring the organisational processes of introducing a recovery-oriented approach to mental health in Australian private health care
'Should it fit? Yes. Does it fit? No': Exploring the organisational processes of introducing a recovery-oriented approach to mental health in Australian private health care
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DOI：
10.1177/1363459319889107
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发表时间：
2019-11-27
期刊：
影响因子：
2.1
通讯作者：
Buus, Niels
中科院分区：
文献类型：
--
作者：
Dawson, Lisa;River, Jo;Buus, Niels
本文探讨了在私人医疗机构中实施创新精神保健方法。开放对话是芬兰出现的一种以恢复为导向的心理健康方法，强调家庭参与、跨学科合作以及灵活的、适应需求的方法。早期研究前景广阔；然而，在芬兰以外的地区，很少有研究探索开放对话。本研究旨在探索在澳大利亚一家私人住院年轻成人心理健康部门引入这种方法。根据一项长期人种学实地研究（包括 190 小时的观察和定性访谈）的数据，研究结果表明，尽管工作人员受到开放对话的启发和支持，但该单位现有的意识形态和组织结构与开放对话原则的整合相冲突。对话式的工作方式受到医疗主导地位和对经济效率的重视的挑战。这项研究强调了组织文化与创新之间“良好”契合的重要性。它还强调了在澳大利亚新自由主义医疗保健背景下转向以康复为导向和以家庭为中心的护理模式所面临的挑战。卫生服务领域需要进行组织和意识形态变革，以接受并切实支持实施以康复为导向的护理的努力。
This article explores the implementation of an innovative approach to mental health care in a private health setting. Open Dialogue is a recovery-oriented approach to mental health that emerged in Finland, which emphasises family involvement, interdisciplinary collaboration and a flexible, needs-adapted approach. Early research is promising; however, little research has explored Open Dialogue outside Finland. This study aimed to explore the introduction of this approach at a private, inpatient young-adult mental health unit in Australia. Drawing on data from a long-term ethnographic field study that included 190 hours of observation and qualitative interviews, the findings show that despite staff members being inspired by and supportive of Open Dialogue, the existing ideology and organisational structures of the unit conflicted with the integration of Open Dialogue principles. Dialogical ways of working were challenged by medical dominance and emphasis on economic efficiencies. This study emphasises the importance of a 'good' fit between organisational cultures and innovations. It also highlights the challenges of moving towards recovery-oriented and family-focused models of care in the Australian neoliberal health care context. There is a need for organisational and ideological change in health services that is receptive to, and meaningfully supports, efforts to implement recovery-oriented care.