'We know from the literature that power relations can be constructive and destructive. In a situation where a patient is in distress and a medical specialist is called in, that doctor can give orders to the team. Especially if this has been practiced in team training, that hierarchy makes healthcare safe. But if healthcare providers consciously or unconsciously behave in a dominant manner towards other healthcare providers, that is not helpful. Power differences sometimes manifest themselves surreptitiously. For example, when a medical specialist unconsciously acknowledges the input of another medical specialist, but not that of other healthcare providers. This can jeopardize patient care and the job satisfaction of colleagues. We therefore want to get rid of that problematic side of power structures.
“All social structures need a classification system,” says Versluis. 'Power is neutral in that sense. If you look at the training of medical specialists, they are taught that they are the ones who have to make decisions. Meanwhile, healthcare has become very complex and patients are more diverse than ever. Good and appropriate care therefore requires teamwork. A medical specialist usually sees a patient briefly and often thinks in a goal-oriented way: 'This is what's wrong, and this is what we need to do.' A nurse often takes a broader view of more aspects of the patient's life. All these skills are needed in the team around the patient; they complement each other.'
‘Where there is power, there is resistance, said philosopher Michel Foucault. Professional Resistance is behavior aimed at countering injustice in a professional setting and can be constructive or destructive,’ explains Versluis. 'For our research, we will work according to Paolo Freire's methodology of Professional Resistance and Critical Pedagogy. The goal is to design educational interventions to develop critical awareness and a mindset that is open to change. If a resident or nurse doesn't want to or dare to call the specialist when a patient's condition deteriorates, because you can no longer deal with that doctor, resistance is not particularly helpful. But there are also healthcare professionals who develop a way to continue to deal with that doctor professionally. We want to draw on the skills that healthcare professionals have to deal with power relations.
As researchers, we are curious about how they do this. That is why we are going to observe situations in the workplace to identify these methods. We want to learn from these constructive ‘tricks’ and describe them as activities and integrate them into education. In medical training programs, advanced medical training and other healthcare training programs. Our observations are not limited to hospitals. Because hierarchical relationships are involved, we will also visit general practitioners, district nurses, and other primary care organizations.'
'We want to make students and professionals curious about power relations, so that they ask themselves questions such as: ‘Is this right?’ or ‘Is it right for me to behave this way or for that colleague to behave that way?’ In short, ‘Does this reality benefit the patient, does it benefit our job satisfaction?’ Critical questioning can break down ingrained power structures.'
