Whose hospital is this? The potentialities of the ethnographic lens for investigating Patient Centred Care

This paper addresses Patient Centred Care as a dimension of the organizational culture: our purpose is to describe and discuss the main organizational dimensions that seem to constitute a lever for the construction of a patient centred organizational culture. We conducted an exploratory case study in an Italian Rehabilitation Ward using an ethnographic method and adopting a practice-based approach. Our exploration leads us to draw a complex picture of patient centred culture. While many artifacts, institutional norms and organizational devices seems explicitly directed to put the patient at the centre, when addressing the routine practices and the “everydayness” of the ward organizing, we find that practitioners might convey different orientations. One “hidden” dimension that seems to shape health professionals practices is the negotiation of the “right of ownership” with patients. The right of ownership encompasses the implicit rules which define who owns the hospital and who holds the power for decision-making. Ownership negotiation process becomes particularly evident when analyzing practitioners’ recurrent ways to make use of the hospital physical spaces and to converse with the patients. Although only exploratory, the paper provides some insights on the complexity of the patient centred organizational culture and on the prerogatives of an ethnographic approach for patient centred research. Such an inquiry method consents the exploration of the possible contradictions between the explicit organizational policy and the accomplishment of daily practices; moreover, allowing a firsthand exploration of health professionals’ typical ways to act and interact with patients, ethnography overcomes the limitations of analysis based only on declarations of intents.