American Sociological Association

Agency and Change in Healthcare Organizations: Workers’ Attempts to Navigate Multiple Logics in Hospice Care

How do major healthcare policy changes affect the delivery of care? Healthcare policy changes often have unintended consequences that affect workers’ practices and patient experiences. Medicare, which pays for the vast majority of hospice end-of-life care, recently changed a policy to curb long hospice stays. Starting in 2011, all patients who were enrolled in hospice for 180 days or more were required to have a face-to-face visit with a physician or qualified nurse practitioner. Prior to this change, nurse case managers conducted the majority of face-to face visits and worked within an interdisciplinary team to make decisions about care. This research investigates how this Medicare policy change affected hospice practices. I conducted participant observation of Rose Hospice, a medium-sized, for-profit, community-based hospice, from 2009 to 2012. This time period included several months before the policy change was announced, the immediate reaction to the policy change, and several months while Rose attempted to translate the policy change into operational decisions. Simultaneously, I conducted semi-structured interviews with workers from Rose and six other hospices in the surrounding area. As the policy change became a concern for the hospice workers, I analyzed both observational and interview data with attention to how the policy affected management, team, and worker practices.


Cindy L. Cain





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