title: "You have to keep fighting": maintaining healthcare services and professionalism on the frontline of austerity in Greece.
abstract: Greece has been severely affected by the 2008 global economic crisis and its health system was, and still is, among the national institutions most shaped by its effects.
  
  
  
  In 2014, this qualitative study examined these changes through in-depth interviews with 22 frontline healthcare professionals in five different locations in mainland Greece. These interviews with nurses, doctors and pharmacists explored perceptions of austerity and how ideas of professionalism were challenged and revised by these measures.
  
  
  
  Participants reported working conditions characterised by dramatic increases in public hospital admissions alongside decreases in personnel, consumables, materials, and also many hospital closures. Many drew on analogies of war and fighting to describe the effects of healthcare reforms on their working lives and professional conduct. Despite accounts of deteriorating conditions and numerous challenges, healthcare professionals presented themselves as making every effort to meet patients' needs, while battling to resist guidelines which they perceived diminished their roles to production-line operatives.
  
  
  
  Participants considered it their duty to defend their professional ethos and serve patients without compromising standards, even if this meant liberal interpretation and implementation of regulations. These professionals regarded themselves on the frontline of healthcare provision but also the frontline defence in a war on their professional standards from austerity.
authors.affiliation: The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK. angeliki.kerasidou@ethox.ox.ac.uk.
authors.forename: Angeliki
authors.identifier: 0000-0001-9344-3297
authors.initials: A
authors.lastname: Kerasidou
authors.affiliation: The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
authors.forename: Patricia
authors.initials: P
authors.lastname: Kingori
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.|London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Helena
authors.initials: H
authors.lastname: Legido-Quigley
mesh_terms: D000067571:Financial Statements / Q000639:trends; D006115:Greece; D006282:Health Personnel / Q000523:psychology*; D006295:Health Resources / Q000600:supply & distribution; D006760:Hospitalization / Q000639:trends; D006801:Humans; D010465:Perception; D000068616:Professionalism / Q000592:standards*; D036301:Qualitative Research; D011787:Quality of Health Care / Q000191:economics*
keywords: Austerity; Greece; Healthcare; Healthcare system reforms; Medical professionalism; Professionalism; Qualitative