title: Prioritising patient care: The different views of clinicians and managers.
abstract: BACKGROUND
  There is little research comparing clinicians' and managers' views on priority settings in the healthcare services. During research on two different qualitative research projects on healthcare prioritisations, we found a striking difference on how hospital executive managers and clinical healthcare professionals talked about and understood prioritisations.
  
  
  OBJECTIVE
  The purpose of this study is to explore how healthcare professionals in mental healthcare and somatic medicine prioritise their care, to compare different ways of setting priorities among managers and clinicians and to explore how moral dilemmas are balanced and reconciled. Research design and participants: We conducted qualitative observations, interviews and focus groups with medical doctors, nurses and other clinical members of the interdisciplinary team in both somatic medical and mental health wards in hospitals in Norway. The interviews were recorded and transcribed verbatim. Ethical considerations: Basic ethical principles for research ethics were followed. The respondents signed an informed consent for participation. They were assured anonymity and confidentiality. The studies were approved by relevant ethics committees in line with the Helsinki Convention.
  
  
  RESULTS
  Our findings showed a widening gap between the views of clinicians on one hand and managers on the other. Clinicians experienced a threat to their autonomy, to their professional ideals and to their desire to perform their job in a professional way. Prioritisations were a cause of constant concern and problematic decisions. Even though several managers understood and empathised with the clinicians, the ideals of patient flow and keeping budgets balanced were perceived as more important.
  
  
  CONCLUSIONS
  We discuss our findings in light of the moral challenges of patient-centred individual healthcare versus demands of distributive justice from healthcare management.
  
  
  CONCLUSIONS
  The clinicians' ideals of autonomy and good medical and nursing care for the individual patients were perceived as endangered.
authors.affiliation: Lovisenberg Diaconal University College, Norway; University of Oslo, Norway.|University of Oslo, Norway.
authors.forename: Helge
authors.initials: H
authors.lastname: Skirbekk
authors.affiliation: University of Oslo, Norway.
authors.forename: Marit Helene
authors.initials: MH
authors.lastname: Hem
authors.affiliation: University of Oslo, Norway.
authors.forename: Per
authors.initials: P
authors.lastname: Nortvedt
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003657:Decision Making / Q000941:ethics; D004993:Ethics, Nursing; D005260:Female; D017144:Focus Groups; D006292:Health Priorities / Q000941:ethics* / Q000458:organization & administration; D006740:Hospital Administrators / Q000523:psychology* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008505:Medical Staff, Hospital / Q000523:psychology* / Q000706:statistics & numerical data; D008875:Middle Aged; D009014:Morals; D009664:Norway; D005791:Patient Care / Q000941:ethics*; D036301:Qualitative Research; D055815:Young Adult
keywords: Areas of practice; clinical ethics; empirical approaches; ethics and leadership/management; ethics of care/care ethics; intensive care; mental health/psychiatry; moral/ethical climate of organisations; professional ethics; qualitative research; theory/philosophical perspectives; topic areas