Healthcare Quarterly

Healthcare Quarterly 11(2) March 2008 : 8-9.doi:10.12927/hcq.2008.19606

Opinions: Looking beyond the System for Sustainable Change Within

James A. Shaw, Timothy M. Shaw and Patrick A. Shaw


Many successful efforts to improve the quality of health and healthcare in the context of system reform are based on distinct theoretical frameworks. These inform the planning, processes and outcomes of organizational or cultural change. Research and theory development in health services support the advancement of many of these progressive evaluative lenses, contributing to the understanding of notable paradigms such as the Behavioral Model of Utilization (Andersen 1995). Since its presentation in 1968 (Phillips et al. 1998), this model has continued to be one of the most frequently cited in assessing factors contributing to healthcare utilization. It has clearly established personal health beliefs as an essential consideration in determining healthcare consumption patterns.  
While personally held health beliefs are but one component of the overall model, Andersen (1995) highlights this element as one of the most powerful determinants, holding the highest likelihood for positive change to personal healthcare consumption. "Look beyond" is our argument for the application of social theory to healthcare in order to understand the nature and timing of the development of health beliefs, and the potential for these beliefs to change in time to support a sustainable health system. Understanding the formation of health beliefs and recognizing the social phenomena that contribute to their development will allow policy makers and acute care oligopolies to attend to those avenues that not only improve patient satisfaction but initiate creative thought toward developing educational strategies that alter deep-seated health system behaviours.

Health beliefs have been defined as "attitudes, values, and knowledge that people have about health and health services that might influence their subsequent perceptions of need and use of health services" (Andersen 1995: 2). John Ramage (2006) advanced a rhetorical theory that examines identity construction and emphasizes the important influence of social phenomena in determining individuals' beliefs, values and attitudes with respect to social institutions such as healthcare. This aspect of identity is referred to as the ready-made and is categorized according to three overarching components of typical contemporary lifestyle: the workplace, the ubiquitous consumer market and the cultural messages received in daily life. The application of the ready-made framework to health and healthcare consumption provides a unique insight into the interpretation of implicit social messages and the impact they can have on health beliefs, current approaches to consumption and sustainability of the current health system.

Ramage's (2006) workplace ready-mades refer to the attitudes and values surrounding the culture of work that have developed throughout modern history, impacting the identity of individuals via important social factors such as class stratification and perceptions of employment. This is important for healthcare on two levels. Firstly, those within healthcare have to consider the socialization of the health professional workforce, recognizing that the values they maintain are influenced by the standardized historical values of the educational system in which they were trained. Secondly, healthcare institutions need consider the impact that ingrained traditions of employment have on patients' lives and their influence on patient perceptions of care.  

Consumer ready-mades reflect the presence of consumer attitudes in contemporary life, indicating that individuals generally take on an individualistic though somewhat informed approach to their endeavours. Experience and expectations encouraged by the system itself, access to the Internet and profit-based advertising all contribute to the views developed by our personal consumer psyche.

Implicit cultural messages, the manifestation of cultural ready-mades, are interpreted in the context of their impact on consumer ready-mades (Ramage 2006). Thus, the influence of negative media-based health messages on individuals' health beliefs, as substantiated by models such as Cultivation Theory, has to be combated in order to provide excellent, client-centred healthcare (Brodie et al. 2001). Popular media portray a dependency of patients upon high-functioning acute healthcare systems, which perpetuates the dominating preoccupation with acute healthcare and reliance on reactive medical services.  

The combination of acute care and dependent-patient portrayals has a significant impact on both the cultural and consumer ready-mades that inform population health beliefs, leading to an unacceptable lack of attention (or policy) to preventive health behaviours, and to unrealistic and unsustainable expectations of healthcare institutions.  

The ready-made framework raises a critical awareness that is thankfully supported with promising solutions. Historic biomedical-dominated value structures of health professionals can be better informed to connect with the real and perceived health beliefs of patients. We must take into account the traditions and implicit cultural messages that contribute to each set of cultural and consumer ready-mades; recognition gets us on the road to change. Health policy makers need to support the development of health promotion programs to actively facilitate positive ready-mades. These are ready-mades that contribute to a sustainable healthcare system by altering public perceptions of healthcare institutions and improving beliefs about the value of healthy lifestyles.  

About the Author(s)

James A. Shaw is with the University of Western Ontario.

Timothy M. Shaw is with the Canadian Association of Chain Drug Stores.

Patrick A. Shaw is with the Quorum Strategic Health Communications.  


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