Defending the hospital or supporting the complainant: morality in medical disputes

Abstract

Why do frontline administrators, as liable representatives of the hospital, sometimes neglect the interests of the hospital when handling medical disputes and help complainants? Fieldwork in a tertiary hospital in northern China found that when the hospital’s frontline administrators handled specific cases of medical dispute, their actions were strongly shaped by personal and moral judgments in different situations, including their understanding of what happened, their relationships in that context, and whether the complainants were worthy of their help. This study challenges the commonly imagined hospital-complainant confrontation in contemporary China and introduces micro-level judgment, morality, and interpersonal interaction of the hospital’s frontline administrators into research work on medical disputes. This case also contributes to a better understanding of the dynamic role of morality in organizational contexts.

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Acknowledgments

The authors would like to thank Cheris Shun Ching CHAN, Kwai NG, Xin HE, and Peng WANG for their valuable suggestions on earlier drafts.

Notes

1 Zhang Ni (2018) did not explicitly define the concept of “medical disputes,” so the figure here is an estimate of the general situation. See Zhang, Ni. 2018. “Guojia weijianwei: 2013 nian yilai quanguo yiliao jiufen zongliang leiji jiang 2 cheng” (National Health Care Commission: Total number of medical disputes nationwide has dropped by 20% since 2013), China News, http://www.chinanews.com/gn/2018/09-07/8620977.shtml. Accessed December 18, 2019.

2 See Zhang, Qiuhong. 2018. “Shuju chulai le! zhongguo yiliaojiufen an 10 nian fanbei” (The Statistical Data has Come Out! Medical Dispute Cases Doubled in 10 Years in China), Sohu News, 29 October, http://www.sohu.com/a/271907448_129883. Accessed September 20, 2019.

3 Sometimes the “complainants” are not the patients themselves, but their representatives, such as their relatives. This article uses “complainant” to indicate any party who has a complaint against the hospital.

4 In 2018, over 85% of Grade II or III public hospitals had established such specialized departments. See: Zhang Ni (2018).

5 Generally speaking, there are usually two uses of the adjective “moral,” one in areas where evaluations of good or bad, right or wrong are relevant, and the other where “moral” is a synonym for “altruistic” or “prosocial.” The former understanding is more often adopted in the fields of sociology and anthropology, while the latter is more often adopted in philosophy and psychology (Hitlin and Vaisey 2013, 5–6). As a study in moral sociology, this article uses the concepts of “moral” and “morality” primarily in the former sense. By “moral judgments,” we imply a personal and evaluative judgment regarding “what is right or wrong, good or bad, acceptable or unacceptable” (Turner and Stets 2006, 544). Based on the moral judgement, a “moral practice” can be understood as an action that is held as morally legitimate by a certain actor, regardless of whether this action carries any benefits.

6 In contemporary China, all public healthcare institutions have been divided into three grades and ten levels: Grade III (Tertiary Level) includes 3S (Special Class for Grade III), 3A (1st Class for Grade III), 3B (2nd Class for Grade III), 3C (3rd Class for Grade III); Grade II (Secondary Level) includes 2A, 2B, 2C; Grade I (Primary Level) includes 1A, 1B, 1C. In practice, specialty hospitals are listed as 3S and are exceedingly rare, so 3A hospitals (san jia yi yuan) are usually regarded as the de facto highest-status hospitals.

7 The local government stipulates that the maximum amount for intra-hospital negotiations cannot exceed RMB20,000, so RMB19,800 or RMB19,900 is often the maximum amount for intra-hospital negotiations.

8 The DMD administrator’s (Chen) role in pushing for compensation is not without risk. For example, when the compensation agreement was reached, another administrator, Liu, questioned the necessity for this compensation. In private, Chen told the first author, “I understood what Liu meant when I heard his words. He implied that the compensation was too much. I told him that the case had been discussed and our hospital had liability.” The first author asked if, “Liu meant that he had a better ability in handling dispute cases than you?” And Chen responded, “That’s exactly what he means! Liu always talks about how many cases have been solved without paying a penny.” (Field observation, July 4, 2018) This episode not only demonstrates the disagreements among the hospital’s administrators, but also supports our argument that special help to complainants often brings risk, instead of interest, to the frontline administrators. It also demonstrates that each administrator is guided by their own moral judgments as Liu primarily sees his role as a defender of the hospital.

9 See also Zhang (2010).

Additional information

Funding

This work was supported by the Fundamental Research Funds for the Central Universities (Project No. 63222037).

Notes on contributors

Long Zhang

Long Zhang is Lecturer in the Department of Sociology at Nankai University, China. He received his Ph.D. from Department of Sociology, The University of Hong Kong. His research interests include medical sociology, cultural sociology, and sociology of knowledge.

Xiaoli Tian

Xiaoli Tian is Associate Professor in the Department of Sociology at the University of Hong Kong. She received her Ph.D. from Department of Sociology, The University of Chicago. Her writings have been published in American Journal of Sociology; Journal of Contemporary China; Sociological Forum; Qualitative Sociology; Information, Communication and Society; Symbolic Interaction; Journal of Contemporary Ethnography; Media, Culture and Society; Studies in Media and Communications; Modern China; Chinese Sociological Review; Journal of Social and Personal Relationships, among others.