تحلیل جامعه شناختی فعالیت ها و عملکردهای موسسات خیریه ای (اتنوگرافی نهادی یکی از موسسات حوزه سلامت)

به موازات عقب‌نشینی دولت و گسترش منطق بازار به حوزه‌های مختلف زندگی اجتماعی، سازمان‌های مردم نهاد به‌عنوان یکی از کانون‌های مقاومت در برابر این هجوم از اهمیت زیادی برخوردار شده‌اند. بر‌ این اساس، هدف مطالعه حاضر، بررسی یک نمونه از این موسسات است که در شهر اصفهان و در حوزۀ بهداشت و سلامت مشغول به فعالیت‌اند. روش این مطالعه کیفی، از نوع اتنوگرافی نهادی است و برای جمع‌آوری اطلاعات از مصاحبه استفاده شد و با استفاده از نمونه‌گیری نظری 12 نفر مصاحبه شدند. اطلاعات به‌دست‌آمده در این مطالعه با روش تحلیل مضمون تحلیل شدند.نتایج پژوهش نشان دادند این خیریه در شهر اصفهان برای خدمات حمایت تسکینی در چهار حوزه مشغول به فعالیت است و در حین اجرای سیاست‌های مربوط به نهاد، درگیر مسائل و مشکلاتی شده است که ناشی از فرسایش کیفیت زندگی کاری کارکنان در وجه عینی شامل (نظام معیوب جبران خدمات، نامناسب بودن فضا و ...)، در وجه ذهنی شامل (فشار و تنش کاری زیاد، افول احساس امنیت شغلی و ...)، مناسبات ارتباطی کژکارکرد در سطوح درون موسسه‌‌ای شامل (کاهش کیفیت تعاملات درون و بین‌گروهی و ...)، بین‌ موسسه‌‌ای شامل (عدم تعامل بین شعب و ...) و فرا‌موسسه‌‌ای شامل (نگاه کالایی به بیماران، فقدان قوانین حمایتی) است.به عبارت دیگر، موسسه مطالعه‌شده در تحقق اهداف خود با محدودیت‌ها و موانعی مواجه است که برای رفع‌شان نیازمند اخذ سیاست‌های ترمیمی، وضع و اجرای قوانین حمایتی از سوی قوای مملکتی، چابک‌سازی ساختارها و درنهایت، تغییر فرهنگ و نگرش عوامل مرتبط با حوزه‌های مدیریتی است.

sociological analysis of the activities and practices of charitable health institutions (institutional ethnography of one of the health institutions)

introductionregarding the government’s withdrawal and the development of the market logic to different areas of social life, non-governmental organizations (ngos) have gained great importance as one of the centers of resistance against such a challenge. the institutions with the main function of healthcare activities are one of the most important ngos. in recent years, the number of such ngos has significantly increased due to the dramatic increase in healthcare costs in iran, so it has been estimated that about 10000 health-related ngos are active in the country (hosseinkhani et al., 2016). despite the importance and increase in the number of such organizations, there is limited research in this regard in iran (mohammadi et al., 2019; damari et al., 2014; khodayari-zarnagh et al., 2020); however, the existing studies have mostly investigated the functions of such organizations and their barriers to suggest strategies to improve their performance. but, the present study mainly addressed the problem from a critical and pathological perspective. to be more precise, this research aimed to study the pathology of such organizations and thus sought to study an example of such health-related ngos[1] in the city of isfahan to critically analyze its function. methodologyto collect data, the representatives of an ngo in isfahan were interviewed to examine their experiences in this regard and the role of such organizations in developing their experiences. a purposive sampling method was used to select this organization and the interviewees. as common in qualitative research, the theoretical saturation method was used to determine the sample size, and the interviews were conducted with 12 representatives and employees of the organization. the content analysis method was used to analyze the data. the analysis started immediately after the first interview and, regarding the goals of the study, it has been tried to extract some abstract themes from the interviews. in addition, it was tried to use appropriate quotations from the interview texts to provide the research credibility.findingsthe results showed that the charitable organization under study in isfahan is working to provide palliative care in four domains, and is involved with problems and issues caused by the erosion of the quality of working life of the employees in objective aspects (defective service compensation system, inappropriate space and limited facilities and equipment, reduced professionalism, neglecting the development of the professional skills and personal characteristic, and neglecting the occupational future of the employees outside the organization); in mental aspects (high work pressure and tension, reduced job security, lack of transparency of the organization’s affairs, reduced quality of assigned tasks to employees); dysfunctional communication at internal levels within the organization (reduced quality of intra-and inter-group interactions, problems to identify issues, lack of bottom-up feedback, lack of communication between the board members and the employees); dysfunctional inter-organizational communication (lack of interaction between the branches of the organization, discriminatory view to the branches of the organization by the main office, failure in recruitment and participation processes), and extra-organizational communication (viewing patients as a commodity, and lack of supportive rules). discussion and conclusion in the analysis section, the results of the present study were compatible with the theoretical foundations of critics of the negative aspects of ngos. the results also indicated that the organization under study moved away from the main goals and, according to the participants, it faced criticism in the objective and subjective fields of the employees’ quality of life, as well as the intra-inter- and extra-communication levels. however, it should be noted that if the ngo under study can overcome the problems in serving cancer patients, its performance will be more in line with the theory of durkheim, habermas, and burawoy, regarding the importance of the role of ngos, because it prevents the market forces and government from making the patient their object, and on the other hand, it especially provides a space where the social subordinates can meet some of their medical needs. in this regard and to improve some of the mentioned problems, the main elements of the system, especially the government, should be involved in supporting health-related charitable institutions and their members including physicians, nurses, social workers, psychologists, experts, and even clients, as well as the assembly to pass facilitating rules. furthermore, the agility of executive institutions and decision-making of public institutions, as well as the deep change of views of the benefactors, managers, and executive staff of charitable institutions, and correction of their attitudes and the achievement of their goals toward ethical and humanitarian issues are of great importance. acknowledgmentwe hereby thank the representatives and employees of the medical institution under study, who cooperated with us in conducting the study and shared their lived experiences and views with the research team. [1] the title of the center is not mentioned in this manuscript due to the ethical limitations of the research for publication.