UNCOVERING SOCIAL-STRUCTURES AND STATUS DIFFERENCES IN HEALTH SYSTEMS

Developing health service systems in order to improve the health and q uality of the lives of patients may benefit from evaluation studies co mbining a quantitative survey methodology with qualitative interviews and observations, Studies using a combination of these methods may pro mote and advance system changes, Quantitative methods provide necessar y documentation of the needs and effects of system changes, They may t herefore motivate decision makers to initiate changing processes, Qual itative methodology is suited for uncovering social conflicts and prob lems that projects attempting to change health systems often meet, The y provide data which may be valuable in the motivation and education o f the professions involved in the health service systems, This paper r eports on some of the underlying social conflicts which were uncovered by a study evaluating the impact of the introduction of a new food sy stem in a hospital ward for children with cancer, Qualitative intervie ws and observations revealed severe status differences between patient s and staff, For the patients and their families the food was a centra l part of their quality of life while staying in the hospital, For the staff the patients' food was a neglected area with low status, This w as changed by the new food system which was organized with considerati on of the social structures of hospitals and other total institutions, This paper argues that projects aiming al: improving the quality of l ife of patients through system changes must address the social conflic ts and the status system embedded in the organization of the service t o be changed.