1. Practicing Privacy: Legal Complianceand Provider-Patient Communication in American Hospitals.
- Author
-
Suchman, Mark C., Brennan, Elizabeth, and Monahan, Susanne C.
- Subjects
MEDICAL communication ,CORPORATE culture ,HOSPITALS ,DATA transmission systems ,PERCEIVED quality ,FEDERAL regulation - Abstract
Long a subject of scholarly interest, doctor-patient communication has traditionally occupied a zone of professional discretion largely beyond the reach of formal law. In the United States, this situation changed dramatically in 2003, when the handling of medical information was, for the first time, subjected to explicit Federal regulation under the "administrative simplification provisions" of the 1996 Health Insurance Portability and Accountability Act (IIIPAA). Nonetheless, much as socio-legal scholars have found in other domains, ambiguities in HIPAA's legal mandate spawned divergent constructions of "compliance" within the newly regulated organizational fielded. This paper examines how hospitals across the United States implemented the new regulatory regime, and how organization-level variations in implementation affected the perceived quality of practitioner-patient communication. Using original survey data on IIIPAA-related practices in US hospitals, coupled with public-access data on hospital-patient communication, this paper demonstrates that the quality of provider-patient communication co-varies with IIIPAA implementation, albeit in complex ways: Although many common compliance practices appear to undermine communication, a subset of patient-empowering practices may reduce or even reverse these adverse effects. In addition, hospital culture significantly moderates the impact of several compliance activities, with some activities that improve communication in the least favorable hospitals also impeding communication in hospitals that might otherwise excel. Looking across a large, representative sample of American hospitals, this study reveals the important role of previously invisible legal and organizational constraints. In the process, it also reveals significant organization-level variations in legal implementation, and significant interactions between organizational culture and legal impact. [ABSTRACT FROM AUTHOR]
- Published
- 2019