June 19, 2018

Disobedience is affirmative action. An act of professional leadership. Not directed against something, but for something. It’s our ability to see, criticize and denounce. For healthcare professionals, showing disobedience is first and foremost feeling free to say NO. It is refusing to practice in unsafe working conditions, refusing to be limited to offering poor quality care because of budget cuts and mismanagement.

That was the message that Amélie Perron, nursing sciences researcher and professor at the University of Ottawa, delivered to the young Network union representatives. In addition to asking them to remain vigilant and ask questions before docilely obeying the employers’ orders, Ms. Perron strongly urged the participants to disrupt the healthcare system’s status quo and provoke political change.

Shelve the idea of a vocation and self-sacrifice

According to Amélie Perron, employers use the healthcare professionals’ codes of ethics too often to silence them. It’s true that society expects a certain kind of submissiveness from those who care for patients. Socialization of healthcare professionals, during their studies or in their workplaces, does not spur them to question things. However, disobedience is not only oppositional: it is a legitimate right.

Quoting Rosa Luxembourg, social activist and Marxist theorist, Amélie Perron explained that “those who don’t move, don’t realize they are in chains”. It is when we begin to shake up the established public order that we become aware of the constraints that we are under. Take for example, healthcare professionals who have been given disciplinary letters for having participated in sit-ins or other pressure tactics since the beginning of 2018. What did they do? Were they disobedient? Disloyal to their employer? Their only fault was to have thought differently. “The idea of a vocation and self-sacrifice must be shelved” says Amélie Perron. “We cannot continue to tolerate that!” she continued, referring to the poor management for which the healthcare professionals pay the price.

New public management: for who and why?

The new public management, which cropped up in Québec health institutions about twenty years ago, promised more efficient management styles for public institutions. By managing health like a private enterprise, by statistics, standards and control and evaluation measures, this new public management has instead corrupted their mission. Allotting resources based on performances might be a good thing in the sales and production world, but is it really appropriate when we are working with patients? Are the standardization processes which now characterize the healthcare professionals’ practice, and performance indicators like the bed turnover rates imposed for the patients’ benefit or that of the administrators? The answer from the Network participants was fairly unanimous.

The mere idea of disobedience calls for critical thinking which, in itself, calls for action. Increasing our capacity for action also means increasing our power balance for changing things!