Qom University of Medical Sciences Journal

Studies in various fields of healthcare seeks to gain the trust of citizens by providing more favorable services. Despite the generality of this view, Bureauphobia questioned these studies. Bureauphobia refers to the fear of bureaucracy, which is exaggerated and even unrealistic. It refers an attitude that the clients are satisfied with the received services, but they have no trust in the service provider. Charles Goodsell in his book “The Case for Bureaucracy” and Frederickson in his book “The Spirit of Public Administration” pointed to a certain ambivalence among citizens that combines a negative image of public administration and officials with a positive evaluation of the actual performance of public services based on direct, personal experiences. Many studies have been conducted in the field of bureaucracy but bureauphobia is a more specific concept, as it implies a contradiction between an individual’ s general view of public administration and his or her satisfaction with its actual performance. Bureauphobia has rarely been studied and the causes of its formation have not been investigated. Researchers are more interested in the consequences of bureauphobia. Therefore, the current study aims to identify the components of bureauphobia in people referred to public hospitals in Qom, Iran.
Methods
This is a qualitative study using a thematic analysis method. The study population consists of all people referred to public hospitals in Qom province including Shahid Beheshti, Amir al-Momenin, Kamkar Arabnia, Nekuei Hedayati Forqani, Shohada, Izadi, and Masoumeh Children Hospital. Because people had an unclear bureauphobia, they were first screened. In this regard, samples were randomly selected and two questions were then asked: “Are you satisfied with the services provided in public hospitals?” and “Do you trust in public hospitals?” Considering that the number of people referred to each hospital was unknown, to ensure the accuracy of the results, each hospital was considered separately with unlimited population; then, 500 samples from each hospital were selected for screening by a random convenience sampling method. In this regard, 3000 people were examined in about 6 months. When a person with bureauphobia was identified, the qualitative phase was started at the same time by using an interview. In this regard, 190 people were interviewed and transcribed. The contents were analyzed in three stages: descriptive coding, interpretive coding, and identifying main themes. After the last interview, no new information and codes were added to the research. In the interview, data collection will continue until data saturation.
Results
Fifty-four percent of the respondents were male and 46% were female.; 11% were in the age group of 18-30 years, 22% in the age group of 30-45 years, 39% in the age group of 45-60 years, and 28% were in the age group >60 years; 39% had a high school diploma or lower, 11% had an associate degree, 35% had a bachelor’s degree, and 15% had a master’s degree or higher; 94% were Iranian and 6% were from other countries (Afghanistan, Iraq and Pakistan). Furthermore, 39% were satisfied with the services received and trusted the hospital staff, 18% were not satisfied with the services and did not trust the hospital staff, 7% were not satisfied with the services, but trusted the hospital staff, 26% were satisfied with the services, but they did not trust the hospital staff (had bureauphobia), and 10% were indifferent to satisfaction and trust. The analysis led to the formation of 131 descriptive codes, 50 interpretive codes and 10 main themes. The results showed that direct experiences, personality, role/example, the political system governing public bureaucracy, social capital, malfunctions of bureaucracy, intrinsic features of the public sector, moneyism, moral values, and social justice were the components of bureauphobia.
Discussion
People with bureauphobia are clearly pessimistic; they are constantly exposed to negative opinions about public hospitals and their attitudes towards these medical centers is then negative. Satisfaction with the services provided by the public hospitals does not necessarily lead to trust in these centers. This study could help significantly distinguish between people’s views of public hospitals and the actual quality of the services provided. The formation of bureauphobia has consequences for governments. Therefore, it is necessary for governments to pay attention to it at macro and micro levels. Bureauphobia can reduce public participation and assistance in the development and expansion of public hospitals, because public hospitals (especially in Qom province) are often built or equipped by benefactors. This lack of participation weakens the public health sector and causes peoples’ dissatisfaction. Bureauphobia can also have a negative impact on the recruitment of new and elite medical staff. For example, there was a noticeable increase in the migration of medical personnel (especially nurses and doctors) during the COVID-19 pandemic in Iran. This study can be useful for the government and public hospitals, and can help improve the quality of public services, because conducting this study by governments involves a lot of expenses. Finally, the results showed that people with a Bureauphobia attitude clearly have a pessimistic view.
Ethical Considerations
Compliance with ethical guidelines
The ethical aspects of the research, including the confidentiality of information, have been observed in all its stages. Also, this article is the result of the doctoral thesis No. 817/2810520 of Allameh Tabatabai University.
Funding
This research is a part of Hossein Azari's doctoral thesis in the Faculty of Management and Accounting of Allameh Tabatabai University. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Authors contributions
Research design, data collection and Data analysis: Hossein Azari and Habib Roodsaz; Final revision and approval: Habib Roodsaz, Behrouz Rezaei Manesh and Mir Ali Seyed Naghavi.
Conflicts of interest
The authors declared no conflict of interest.
Acknowledgements
The authors consider it necessary to appreciate and thank all Managers and staff of Qom University of Medical Sciences who have cooperated in this research.