The decisions made by health workers have a huge influence on patients. When the decisions they make are erroneous – either due to ignorance or false assumptions – the effects could be damaging to the clients, it is therefore important for health workers to provide quality and ethical services to their clients since they understand the pitfalls they could find themselves in if they make errors. The barriers to making good and ethical decisions lie at the mezzo, macro, or micro-levels. The health workers lack control of situations from mezzo to meta-levels; the only control they may have is at the individual level. Regardless of this, they gain from evaluating the mezzo and macro levels where they evaluate how the process of making decisions is influenced by these factors. This paper will discuss the impacts that systems perspective has on clinical theories at mezzo, macro, and Meta levels.
Systems Perspective and Choice
The systems perspective theory describes how systems work within their environment. In sociology, this theory states that the behavior of an individual is affected by different individual factors that come together to form a system. A social worker, like health, must ensure that they analyze and understand all individual systems that impact the behavior and welfare of an individual and ensure that they strengthen these systems. Social workers deal with four levels, namely; micro, mezzo, macro, and Meta. The mezzo level involves dealing with small groups, while macro involves larger groups of individuals, such as a region (USC Suzanne Dworak-Pek, 2018) . The Meta level is higher and more abstract than others and may include all the lower levels. Health workers make different choices on clinical theories at mezzo, macro, and macro levels based on the systems perspective.
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Mezzo Level
Health workers make decisions on clinical theories at this level. This setting influences choices made by health workers depending on available options, how to make decisions. The factors at this level consist of settings, media, and professional literature and education (Lacasse & Gambrill, 2015) . Host settings are the factors that are not organized around the mission of a health worker. Every social agency works based on its hierarchies, procedures, requirements, and other constraints that may limit the health workers' options. The re is a power imbalance between the clinicians and other professionals. The decisions on the theory to use by the health worker are influenced by that of their superior. Even when a clinician is practicing at the private level, their decisions are often influenced by insurance companies to get reimbursements.
Also, the media has a lot of influence on clinical practice and acts as a source of information to the public. Information that the media may provide to the public can be misleading. Often, the media persuades the public that decisions made are not in favor of the public but instead of APA. After receiving this information, the individuals develop different perspectives towards treatment. The decisions of the health workers regarding the best theory to apply are influenced by the decision of an individual, which the clinician must follow.
Finally, professional literature and education have come under scrutiny where individuals believe that the information is biased. When making decisions regarding a clinical theory to apply, health workers should evaluate the information that may have compelled them to use a certain theory. Sometimes the information may be misleading and may result in huge errors that may be damaging to the patient.
Macro Level
The current health system has become like an industrial complex where entities work and depend on each other. Some of the interrelating entities include pharmaceuticals, government agencies, APA, insurance companies, among others (Lacasse & Gambrill, 2015) . All these entities play an important role in care delivery. In addition, these factors determine the decisions made by health workers regarding the treatment to be administered to a patient. All these bodies have regulations, ethical issues, and guidelines that clinicians should follow when handling patients. For example, the insurance company may have an influence on the treatment a patient should undergo to reduce the cost. The health workers sometimes are therefore unable to make decisions depending on their opinions or options they see viable, but the decisions are coerced and influenced by these bodies.
Meta Level
This includes the other levels and is international. In health practice, there are universally accepted. Every health worker is supposed to follow the universally accepted practices (Miller & Owens, 2014) . Health workers are, therefore, supposed to adhere to the accepted policies when providing care. The treatment and decisions that clinicians make are not based on a single study since the outcomes may be different. The health workers use meta-analysis to determine what practices work and which do not, and therefore, the choice of the clinical theory they decide to use should work and be universally accepted.
Diversity Attributes
Working in the field of healthcare is very challenging, regardless of the position. Many procedures involved have their benefits and shortcomings, and making one wrong decision could have damaging effects both to the health worker and the patient. This is even made complicated by the fact that health workers encounter different client systems every day. All these clients have various beliefs, principles, and opinions of their life and healthcare. Dealing with these diverse opinions is very challenging for health workers. Clients have the freedom to choose the type of care they want. This is strengthened by the freedom they have over their bodies as per the principle of autonomy. Under this principle, the patient has all the control of their bodies. When it comes to this, the opinion of the health worker may be highly meaningless.
Various client systems differ depending on factors like knowledge, education levels, and interest. Often, clients choose theories of interventions on conditions they have depending on their interest and knowledge about a theory (Vahdat et al., 2014). Some patients choose some theories depending on what they know, what they have heard, or recommendations by others. Either way, the choice is based on the interest of the patient, which is to get better. The client's choice may be controversial depending on their conditions, but the health worker must respect the decision of the client.
Medical ethics often guide all clinical decisions. When applying any clinical theory, health workers should ensure that all ethical principles in medicine are applied. According to Kemparaj & Kadalur (2018), some of the ethical considerations that the health worker should consider includes;
Autonomy. This principle allows the patient to have full control of their body if they can make sound judgments. The hands of the health worker are tied at this moment, and the best they can do is to give a suggestion, although any actions that may seem coercive are against this principle. The patient can, therefore, make a decision even whether other people may disagree with the situation.
Beneficence. According to this principle, health workers should offer the best they can to the patient at all times. All interventions and actions taken by the health worker must be to safeguard the wellbeing of the patient. It is, therefore, necessary for the health worker to choose the best clinical theory the
At will bring the best outcomes.
Non-maleficence. According to this theory, the health worker should not do any harm to the patient. Therefore, it is important to choose the best clinical theory that will not harm the patient.
Justice. This principle requires the health worker to make decisions based on fairness. In this case, the health worker should make decisions regarding the clinical theory to be applied with fairness in any client systems.
Justification of System Perspective
The systems perspective theory is very important in any social work. It helps workers evaluate the relationship that exists between different factors forming the entire system. Understanding this relationship helps the worker make the best decision depending on the factors involved. In healthcare, health workers strive to provide services that meet the need of the patients. This helps the health worker provide services that suit the need of their client. When providing healthcare, I would use the systems perspective to evaluate the different factors involved in the issue of clients to understand the problems they are going through better. Having a deeper understanding would enable me to have an understanding of what the client is going through.
For example, when working with a low-income family on the issue of boundaries, the system perspective would help me create a relationship between the environment and the issues affecting the family. I would use this information in determining a theory which I would use to provide an intervention. Considering these factors would help me propose the theory which would work best for the family. This involves the cheapest theory that would guarantee the best results for the family. This would help kill two birds with the same stone as the family would not be heavily affected financially, and proper care would be administered.
Conclusion
A systems perspective is very important in all social work, including health. It helps understand all factors resulting in a situation and how these factors contribute to the whole system. There are different levels involved when making healthcare-based decisions, such as clinical theory to use. These levels range from micro to Meta level, and all have different influences on the decision of the health workers towards a certain decision. Understanding all these levels is important to health workers since it prevents making mistakes that could be damaging. All the decisions are governed by medical principles, such as autonomy and beneficence, which helps safeguard the wellbeing of the patient. Every health provider should utilize the systems perspective to have a better understanding of the client's issues.
References
Kemparaj, V. M., & Kadalur, U. G. (2018). Understanding the principles of ethics in health care: a systematic analysis of qualitative information. International Journal of Community Medicine and Public Health , 822-828. doi:10.18203/2394-6040.ijcmph2018073
Lacasse, J. R., & Gambrill, E. (2015). Making Assessment Decisions: Macro, Mezzo, and Micro Perspectives. Springer. doi:10.1007/978-3-319-17774-8_4
Miller, J. J., & Owens, L. W. (2014). Responding to Global Shifts: Meta-Practice as a Relevant Social Work Practice Paradigm. Journal of Teaching in Social Work , 46-59. doi:10.1080/08841233.2013.866614
USC Suzanne Dworak-Pek . (2018, February 27). Retrieved from School of Sociology Website: https://dworakpeck.usc.edu/news/do-you-know-the-difference-between-micro-mezzo-and-macro-level-social-work
Vahdat, S., Hessam, S., Hamzehgardeshi, Z., & Hamzehgardeshi, L. (2014). Patient Involvement in Health Care Decision Making: A Review. Iran Red Crescent Medical Journal . doi:10.5812/ircmj.12454
