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Institutional Health Voids, Learning Myopia, and Counter-Knowledge: Unveiling Blind Spots in Healthcare Decision-Making

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Jun 25, 2025

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Figure 1.

The influence of weak signals on the formation of counter-knowledge
Source: own processing
The influence of weak signals on the formation of counter-knowledge Source: own processing

Blind spots in the Spanish national healthcare system

Actors Blind spots References
Users

Excessive delays in care delivery, with waiting times frequently surpassing two weeks.

Shortages of medical professionals in both primary and hospital care, largely stemming from politically driven selection and hiring processes.

Overburdened emergency services and an increasingly burdensome medication co-payment scheme.

Structural and systemic inefficiencies affect the overall functioning of the healthcare system.

Limited awareness and enforcement of data privacy, resulting in obstacles to accessing personal health information.

(Coventry et al., 2020; Fotaki & Hyde, 2015; Gillespie & Reader, 2018; Morsø et al., 2022; O’Dowd et al., 2022)
Doctors and Nurses

Low public sector salaries have led to significant dual employment, with many healthcare professionals working simultaneously in both public and private sectors.

An aging medical workforce, combined with precarious employment conditions for younger doctors, often limited to temporary contracts, has resulted in high staff turnover.

Diminished patient engagement, with reduced time allocated per patient, negatively affects communication and the speed and accuracy of diagnoses.

Inadequate data privacy awareness, limiting effective protection and management of personal health information.

(Coventry et al., 2020; Kruse et al., 2017; Latukha et al., 2022)
Administrators

The duplication of medical records and documentation contributes to poor coordination between primary care and specialized services.

Poor management of public hospitals and lack of resources.

Existence of individual interests.

Inadequate attention to organization culture.

Lack of awareness about patients’ data protection.

(Coventry et al., 2020; Denis et al., 2021; O’Malley et al., 2010; Papadimos et al., 2020)
Policymakers

Politicizing the process.

General complacency.

Poor essential infrastructure and public works.

Weak legal frameworks.

(Adebowale et al., 2020; Motta et al., 2020; Papadimos et al., 2020; Scopelliti et al., 2015, 2017)

Institutional health voids, weak signals, and corresponding counter knowledge

Institutional Health Voids (IHVs) Weak signals Counter-knowledge
Inter-institutional coordination Cost-based service Rumors regarding healthcare quality
Public financing Unclear procedures Confusion regarding the final price of medications
Social power systems Discrepancy based on community-affiliation Impression of bias toward political or economic interests