Academic journal article Frontiers of Health Services Management

Hospital-Physician Relationships: Imperative for Clinical Enterprise Collaboration

Academic journal article Frontiers of Health Services Management

Hospital-Physician Relationships: Imperative for Clinical Enterprise Collaboration

Article excerpt

SUMMARY *

The need for new venues for physician-hospital collaboration is significant and growing, especially between independent physicians and health systems. Often physicians and hospitals act independently of each other, even though maintaining and sustaining a productive relationship between physicians and hospitals is essential to good patient care and improving the health status of the communities we serve.

The tension in physician-hospital relationships is a long-standing and widely acknowledged concern. The old model of hospital-physician relationships, governed by the rules of the organized medical staff structure, doesn't work in the current environment, which has grown increasingly complex as a result of economic, legal, and care-delivery changes.

These complexities make relationship management challenging. Hospitals and physicians struggle to align behaviors to achieve cost and quality goals. The need has never been greater for hospitals and physicians to work together as a joint clinical enterprise to improve quality, reduce practice variation, and control the cost of healthcare. This article explores the challenges and some options for improving the physician-hospital relationship in the current environment.

PHYSICIANS AND HOSPITALS face significant challenges in today's turbulent environment. These challenges include declining reimbursement levels, increasing competition, rising consumer expectations, and transparency pressures against a backdrop of increasing demands for greater efficiencies and cost-effectiveness. Too often physicians and hospitals act independently of each other, even though maintaining and sustaining a productive relationship is essential to good patient care and improving the heahh status of community served. While Michael Porter has correctly noted that more leadership is needed from physicians if we are to improve health and healthcare value for patients (Porter 2007), physicians cannot do it alone. Improving the value of healthcare will require a higher level of collaboration between hospitals and physicians than exists today.

Physicians are results-oriented people, quickly frustrated by organizational bureaucracy. Physicians think in terms of practicing their specialty well, seeing more patients, or increasing the revenue of their practice (Porter 2007, 1104). Hospital executives think in terms of managing the hospital as a whole, weighing the demands of the specialty areas and physicians against each other, and maintaining a sustainable financial balance. Significant cultural differences exist between the hospital environment and physicians' practice environments. These differences create tensions that at times can be counterproductive to the achievement of shared goals. David Shipman noted many of these cultural differences in a recent article entitled "The Solution to Hospital/ Physician Relations Is Management" (Shipman 2007). Shipman cited a series of differences including:

* most hospital administrators are grounded in business while most physicians are not,

* hospital administrators believe bigger is better while physicians focus on one patient at a time,

* hospital administrators focus on profitability while physicians focus on income, and,

* perhaps most significantly, hospitals need physicians to provide patients while physicians do not need hospitals to provide them with patients.

The recent findings of a national study on physician-hospital alignment strategies highlighted the need to strengthen physician and hospital relationships to be successful in the race for excellent quality and efficiency measures (McGowan and McNulty 2006). The report highlighted that two of the most significant challenges hospitals across this country are facing is the need to become more economically aligned with physicians and the need for hospitals to reach out to physician practices in a more proactive manner to help physicians be successful (McGowan and McNulty 2006, 6-7). …

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