Academic journal article Frontiers of Health Services Management

Physicians and Organizations: Strange Bedfellows or a Marriage Made in Heaven?

Academic journal article Frontiers of Health Services Management

Physicians and Organizations: Strange Bedfellows or a Marriage Made in Heaven?

Article excerpt

Summary

Underscoring the importance of physician-organization alignment as a necessary condition for building and sustaining integrated healthcare systems, this article provides information regarding the nature of such alignment, the key influential factors, and the processes employed to make alignment a reality. Structural and strategic factors address the influence of environmental, market, and organizational characteristics on alignment. The strategic intent of organizations and physicians, and physician perspectives on the effects of integration, are explored. Key processes examined include building trust, placing physicians in management and governance, and developing physician leadership. Continuing issues and challenges are considered, and a set of principles to help guide the journey of physicians and organizations toward successful alignment is suggested.

For the past decade, healthcare delivery organizations and physicians have faced an increasingly turbulent and constrained environment, characterized by concurrent governmental, industry, and purchaser concerns regarding cost, quality, and access. In this environment, it has not been uncommon to find delivery organizations (e.g., hospitals and hospital systems) and physicians competing and in conflict. It has become increasingly evident to many, however, that the futures of hospitals, hospital systems, and physicians are interdependent and inextricably intertwined. Continuing growth of managed care; market-based health reform; closer scrutiny of organizational and professional practice; and increasing social, economic, political, financial, and clinical accountability have led many to conclude that collaborative strategies among physicians and organizations are essential to sustaining the long-term viability of each (Shortell et al. 1996; Gillies et al. 1993; Coddington, Moore, and Fischer 1994, 1996; Griffith 1996; Davidson, McCollom, and Heineke 1996).

Hospitals and hospital systems have responded by attempting to transform themselves into integrated healthcare systems. Such systems have been defined as "a network of organizations that provides or arranges to provide a coordinated continuum of services to a defined population and is willing to be held clinically and fiscally accountable for the outcomes and the health status of the population served" (Shortell et al. 1993). In the pathbreaking work known as the Health Systems Integration Study (HSIS), Shortell and colleagues (1996) found that such systems are characterized by three types of integration-functional, physician, and clinical. In this study, physicianorganization integration is seen not only as an end in itself but also as a crucial prerequisite to clinical integration. Specifically, greater physician-system integration was significantly related to higher inpatient productivity and higher levels of clinical integration. Further, greater perceived clinical integration was related to greater system net revenue and to higher inpatient productivity (Shortell et al. 1996, Conrad and Shortell 1996). As systems redefine their core business in terms of population health and managing clinical processes of care across the continuum, the need for physician and organization linkages becomes all the more apparent.

To substantiate further the centrality of physician-organization alignment, a recent national survey of health system executives indicated that 90 percent believed physician integration was critical to a system's success (Japsen 1997). Nevertheless, these executives also noted that there are countless pitfalls as they seek to involve physicians with their organizations. As shown in Figure 1, 57 percent of the executives identify integrating physicians as the "most difficult aspect" of building an integrated delivery system. Thus, while the idea of physician-organization alignment has strong support, much remains to be learned about the nature of alignment, the key factors influencing alignment, and processes employed to make such alignment a reality. …

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