Academic journal article Frontiers of Health Services Management

How to Improve Hospital-Physician Relationships

Academic journal article Frontiers of Health Services Management

How to Improve Hospital-Physician Relationships

Article excerpt

SUMMARY * FOR HEALTHCARE ORGANIZATIONS (HCOs), successfully partnering with physicians is the strategic imperative. A number of misperceptions and limiting beliefs compromise partnering initiatives. To pursue a more successful approach to partnering, it is important to understand some of the forces that are affecting the healthcare industry. The accelerating pace of change demands that healthcare leaders serve as change agents, evoking resentment from the majority of healthcare stakeholders. Demands for measured accountability and the shift of control from provider to consumer threaten the physician perception as "captain of the ship." Cultural differences between the expert culture f physicians and the affiliative culture of the HCO perpetuate feelings of distrust and compromise efforts to actualize interdependencies. Economic pressures and an unwillingness to make time to engage in dialog prevent the provider community from serving as a creative force in shaping its own future and restrict the ability to build the mutual trust that is necessary for the establishment of successful relationships.

Measures that would enhance the likelihood of forming successful and lasting relationships include the following. Adopting an orchestration model would allow a flexible way to bring services to a community. It may be the only way to simultaneously integrate and specialize. Budgeting to reflect service-line functioning would allow the systematic integration of patient care throughput and provide a necessary metric for assessing clinical and operational performance. Segmenting the medical staff would allow the establishment of pluralistic relationships based on shared goals and values and allow change agents to lead to critical mass rather than consensus. Focusing on the customer would ensure relevance in the changing medical marketplace. Adopting a complexity science metaphor rather than continuing in a command-and-control, top-down organizational structure would enhance adaptability and help maximize human capital. Most importantly, forming relationships that center around shared purpose and values will lay the foundation for excellence and sustainability while restoring a sense of meaning, pride, and joy to the healthcare professions.

ARE PHYSICIANS AND hospitals or health systems interdependent? From the hospital or health system's perspective, the answer is an obvious and emphatic "yes," for the following reasons:

* All efforts to achieve balanced accountability require physician assent and engagement.

* The cost (efficiency), quality (medical outcome), and appropriateness of care (utilization management) are all critically dependent on physician attitudes, beliefs, and behaviors.

* Physicians continue to bear the ultimate accountability for patient outcomes.

* The CEO is in charge, but not in control.

* Organizational decisions are primarily based on professional standards and technological dictates, not business considerations (Mintzberg and Glouberman 1999).

Fundamentally, hospitals and healthcare systems are critically dependent on individuals who for the most part do not work for them and carry no direct organizational accountability. That is a challenging environment.

From the physicians' perspective, the answer to the question of whether hospitals and physicians are mutually reliant is "it depends." For many physicians there is little need to interact with the healthcare organization (HCO). This is especially true for family practice physicians, general internists, dermatologists, ophthalmologists, plastic surgeons, rheumatologists, and endocrinologists, among others (the advent of physician-owned outpatient surgery centers and specialty hospitals has extended this list considerably). Family practice physicians no longer assist at surgery and, because of increasingly unaffordable malpractice insurance rates, infrequently do obstetrics. They earn more money by seeing patients in their office than they can earn caring for patients in the hospital setting. …

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