Thursday, September 30, 2004
What Doctors (and Hospital Managers) Want (but Can’t Have)
The July/August 2004 issue of Healthcare Management included an article titled “What Doctors Want.” It dealt with the often-strained relationships that exist between doctors and hospital managers, comparing the situations in the U.S. and the U.K. Neither the results reported nor the authors’ recommendations for improvement were particularly surprising.
I did, however, find two comments both interesting and revealing. The first was the following quote from the March 22, 2003 issue of the British Medical Journal, which was devoted to this same topic:
“The fundamental problem is a paradox between calls for a common set of values and the need to recognize that doctors and managers do and should think differently. If managers suddenly became preoccupied with the needs of an individual patient, irrespective of the consequences for others or for their budget, then the health system would collapse. If doctors decided that their principal concern was to ensure the smooth running of the system and the delivery of policy irrespective of the consequences for the patient in front of them, then both the quality of care and public support would collapse.”
The second, as follows, was directly from the article:
“The independence of doctors from corporate control and the autonomy of doctors to admit patients to any hospital (where they have admitting privileges) and to be free to use any pharmaceutical, prosthesis, or medical device regardless of cost have been widely accepted values in American society since the early twentieth century.”
If one recognizes, as I do, that the realities of modern health care are causing hospitals and their managers to accept, however reluctantly, responsibility for supervising medical practice, then the traditional roles of doctors and managers as described in these two quotes cannot be sustained. Furthermore, trying to sustain those roles may well be the most important cause of strained relationships between them.
It is unavoidable that the needs of the institution and the needs of an individual patient will sometimes be in conflict. In practice, the conflicts are always resolved. In the traditional setting, each resolution emerges out of the particular characteristics of the doctor and the hospital and the power relationships that happen to exist between them. Predictably, the results vary widely.
The alternative is for hospitals and their managers to accept responsibility for managing both the institutional and clinical components of patient care, and to learn how to do so in ways that optimize benefits to individual patients and the health of the institution.
This approach is essential to bringing costs under control and achieving high and uniform levels of quality. It is central to the successful redesign of the health care system.
The medical profession understandably wants to maintain the professional independence it has enjoyed for so long. Hospitals want not to take responsibility for supervising clinical practice. Unfortunately, neither can have its want satisfied.
The July/August 2004 issue of Healthcare Management included an article titled “What Doctors Want.” It dealt with the often-strained relationships that exist between doctors and hospital managers, comparing the situations in the U.S. and the U.K. Neither the results reported nor the authors’ recommendations for improvement were particularly surprising.
I did, however, find two comments both interesting and revealing. The first was the following quote from the March 22, 2003 issue of the British Medical Journal, which was devoted to this same topic:
“The fundamental problem is a paradox between calls for a common set of values and the need to recognize that doctors and managers do and should think differently. If managers suddenly became preoccupied with the needs of an individual patient, irrespective of the consequences for others or for their budget, then the health system would collapse. If doctors decided that their principal concern was to ensure the smooth running of the system and the delivery of policy irrespective of the consequences for the patient in front of them, then both the quality of care and public support would collapse.”
The second, as follows, was directly from the article:
“The independence of doctors from corporate control and the autonomy of doctors to admit patients to any hospital (where they have admitting privileges) and to be free to use any pharmaceutical, prosthesis, or medical device regardless of cost have been widely accepted values in American society since the early twentieth century.”
If one recognizes, as I do, that the realities of modern health care are causing hospitals and their managers to accept, however reluctantly, responsibility for supervising medical practice, then the traditional roles of doctors and managers as described in these two quotes cannot be sustained. Furthermore, trying to sustain those roles may well be the most important cause of strained relationships between them.
It is unavoidable that the needs of the institution and the needs of an individual patient will sometimes be in conflict. In practice, the conflicts are always resolved. In the traditional setting, each resolution emerges out of the particular characteristics of the doctor and the hospital and the power relationships that happen to exist between them. Predictably, the results vary widely.
The alternative is for hospitals and their managers to accept responsibility for managing both the institutional and clinical components of patient care, and to learn how to do so in ways that optimize benefits to individual patients and the health of the institution.
This approach is essential to bringing costs under control and achieving high and uniform levels of quality. It is central to the successful redesign of the health care system.
The medical profession understandably wants to maintain the professional independence it has enjoyed for so long. Hospitals want not to take responsibility for supervising clinical practice. Unfortunately, neither can have its want satisfied.
