Monday, July 20, 2009

Response to Valpodoc

Valpodoc responded to my posting entitled Recommendation as follows:

Let me get this straight. Your solution is to make the doctors, employees of the hospitals. An [sic} the hospital administration would then "fix" the problems. Sounds like government healthcare with a different name.”

This comment offers an example of the hazards of trying to deal briefly with complex issues.

As a practical matter, it may well usually be the case that consolidating the professional and institutional components of health care means making doctors “employees of the hospitals.” Only large group practices can do it the other way round.

But the comment about hospital administration “fixing” the problems calls for further comment.

The health care delivery system is very much in need of individuals who can be effective leaders of organizations that employ physicians and that undertake to manage patient care (which requires the management of medical practice). Those individuals are probably not the hospital administrators of the past whose main role was to keep the doctors happy and the bills paid. Neither are they likely to be patterned after the legendary autocrats who founded the famous group practices or the later physician executives who held administrative processes in contempt.

Instead, they will be individuals – some physicians and some not - with the skill of leading health care organizations that foster loyalty and dedication to a common purpose and that encourage imagination and productivity.

For the foreseeable future, they will also need the ability to change the cultures of the institutions they head. That process will not always be smooth and so they will need the understanding and support of their governing bodies as well as of their communities.

They will not be people who “fix” problems so much as people who maintain the organizational environment needed by those who understand the complex issues involved and who can design and implement the health care system of the future.

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