The Management/Clinician Paradox
One of my post education goals is to work my way up the corporate ladder of a health care system. Whether that takes the form of continuing to work at my current place of employment within the insurance industry or make a lateral move into our associated hospital system, one thing is for sure: anywhere that I end up, I could potentially end up managing healthcare professionals. To be completely honest, this prospect is a little intimidating. Fortunately, there is a wealth of advice on the internet that is there to help out anyone who may be struggling with the same concerns that I have.
Influencing clinician behavior can be very difficult given the default nature of the healthcare economic system, where a there exists a matrix of accountability to many different types of stakeholders. Unlike companies in most any other line of business, there exists no singular “boss” or individual who has hiring/firing authority in the relationship between hospital, insurance companies, patients and physicians.
I have no doubt that there may come a day when I will experience the natural tension that can occur between doctors and managers. According to one article, 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 the, then both the quality of care and public support would collapse. Managers worry about patient experience while doctors worry about patient outcomes. It is suggested that patients are best served by a tension between the two.
Before we address the aforementioned paradox, we must first admit that it exists. Clinicians have traditionally favored professional autonomy, the focus on individual patients, the desire for self-regulation, and the role of evidence based practice. Managers, however, have consistently emphasized populations, the need for public accountability, the preoccupation with systems, and the allocation of resources.
How can we reconcile these differences? The article proposes three solutions as well as potential concerns:
1) Is the solution to deny the legitimacy of any management involvement in clinical issues? This argument ignores the mounting body of evidence that badly managed organizations fail patients, frustrate staff, deliver poor quality care, and cannot adapt to the rapidly changing environment in which they operate.
2) A second solution is to improve the quality of health service managers although there is little evidence to support this view and some to the contrary.
3) A third solution is to make managers think and behave like doctors or vice versa – this may not be possible or desirable. There is undoubtedly much more scope or mutual understanding. Education, training, induction, and possibly regulation can contribute to this but we should not pretend there are no differences between the way that doctors and managers see the world.
Regardless of what we may feel should be the potential solution, there should be open communication between both parties about a shared purpose and mutual respect rather than an environment of conflict, personal abuse, and blame. Both sides should find ways to work towards the shared goal of better patient care. Solutions can be found that involve constructive dialogue, improved understanding, and mutual respect, but they have to be discovered locally and continually maintained.
While searching for potential sources for this blog, I came across a couple of books that I will try to read during summer break. They are, “Influencer: The Science of Leading Change” and “Difficult Conversation.” If anyone has any other advice that they would like to share about working with clinicians please comment!
Thank you for reading.