Building hospital-physician relationships through servant leadership.

THE ARTICLES BY Joseph S. Bujak, M.D., and Chris Howard provide thoughtful and insightful commentaries on the state of hospital-physician relationships and what my faculty often describe as "the real world." Each in their own way describe how we have gone past the covenental relationships that defined hospital-physician interactions in years past to the dependence on contractual relationships in a world characterized too often by competition instead of collaboration. The complexity of hospital-physician relationships and the strain that results are well described in these articles, particularly the lack of trust; these consequences should have been easily predicted as a result of the corporatization of healthcare (Anderson 1997). Furthermore, recent surveys from coast to coast have revealed a growing dissatisfaction among physicians with the current practice environment. Older physicians are retiring early, and many physicians say they would not choose medicine again, nor would they recommend medicine to their children as a career (Merritt, Hawkins 2000). Physician dissatisfaction should not be surprising given unfavorable practice economics and what they perceive to be a decline in the quality of the practice environment. As incomes have fallen, many physicians have chosen to try to become equity partners in day-surgery centers, diagnostic imaging centers, and even hospitals that compete with the very hospitals that have provided them a practice environment in the past. In the workforce, younger employees now often question why their fathers and mothers were loyal to institutions, for they have seen them laid off and forced into early retirement. Likewise, younger employees may not trust long-term relationships or institutional covenants to the degree their predecessors did. This phenomenon affects younger physicians as well. These same physicians' expectations concerning lifestyle and income have not kept pace with inflation over the last decade (Massachusetts Medical Society 2001). Complicating matters further, physicians have seen their practice costs rise, particularly for malpractice premiums. They have seen the physician-patient relationship come under attack by managed care, and they have seen a growing consumerism wherein patients seeking affordable insurance premiums have shopped health plans and as a result ended physician relationships seemingly in exchange for a savings of a few dollars a month. Likewise, hospitals have felt that they are under assault with unfair competition from "niche" players in the marketplace, many of which are working in partnership with physicians who used to provide "nutrients" to the hospitals' bottom line. Many of these same hospitals, even though not-for-profit in nature, mimicked their for-profit sister institutions and provided ample opportunity for physicians to participate in joint ventures on equity arrangements. The hospitals also may have purchased physician practices, giving physicians a taste for sources of income other than professional fees. Professional values were too often sacrificed for short-term market advantage: What we say is not nearly as powerful as what we do or what we are perceived to be doing. RELATIONSHIP-CENTERED CARE Many of us in the healthcare delivery community have invested in the concept of patient-centered care, but I believe it is now time to argue for the concept of relationship-centered care. Physicians need a hospital that can provide them with a climate that supports their efforts to bring healing to individual patients and populations of patients. It is not enough to be centered solely on the patient for healthcare delivery. The healing environment requires a number of other healthy relationships (Tresolini and the Pew-Fetzer Task Force 1994). Many physicians find themselves distanced from relationships with almost everyone else except the patient, including their family, their peers, their faith, and even themselves. …