Hospital-physician relations--a response.

PHYSICIANS, HOSPITALS AND other Healthcare organizations, and even patients have often reeled as waves of change have washed over them during the past few years. However, despite buffeting, the medical profession and healthcare organizations have rebounded and begun to move forward. At times that process has been anything but smooth or comfortable, but the profession has continued to serve the population, advance the science, and improve care. The current tension between hospitals and physicians is nothing new. "Hospitals and physicians have been dancing for decades, but they have not always been following the same music" (DeMarco and Hekman 1998). One can trace history back to the time when physician leadership built some of the first hospitals, when Dr. Ernest Codman, the "acknowledged founder of what today is known as outcomes management" (JCAHO 2003), and others advanced a quality agenda, and how traditions of public responsibility shaped the profession. But one can also track how physicians lost their status as leaders in the healthcare delivery system as economic and social forces changed. The late 1980s and early 1990s was a time of change in payment and reimbursement relationships, of threat to income streams and traditional relationships. These threats greatly affected both physicians and hospitals. Some individuals as well as systems responded as true leaders and developed new bases for their relationships. Others were ostriches, burying their head in the sand and hoping when they came up for air that the "good old days" would magically reappear. In this most recent onslaught of rapid change, those entities with the highest likelihood of success had to be willing to assess the environment, evaluate their management approach with regard to that environment, and then be flexible in response and willing to periodically reevaluate the steps they were taking (Moore and Simendinger 1993). Part of that flexibility in response is finding the same beat in the music as their partner and deciding which partner will lead in the current turn around the floor. Howard and Bujak concur that there has been substantial upheaval and change for all involved in healthcare delivery over the last two decades. However, the two lead articles present somewhat different perspectives on how these changes have affected the relationship between physicians and the hospital administration as well as the expectations of the facility and the profession. Following is an examination of the divergence of the perspectives as well as evaluation of the potential impact of implementing various responses or philosophies. Bujak says that "for healthcare organizations...successfully partnering with physicians is the strategic imperative." However, he goes on to be extraordinarily cynical in his view of the physician medical staff and pessimistic about the possibility of their effectively entering any partnership. Bujak says that the concept of an organized medical staff is an illusion, physicians are incapable of strategic planning, they place their independence and autonomy above the well-being of colleagues and organizations, they are incapable of identifying or responding to leadership, and so on. In a study conducted by VHA, Inc. (2002), many of Bujak's perceptions are repeated. According to the study, the organized medical staff is not currently structured to effectively ensure optimum patient care or to engage physicians in supporting the needs of the healthcare organization. The study identifies, however, many potential synergies existing among healthcare organizations and their physicians that could be used to reenergize their mutual commitment to clinical quality and patient safety as well as economic well-being. The study demonstrates that the priorities of the medical staff within the healthcare organization are primarily those of meeting the needs of patients. The study further notes that physicians are increasingly using information on their patients' outcomes and satisfaction. …