Canadian National Study of Interprofessional Relationships between Physicians and Hospital Administrators
Part 1: The importance of physician–hospital relations in the Canadian health care system*
*Part 2: A summary of CANSIRPH will be published in a subsequent issue of the CJPL.
Studies have shown that physician–hospital relations are among the most important concerns of hospital leaders and paying attention to this issue is urgent if health care decision-makers plan to improve the quality of patient care and reduce health care costs. Industrialized countries have been focusing on improving the quality of relations between medicine and management, but in Canada no national detailed study has addressed such interprofessional relations. Physician–hospital relations have a tremendous effect on quality of patient care, and good hospital relations are crucial to the professional lives of physicians. This article explores the role of physician–hospital relations and the need for Canadian data in this area. In a subsequent article, I summarize the Canadian National Study of Interprofessional Relationships between Physicians and Hospital Administrators, a quantitative multivariable correlational study designed to understand how physician leaders and non-physician leaders perceive the relations between medical staff and hospital management across Canadian hospitals.
Introduction and background
The results of a survey by the American College of Healthcare Executives showed that physician–hospital relations are among the most important concerns of hospital leaders and have remained so for many years.1,2 A survey by the American Hospital Association’s Society for Healthcare Strategy and Market Development and Mitretek Health Care showed similar results.3,4 Members of the American College of Physician Executives reported that lack of trust is one of the main issues affecting the development of collaborative physician–hospital relations.5 However, such relations are an important aspect of health care systems in industrialized countries, and paying attention to this issue is urgent if health care decision-makers plan to improve the quality of patient care and reduce health care costs.6 According to Weiner et al 7 road blocks to physician involvement are the most important barriers to improvements in quality of health and patient care. Top
Physician–hospital relations in OECD countries
In industrialized countries, differences in the viewpoints of physicians and hospital executives tend to occur in most hospitals.2,4,8–12 The situation is similar in Australia, Sweden, the United States, Canada, Denmark, the Netherlands, the United Kingdom, and other countries.13 In fact, in comparing the quality of the health care systems of its members, the Organisation for Economic Co-operation and Development (OECD) found that any simple change in one system eventually disseminates to other member countries.14,15 Top
Physician–hospital relations have been a topic of research in the United States, the United Kingdom, Norway, Germany, and Australia.9,10,16–19 Neogy and Kirkpatrick18 compared physician–hospital relations in European countries, where reforms in health care began during the 1980s, with France holding back until recently. Denmark is most advanced in terms of involving doctors in managerial roles. France and the United Kingdom are less advanced than Denmark and Germany in this respect, while, in the Netherlands and Italy, some hospitals have medical personnel involved in management and some do not.
Physician–hospital relations in Canada
In Canada, the use of effective clinical leadership varies among provinces and among hospitals in each province. One might argue that Canada has a national health care system and does not have any issues with physician–hospital relations. Nevertheless, the results of the National Physician Survey showed that Canadian physicians have also been dissatisfied with their relations with hospital or health care administrators: about 20% are dissatisfied and about 30% indicated borderline satisfaction (neither satisfied nor dissatisfied).20 Good physician–hospital relations are crucial to the professional lives of physicians and their overall level of satisfaction with other aspects of their lives.21 Physicians who are satisfied with their hospitals are twice as content as other physicians.22
In contrast to the large number of research studies in other OECD countries, a review of the literature through to 2010 showed only a few studies focusing on physician–hospital relations in Canada.23–25 To address this gap, the Canadian National Study of Interprofessional Relationships between Physicians and Hospital Administrators (CANSIRPH) was undertaken in 2011–2012 to examine such relations in all provinces and territories. In CANSIRPH, the term “interprofessional relationships” referred to physician–hospital relations, physician–hospital relationships, and doctor–manager relationships.26,27 The focus on the term interprofessional was intended to emphasize relations between physicians and hospital administrators as intertwined rather than interdisciplinary and separate.28–30Top
Physician–hospital relations and quality of patient care
Lack of collaboration with physicians is one of the most important challenges that hospital administrators face.1 In contrast, patient satisfaction is at the bottom of the list of hospital CEOs’ concerns, although paying attention to “customer” needs improves performance and, consequently, the financial status of hospitals.31 Patients and physicians
are among the most important customers of hospitals.25 Patients want choice, ease, and access to physicians’ services; administrators should be asking about the needs of patients and physicians instead of thinking on their behalf.32
Noncollaborative interprofessional relations between physicians and hospital administrators adversely affect the quality of patient care, patients’ satisfaction, and the number of adverse events at the hospital.23,25,33–36 Currently, the quality of interprofessional relations between physicians and hospital administrators in Canada and the factors that affect these relations are unclear.23,25,33,36,37 However, improving such relations would be useful in improving the quality of patient care.7,25,33,38–40 Top
Regardless of financial issues, the core values of physicians and hospital administrators are very similar, and both groups have common ground for successful interprofessional collaboration.11 Physicians are not regular employees, even if they are employed by the hospitals. Rather they collaborate with hospital administrators, but only if the voices of physician leaders are as strong as those of hospital administrators.41 Participating in decision-making meetings when hospital administrators make the final decision does not constitute having an equal voice. Physicians should be equally involved in advocating as well as finalizing any strategic decisions that affect patient care in hospitals.41 Shared control is an important factor in successful physician–hospital relations.42
Paying careful attention to the intertwined needs of physicians and hospital administrators has a positive effect on the quality of patient care as well as on the financial outcomes of hospitals.37,38 According to Gosfield and Reinertsen,43 establishing common grounds to improve the quality of patient care will resolve most challenges that exist in physician–hospital relations. Top
Patient care in a hospital is only as strong as the interprofessional relations between physicians and hospital administrators.25,33,44 Porter and Teisberg45 asserted that if physicians lead the value process in health care, hospital administrators, board members, patients, and other health care professionals will benefit, because physicians allocate the use of resources in health care systems.46,47 Physicians have also emphasized that hospital administrators should listen to their ideas and include their viewpoints in hospital decision-making processes.48
Canada’s health care system values interprofessional and interdisciplinary relations among health care professionals because of their importance in patient care and patient satisfaction.30 Among the most important such relations is that between physicians and hospital administrators, who share common values and have extremely important roles in clinical and administrative aspects of health care management.11 Successful interprofessional relations benefit the quality of care, decrease the number of adverse events, reduce health care costs associated with inadequate interdisciplinary decision-making, and, eventually, increase patients’ satisfaction.25,49–53 The business of hospital administrators and physicians is health care and patient care,54 thus, improving relations between these professionals means improving patient care and health care.38,40 As Weiner et al 7 emphasized, anything that negatively affects physician collaboration with hospital administrator results in worsening the quality of patient care. Top
Physician–hospital relations and physician leadership
A UK national survey showed that open communication and clinical leadership help align priorities and shared decision-making among hospitals and physicians.17 Hospital strategies that not only focus on economic incentives, but also on including physicians in decision-making processes as part of the management team can benefit both hospitals and physicians.55–57 Walker et al58 recognized that managers and hospital administrators have specific talents that complement those of physicians, thus strengthening the partnership between medicine and management.
Hospital administrators consider physicians to be a main pillar of the health care system, and strengthening their relations with physicians creates a strong and error-free system.25,33,59 Physicians should remember the role health care leaders play in dealing with many stakeholders to provide the facility and environment for the patient care; without administrators, quality patient care is not possible.1,33 Governing boards should emphasize the inclusion of both physicians and administrators in the hospital decision-making process to create balance in satisfying both internal and external stakeholders by providing quality patient care.33,37,60 Top
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26.Samadi-niya A. Differences in perceptions of physician leaders and hospital administrators toward physician–hospital relations across Canadian hospitals. Poster presented at the 2014 National Health Leadership Conference: Raising the bar: a critical time for bold leadership, Banff, Alberta, Canada, 2–3 June 2014. Ottawa: Canadian College of Health Leaders and HealthCareCAN; 2014. Top
27.Samadi-niya A. Canadian national view on physician–hospital relations. Presented at the 2014 National Health Leadership Conference: Raising the bar: a critical time for bold leadership, Banff, Alberta, Canada, 2–3 June 2014. Ottawa: Canadian College of Health Leaders and HealthCareCAN; 2014. Available: http://www.nhlc-cnls.ca/assets/25_Canadian%20national%20view_Samadi-niya.pdf
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43.Gosfield AG, Reinertsen JL. Finding common cause in quality: confronting the physician engagement challenge. Physician Exec 2008;34(2):26-31.
44.Samadi-niya A. Interprofessional relationships between physicians and hospital administrators across Canada: A quantitative multivariate correlational study. PhD thesis. Phoenix AZ: University of Phoenix; 2013.
60.Sandrick K. Physicians on the board: inside or outside? Trustee 2006;59(5):14-7.
Atefeh Samadi-niya designed and led CANSIRPH. She is currently acting as vice-president and cofounder of IRACA Solutions, Inc., which provides consultations in health care, information technology, and physician–hospital relations.