The growing pains of physician-administration relationships in an academic medical center and the effects on physician engagement

Abstract

Background Physician engagement has become a key metric for healthcare leadership and is associated with better healthcare outcomes. However, engagement tends to be low and difficult to measure and improve. This study sought to efficiently characterize the professional cultural dynamics between physicians and administrators at an academic hospital and how those dynamics affect physician engagement. Materials and methods A qualitative mixed methods analysis was completed in 6 weeks, consisting of a preliminary analysis of the hospital system’s history that was used to purposefully recruit 20 physicians across specialties and 20 healthcare administrators across management levels for semi-structured interviews and observation. Participation rates of 77% (20/26) and 83% (20/24) were achieved for physicians and administrators, respectively. Cohorts consisted of equal numbers of men and women with experience ranging from 1 to 35 years within the organization. Field notes and transcripts were systematically analyzed using an iterative inductive-deductive approach. Emergent themes were presented and discussed with approximately 400 physicians and administrators within the organization to assess validity and which results were most meaningful. Results & discussion This investigation indicated a professional cultural disconnect was undermining efforts to improve physician engagement. This disconnect was further complicated by a minority (10%) not believing an issue existed and conflicting connotations not readily perceived by participants who often offered similar solutions. Physicians and administrators felt these results accurately reflected their realities and used this information as a common language to plan targeted interventions to improve physician engagement. Limitations of the study included its cross-sectional nature with a modest sample size at a single institution. Conclusions A qualitative mixed methods analysis efficiently identified professional cultural barriers within an academic hospital to serve as an institution-specific guide to improving physician engagement.

Medical leadership: boon or barrier to organisational performance? A thematic synthesis of the literature

“… 31 Physicians are socialised into a specialty with a focus on individual excellence, whereas administrators are team players with diverse backgrounds; clinical decision making has a short time horizon with a single course of action whereas administrative decision-making results in multiple alternatives. 31 When clinicians take on managerial roles, they are perceived to occupy a no-mans-land, 32 often not meeting the expectations and authority vested in them. 33 Many are concerned with losing their credibility among their peers and becoming outsiders, 34 with management referred to as the ‘dark side’.…”

“… 24 Any collaboration with non-clinicians is thought of as ‘making them understand’ or ‘getting them on board’. 31 …”

“…[27][28][29][30] Management, perceived as an administrative domain, and the medical domain have distinct cultural differences. 31 Physicians are socialised into a specialty with a focus on individual excellence, whereas administrators are team players with diverse backgrounds; clinical decision making has a short time horizon with a single course of action whereas administrative decision-making results in multiple alternatives. 31 When clinicians take on managerial roles, they are perceived to occupy a no-mans-land, 32 often not meeting the expectations and authority vested in them.…”

“…35 Clinicians and non-clinicians act as partners where understanding is built through communication and presence. 31…”

“…24 Any collaboration with non-clinicians is thought of as 'making them understand' or 'getting them on board'. 31 On the other hand, managerial strategies can follow a 'professional path', that is, build on medical leaders' inner drive, resonate with their mental models and be anchored in quality improvement. 30 Collaborative leaders surpass organisational and disciplinary boundaries to co-produce care with high quality and cost efficiency, that is, they see the context as a resource that can be collectively adjusted as opposed to individually shaped (heroic leaders).…”