How to smooth out the friction between physicians and hospital administrators

Do you feel engaged at work? Your answer may be of great concern to the leaders of your healthcare organization. Research shows that physician engagement—which includes gratification with the work of being a doctor and support from employers—is predictive of their productivity, likelihood to stay with their employer, and of medical mistakes. 

Unfortunately, it’s often strained relationships and cultural differences between administrators and physicians that undermine physician engagement. Better understanding these interpersonal and inter-group dynamics points the way toward solutions.

The disjoint explained

In a qualitative study published in PLOS ONE, researchers from Northwestern Medicine surveyed 20 physicians from a range of specialties and 20 medical administrators at different levels of management. 

The authors of this cross-sectional study found that a cultural disconnect between physicians and administrators derailed initiatives to enhance physician engagement. A minority (10%) of respondents didn’t believe a disconnect existed, which further exacerbated the issue. The authors noted that physicians and administrators desired a common language to develop targeted interventions to boost physician engagement. 

Dangers of stereotyping

At the root of the problem was the tendency of different groups to stereotype, and for physicians to typify administrators more broadly and vice versa. The more disconnected the groups, the more stereotyping occurred. Of note, physician-administrators, who exist in a liminal space, were less likely to stereotype. 

When these disconnected groups were forced to work together, problems tended to arise, and each group felt as if their identities were in jeopardy. These groups also felt isolated from each other’s worldviews. 

If such concerns are not resolved, then burnout and high turnover or further professional conflict can arise. These conflicts can entail a physician feeling a need to “stand up” to an administrator in order to do their job well. The longer that a physician is within the healthcare institution, the more entrenched sentiment becomes, with longer-serving physicians more jaded, according to the authors of the  study.

Interventions

The authors of the aforementioned study noted that regardless of friction between groups, they can still jibe. It depends on how these separate groups respond to the differences. 

“If groups are well-integrated with secure professional identities, these differences in perspectives and experiences can be the lifeblood of innovation and organizational success,” they wrote. “The goal of interventions to improve engagement should not be to eliminate distinct professional groups but to foster understanding and integration.”

Establishing role security and group integration however, is more difficult than initially thought. 

“Groups tend to be quick to offer solutions such as increasing communication or teamwork without realizing their conflicting meanings. If present, these seemingly shared solutions can invalidate concerns and reinforce divisions and hierarchies,” the authors wrote.

What the AMA says

The AMA also recognizes inherent distrust between physicians and administrators. It exacerbates drivers of burnout, including disintegration of community, lack of control, lack of fairness, and conflicting values.

“Physicians may feel that administrators don't understand, or don't care, about the challenges they face taking care of patients,” the AMA wrote. “They may feel as though they are treated as line production workers with little control over their schedules, support team, and even clinical decision-making. At the same time, administrators may think physicians do not understand the challenges of running a complex organization such as a hospital or health system, including the financial and management challenges that ensure long term sustainability.”

Trust and transparency among physicians and specialists can limit burnout, enhance professional interactions, improve workplace health/resilience, and improve the experience for the patients.

In a learning module, the AMA offers four steps to improving physician-administrator relations.

1. Assess the status of the relationship. Examine factors such as physician burnout, turnover, and no-confidence/lack of support to determine the exigency of the issue. Physicians and administrators in leadership roles can also be evaluated.

2. Open communication channels. Administrators and physicians rarely communicate as much as they should. When a C-suite executive makes a decision about finances, HR, or IT, the effects can directly impact frontline physicians, necessitating improved communication. Improved communication can take the form of CEO-physician forums, town halls, or social events without an agenda.

3. Educate administrators and physicians on each other’s  roles. Because non-clinician administrators may not realize how their decisions affect patient care and physician roles, increased understanding of these roles is a good idea. Administrators can better understand physician roles by rounding with them or participating in team huddles or meetings in the clinic. These initiatives will improve trust and invest the administrator in fixing issues with healthcare.

4. Build trust. Trust is necessary in the dynamic context of healthcare. The AMA recommends three approaches to trust building: administrator-clinician dyads, collaborative, strategic planning, and organizational compacts.

Sources

1. Building Bridges Between Practicing Physicians and Administrators. AMA.

2. Keller EJ. The growing pains of physician-administration relationships in an academic medical center and the effects on physician engagement. PLOS ONE.