If anything that has been made clear during these strenuous times, it’s how wide the gulf yawns between administrators & physicians. Both are essential for large health care institutions. The administrators won’t take a smaller paycheck but expect the volume of the patients to increase. The doctors understand the costs but see past the insurances. They’re trained to be logical following the standard algorithms to investigate and treat to achieve the desired outcome. I’m not taking sides here. I’ve worked in places where the money was the focus and in places where the patient was the focus. It’s a big difference in work environment.
Both sides are correct. There are costs. Do we really need to occupy an ICU bed and use the most expensive tech for this terminally ill patient, ask the administrators. While the physician doesn’t quite know the numbers and costs associated with each of their medical decisions. Few doctors have taken any finance courses.
So who’s right?
There’s no winner. Yet, it seems that with every disagreement, the divide widens. Studies have shown that adhering to the principles of organizational justice would enable us to reduce conflicts while striving to provide value for patients. Organizational what?
“Organizational justice refers to employee perceptions of fairness in the workplace. These perceptions can be classified into four categories: distributive, procedural, informational, and interactional. Distributive justice reflects perceptions regarding fairness of outcomes, while procedural justice reflects perceptions of processes that lead to these outcomes. A third type of justice, informational justice, relates to the accounts provided for justice-related events. Finally, interpersonal justice reflects perceptions of interpersonal interactions and treatment. Research demonstrates that, although correlated, these specific justice judgments are each predictive of work- and worker-related outcomes.” (From Oxford)
How to Prevent Conflicts Between Administrators & Physicians?
Let’s do away with the big words. That word salad doesn’t really help people on the floors. In theory, yes but practically no. It takes years to build that kind of an organization and if changes are needed they are slow to come. Here are a few ways to resolve conflicts.
Do Your Homework Before Employment
Research the organization you work for. Read their mission statement. Why? Because it tell you what the goal is? Read between the lines. You can tell just by looking at a hospitals’ website where the focus is. Is it directed towards the patient or to establish a brand? What is the goal of the hospital? Physicians rarely research the health of the finances of an organization. The moving fees, the bonuses, and the pay package are all that interests us. Maybe review the financial standing of a hospital. Who are their investors? Do they have loan payments? Are they subsidized? Do they get grants? Their financial state will determine the ferocity of the administration and guide most of their policies. Find out what the work culture is like and what is the management style: autocratic or democratic?
Keep Your Own Records
So now you’ve started working. There’s going to be the initial honeymoon period. Then a first quarterly review to see your numbers. Emails will arrive and then administrators will ask you to call in the annuals, give everyone a Pap smear and vaccinate left, right and center. It’ll feel like squeezing blood out of a stone. Most of the time, you’re doing your bit, scheduling follow ups but the numbers might not add up. This could be because insurance hasn’t cleared payments and data is usually a quarter late. Having your assistant keep a physical record/paper trail can help you when you attend these heated meetings. Your own data will be helpful. Maintain your own records of what you’ve done and keep checking your own numbers. Believe me, you will need them.
Communicate, Communicate
Communicate at meetings. Most administrators are people with MBA’s and or MHA’s. At best they’ve done a one year internship followed by a job at a hospital. They bring the culture of that hospital with them. They look at data and numbers. They’re not looking at how long a neurological examination takes. When they say 15 minutes, they expect a wham-bam thank you mam in twenty minutes. Sad. However, you will have to explain exactly why you cannot finish writing forty notes the same day. Or why you need a Type 1 DM person to have frequent HbA1c’S every quarter, even though they’re young. You have to educate them.
Even if they sound like they know, most of the time they don’t. I’ve met people who will throw out a lot of words that they’ve picked up from wherever but can’t understand medical reasoning. We shouldn’t expect them to because we’ve spent 10 years of our lives just studying this in various formats. Neither will they understand that with this job comes the responsibility to be right every single time. A nurse practitioner can go home every night, knowing that if something does go wrong, its the license of the MD under whose umbrella they practice that’s at stake. The same goes for every other member of the medical team. Every decision made by a doctor thus is stress inducing because you have to get it right every single time.
Ask for Targets
Be transparent when it comes to this. After working in corporate healthcare, I’ve come to talk the language of management without any fear or shame. In many places, it’s still taboo or the data is sugarcoated with statements like “the hospital is not doing well” and “doctors need to do more.” No. You need to have numbers. This is the number I have achieved and this is what is expected of me. What is the target set for me/or my department? Is there room to increase walk-ins/ annuals? If yes, they will be scheduled. If not, and there’s no way to stretch the schedule, then no. The targets have to be realistic for the numbers and the money.
Clarify your role
At many places, doctors are expected to shoulder the marketing. They’re told to make phone calls for potential patients from health care screenings/fairs/ signup sheets. As a physician, set the boundaries early. It’s not your job to bring in new patients. Your job is to treat people. If you’re doing anything other than that you’re wasting your time and you’re probably ineffective anyway. Just do your job and do it well.
The Patient Always Comes First
When it comes to the money, the insurance, the payments, the backend costs and all those minute details, keep putting your patients first. They are the reason why you exist. They make take up a hospital bed, require advanced care for longer periods but never make your decisions based on money alone. Work with administrators to find a way to make it work. They are after all human.
The Battle and the Victor
There’s no victor here. At the peak of the pandemic last year, hospital laid off 1.4 million healthcare workers last year. Most of them medical staff and nurses. Non-medical staff and administration retained their jobs. And while I’m not claiming that they should have, we’ve seen growing number of institutions with bloated management staff that need to justify their large pay. The way to do so is turning the customer into product and squeezing every last penny out of them. The only person who loses here is the patient. And let’s not forget at some point in our life, that will be every one of us.
What are your tips for resolving conflicts between administrators & physicians, let me know.