Mending the Gap between Physicians and Hospital Executives

This chapter explores the relationship between two components of our healthcare system: physicians, representing all providers of direct care, and hospital executives, referring to those with administrative responsibilities, regulatory obligations, and resource control. Currently, there is a wide gulf, or gap, representing an adversarial interaction. Over the past 50 years, there have been dramatic, frankly, revolutionary, changes in the practice of medicine without corresponding or matching adjustments in the healthcare system. As a result, both physicians and healthcare executives are frustrated. The present adversarial tone between healthcare executives and physicians adversely impacts healthcare outcomes. We discuss data showing differences between physicians and healthcare executives in education, background, work experience, and culture. However, the two share common core values: altruism, service, and love of a challenge. They also have common concerns about the future. We conclude that the real enemy is not the so-called other—physicians or healthcare executives—but our dysfunctional healthcare system. The common values and concerns shared by physicians and healthcare executives could provide the framework for successful communication leading to a bridge across the gap and a collaborative rather than confrontational relationship. Physicians could teach healthcare executives about clinical priorities, useful new technologies, and scientific methodology, including evidence-based decision making. Healthcare executives could educate physicians about management tools and techniques for planning, implementation, and assessment, especially systems thinking. Together as partners, healthcare executives and physicians could address many of the currently insoluble problems in healthcare.