Physicians, professionalism and organizational efforts to improve quality--a systems perspective.

The issue of physician professionalism has grown in importance in recent years, in part because of perceptions that our rapidly changing health care system and the incentives associated with managed care threaten professionalism. Inherent conflicts between physician professionalism and the financial and non-financial incentives used by health care organizations in quality management may be undermining the effectiveness of quality improvement initiatives. This paper examines the role of system redesign in quality improvement and the implications of a systems approach for physician job satisfaction, professionalism, and the quality of patient care. We contend that a systems perspective may be more compatible with physician professionalism and may be a more effective method of quality improvement that could alleviate some of the resistance that accompanies the implementation of quality improvement efforts. Disease management programs and multidisciplinary patient care teams are discussed as examples of potentially useful system-level interventions.