the eye of the beholder: A Qualitative Study of Mutual Obligations and Areas of Ambiguity in the Hospital-Physician Relationship

Hospitals and physicians have been working together for years in providing specialized health services. However, Hospital-Physician Relationships are considered lukewarm at best. We build on psychological contract theory to develop an in-depth understanding of how physicians (N=15) and hospital executives (N=15) in Belgium experience and interpret obligations in their working relationship. Our analysis yielded a rich understanding of mutual obligations and areas of ambiguity. Two major themes emerged from the analysis. A distinction should be made between administrative obligations (adequate support and responsive decision making) and professional obligations (clinical excellence and physician autonomy). Two areas of ambiguity could be identified reflecting both dimensions. An economic trade-off exists in the day-to-day interaction and therefore views on how the way care should be organized differ. In addition, the extent to which medical decisions should take into account the corresponding impact on hospital finance varies.