The void between physicians and administrators in hospitals

In a hospital setting, administrators love to work with physicians; they make sure whenever a new system is being formulated and implemented, this is discussed with a team of physicians, as they are also an integral part of success. All physicians work with each other in harmony and synchronicity.

Cardiologists never step on each other’s toes, radiologists call admitting doctors for any bizarre findings and hospitalists notify the primary about their patient’s update.  Physicians discuss their plan of care with nurses and nurses in turn make sure all support staff is conveying the same message to the patient. Nurses keep a direct contact with their assistants, physical therapist etc and they inform each other about any significant changes.

And … by now I usually wake up from sleep and face the nightmare of reality.

There is no “I” in a team. I often feel that there is a desire from everyone to work as a team, but we all work in our little domains — administrators do their own thing, physicians after seeing a patient do not see the big picture and nurses immerse themselves more in entering data rather than reviewing what data means.

In every hospital I have worked at, there is a huge void between physicians and administrators. I often feel a free flow of information and mutual trust can reach goals better than a “need to know” policy.

On one hand, one half of physicians do not get along with each other. There is constant bickering about stealing patients and how unethical the other doctor is. Please do not take me wrong way.  I have my moments of bickering too but I try not to. If a primary decides to use another physician to admit a patient other than our group, I try to self evaluate ourselves and ask why did this happen — were we doing something wrong or was it a purely business decision from primary care? And if it is the latter, then it is a free country.  I believe in free will and enterprise.

I call this overall behavior “maximum of minimum attitude,” where you do the minimum best among our own domains and seldom cross over. I think we need to put more emphasis on teamwork. Workshops among all hospital based personals should be encouraged.  We need to emphasize on the bigger picture rather than our cocoons.

There needs to be one hero everyday rather than one hero all the time.

S. Irfan Ali is a hospitalist who blogs at Human Factor in Medicine and Life.

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  • Dirk Stanley, MD, MPH

    I recently figured out a major contributor to this phenomenon – the policy/governance structure. And why SO many hospitals struggle with this? Almost no guidance or education about the subject. I’m hoping to put some cost data together to support this.

  • http://leaflady.org Dr Gayle

    There is a major disconnect between administrators and the nursing staff too!

  • soloFP

    In my area two large groups, sponsored by two separate hospital systems, control 60-70% of the primary care and specialty docs. Referals are kept within the group, unless a patient becomes disgruntled.
    What most of the docs do not see is the extra adminstratos and staff to take care of the group and the squables within the group simply increase overhead from the decreased efficiency. Depending on the group and after guaranteed base salaries, the group administrtors skim administrative fees and have a lower collection rate from patients than the community average.
    Communication between specialists and primary care, despite email, telephones, and electronic records. is minimal in the hospital setting. Abnormal results rarely, unless life threatening, are called to me by nurses, radiologists, or technicians. I call in each day at the end of the day and/or go online to find any abnormal results on my inpatients. The technology exists to beam the results to smartphones, yet neither of my local hospitals does this.

  • Laura L. Nelson

    This occurred in higher education parallel with if not prior to its happening in health care. Faculty made the mistake of allowing an administrative track develop that did not require administrators to pay their dues in the classroom and work up through the ranks. Lowest level admin salaries are now more than senior faculty make in many fields and administrators think they know best– only tenure allows us to tell them when their newest bright idea is stone cold crazy. Colleges and hospitals are now being run by business people– education and health care are now in the marketplace to make money– both are signs of a sick society.

  • KKrumrine

    Many years spent working as an RN in hospitals. They are always remodeling units. They NEVER ASK THE NURSING STAFF for input on what would help the unit. Great example: The L&D/Nursery unit I worked in. THEY knew best. WHAT COULD THE NURSES POSSIBLY KNOW ABOUT RECONSTRUCTING the OB ward? The first baby born, after the unit was completed needed a chest xray. The Radiology tech couldn’t get the portable X Ray unit into the nursery!!!! So much for the disconnect between administrators and medical staff. That was not only stupid, dangerous, but very costly!

  • jsmith

    Anecdote:
    A hospital system in Spokane (where we refer pts for sub-specialty care, but not part of our system) recently bought out a group of docs. Silly docs. Now, our little local hospital administrator is actually one of the better ones. He seems to care about the community, is not overly power-mad, and seems competent. If he abuses his employees, I haven’t heard about it. Anyway, this guy stood up at the quarterly medical staff meeting and described the Spokane machinations and asked us docs what we thought about it. He was greeted with complete silence.
    Look, even if this guy hasn’t hurt us yet, maybe he will in the future. Maybe his successor will. A physician who trusts a hospital administrator is a fool.

    • richard scottr

      I long preached to residents that “hospitals are not your friends”. This was when most docs were self employed. –thus the bickering and ownership of patients. Now if more than half of docs in the U.S. are hospital employed there is more need for collegiality and working together. The forces on the outside of the hospital are far scarier than even a malfeasant administrator. I wish it were possible.