Monday, November 15, 2010

Resolving Hospital-Physician Conflicts

Given the systematic scheduled fee reductions for hospitals and physicians under the new health reform law, more hospital-physician conflicts are inevitable.


Hospitals and physicians desperately need each other, yet they compete. As someone observed, “Without doctors, hospitals are simply buildings with bad food.” It doesn’t take a rocket scientist to know this is a formula for conflict and complex negotiations.

This problem came to mind as I was reading a newspaper piece about a dispute between a hospital CEO and his Board of Directors. Eight of the 12 directors were members of the medical staff. Many of the doctors were demoralized by changes in the health care system.

What struck me about the newspaper article was the complexity of the hospital-doctor arrangements and the various special interests of the physicians.

These special physician business interests included.

• Hospitalists, employed by the hospital to take care of admitted patients.

• Private practice doctors with exclusive hospital contracts.

• A hospital network of dozens of primary care doctors and specialists who work out of their offices, created to relieve doctors of administrative doctors.

• Independent doctors who want to keep their private practices and administer their own business functions and who seek to be consulted about hospital plans.

According to the president of the medical staff, “A lot of physicians are scared right now. The health care economy is changing, and people are trying to figure out where they fit in.”

This anxiety brings to mind an interview I conducted back in 1999 for The Physician Executive with Leonard Marcus, PhD, Director of the Program for Healthcare Negotiation with Conflict Resolution at the Harvard School of Public Health. Marcus had just published a book Renegotiating Health Care: Resolving Conflict to Build Collaboration (Jossey-Bass, 1999).

I recommend readers of this blog engaged in conflicts between hospitals and doctors buy a copy of the book in order to understand the nature of these complex conflicts and how to move beyond them.

Marcus asks, “What if this complex puzzle does not fit smoothly together? What is there are differences about what and who is more important? What if a mistake occurs? What is there is a clash of personalities among people who must closely interrelate? What is there is dissonance between the policies and procedures defining these relationships? What if people are working under different incentives? How will this affect what do and how we do it?”
What if and how? You may need a mediator to resolve the conflicts and build collaboration.

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