Decision support systems and applications

Trust Between Management and Physicians in Hospitals

Trust: 1 a: assured reliance on the character, ability, strength, or truth of someone or something; b: one in which confidence is placed; 2 a: dependence on something future or contingent - Merriam-Webster Online.

Do families of patients who are hospitalized for injuries or illness "trust" that their loved ones are getting the best possible care? Of course families do, in all cases, have an "assured reliance" (Merriam-Webster) on a doctor's "character, ability, strength [and] truth," when it comes to care-giving of family members. So, there can be no doubt: the element of trust has always been part of the medical community's pivotal responsibilities when it comes to care-giving to injured or ill citizens.

And meantime, if trust is indeed a "key element" in forging strong work relationships between doctors and administrators - with the good health and well-being of patients at risk, and with potential malpractice suits looming on the horizon - why, it's fair to ask, is so little known in the medical community about the ingredients that go into creating trust? This need for trust between the two groups would appear to be a no-brainer, a need that is so obvious it shocks the senses to realize that trust is so elusive. But according to the Melissa J. Succi research, systems for creating trust are not very often in place.

And while the Succi (et al.) research indicates that there is a dearth of information as to the ways and means of developing solid ties of trust, the article states that most "physicians perceive greater trust" between themselves and administrators "when they hold more power" in four decision-making fields. Power, that magic word, apparently plays a key role in doctors' establishing a sense of trust with management.

As for administrators, their sense of trust with physicians, Succi asserts, boils down to one area - "cost/quality management." When alluding to costs of providing services to patients, therein lies a very important factor in running a hospital, and there is little doubt that administrators are keenly interested in keeping costs from rising out of sight. And since hospital administrators are "rewarded for conserving resources and containing hospital costs" and physicians are gaining credibility for offering ever-higher levels of care, Succi believes these two conflicting concepts create an erosion of trust.

So, if one accepts that there is a salient trust factor lacking, and that both administrators and doctors say they need more authority to run hospitals, the problem seems to be dichotomous: to wit, in her "Managerial Implications" section of the paper, Succi states that "Greater power and involvement in hospital decisions means that managers and physicians may spend less time in their areas of expertise," and they may, because of their new areas of responsibility, spend "more time in new and unfamiliar territories." Both groups want more power to run hospitals more efficiently, but by giving them addition power, they may not carry out their duties as fully and effectively. How wasteful and unprofessional is that?

And when it comes to incentives for doctors to do their work excellently (such as being clinically productive), how will they have time to achieve those incentives if they are bogged down in boring meetings with administrators? That is a fundamentally key question that cries out for an answer. (Succi's work suggests doctors be paid bonuses for attending administration-type meetings, but that seems a stretch; if they wanted more power, and they already earn a fabulous living from their profession, why pay them extra for what they wanted to do in the first place? With power and authority come decision-making meetings. There's no getting around that fact.)

The Jones' article, meantime, doesn't propose incentives, and indeed offers a more simplistic approach to building trust between the two groups. Jones, a CEO says, first, the two sides need to "begin by listening" (which seems almost too pedestrian, cliche and obvious to even be in the vocabulary of a CEO); and secondly, they need to "recognize that the system creates rivalry." Jones' remedy continues with number three: "Let quality patient care be your common objective."

Now, to the uninformed lay person walking down the street in front of a busy hospital, those three precepts probably sound like a good start towards unity between doctors and administrators. But to the sharp eye of an informed objective person who is conversant with hospital issues, it sounds like a second-grade solution to a PhD-level conundrum. Saying to doctors and managers, "Let quality patient care be your common objective," is like saying to a major league baseball team and their manager, "Let winning ball games by your common objective," or to an orchestra leader, "let your music entertain the audience."