Improving the doctor-manager relationship. Building a successful partnership between management and clinical leadership: experience from New Zealand.

Aotearoa Health, RD1, Lyttelton, New Zealand.
BMJ (online) (Impact Factor: 17.22). 04/2003; 326(7390):653-4. DOI: 10.1136/bmj.326.7390.653
Source: PubMed
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    ABSTRACT: The most recent reforms, facilitated by the new integrated district health board structure and guidance from the New Zealand Health Strategy, have led to important quality progress in secondary care. This is associated with a 'convergence' of managerial and clinical cultures. The role of the 'centre' emerged only recently, providing support and resources to assist rather than exert leadership for quality. New Zealand appears to be adopting Freidson's preferred model of clinical organisation—a 'new professionalism' that recognises the importance of professional leadership and the organisational context for collective accountability for both health services quality and cost.
    The New Zealand medical journal 08/2004; 117(1198):U978.
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    ABSTRACT: Professional expectations for communication skills are explicit. These skills are needed for professional integrity and personal morale. Nevertheless, occupational physicians see doctors as patients for whom communication among between doctors and with their managers are the principal cause of their presenting health problems. To describe the frameworks of professionalism in medicine and the duty to care for good communication; present issues surrounding competency in communication skills; identify health problems among doctors associated with poor communication; and consider roles of economic appraisal and preventive strategies. A literature review identified key publications of professional expectations and requirements of doctors for their communication skills. Health problems among doctors associated with poor communication and presenting at least twice in a National Health Service (NHS) occupational health (OH) department during January-December 2002, were sought by manual retrieval of all doctor-patient records. The categories of communication difficulty were agreed in the focus group discussion of the presenting problems with occupational physicians. Nine categories of communication difficulties among doctors resulting in their presentation in OH departments with health problems were identified. Personal health problems caused by poor communication involve considerable time and potential litigation costs. Doctors need to be reminded of their responsibilities. Opportunity cost studies would help to strengthen an evidence base for the need of doctors to adhere to the professional requirements of good communication skills.
    Occupational Medicine 02/2005; 55(1):40-7. · 1.45 Impact Factor
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    ABSTRACT: This chapter explores the relationship between two components of our healthcare system: physicians, representing all providers of direct care, and hos- pital executives, referring to those with administrative responsibilities, regulatory obligations, and resource control. Currently, there is a wide gulf, or gap, represent- ing an adversarial interaction. Over the past 50 years, there have been dramatic, frankly, revolutionary, changes in the practice of medicine without corresponding or matching adjustments in the healthcare system. As a result, both physicians and healthcare executives are frustrated. The present adversarial tone between health- care executives and physicians adversely impacts healthcare outcomes. We discuss data showing differences between physicians and healthcare executives in education, background, work experience, and culture. However, the two share common core values: altruism, service, and love of a challenge. They also have common concerns about the future. We conclude that the real enemy is not the so-called other—physicians or healthcare executives—but our dysfunctional healthcare system. The common values and concerns shared by physicians and healthcare executives could provide the framework for successful communication leading to a bridge across the gap and a collaborative rather than confrontational relationship. Physicians could teach healthcare executives about clinical priorities, useful new technologies, and scientific methodology, including evidence-based decision making. Healthcare executives could educate physicians about management tools and techniques for planning, implementation, and assessment, especially systems thinking. To- gether as partners, healthcare executives and physicians could address many of the currently insoluble problems in healthcare.


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