Framing the Issue

Framing the Issue

  • The CVS Health associate CMO details the company's growth strategy and the tremendous disruption he expects from telehealth.
  • During a presentation Thursday at the American College of Healthcare Executives 2016 Congress, Andrew Sussman, M.D., executive vice president and associate chief medical officer of CVS Health, told hospital leaders how the company plans to do so. The nation’s largest retail clinic chain, with more than 1,135 locations in 33 states, has been in rapid expansion mode in recent years.
  • The increasingly consumer-minded patient is also fueling growth for the Woonsocket, R.I., retail chain. With patients being asked to take on a larger share of the health care dollar, they’re shopping around more carefully for the most affordable experience. More often than not, they’re ending up at CVS’s doors.
  • Sussman believes telehealth certainly has the potential to turn health care on its head.
  • Short and sweet story

As a doctor of medicine and a doctor of health administration, I endeavor to find ways to strengthen the relationship between medicine and management (that is, between physician leaders and nonphysician leaders). I believe we can have a stronger health care system, improve the quality of our patient care, and effectively reduce the waste in budgets and resources by creating interprofessional accountability toward our common goals. To that end, I designed a national research study a few years ago: the Canadian National Study of Interprofessional Relationships between Physicians and Hospital Administrators.

The study showed differences in how health care leaders perceive the quality of interprofessional relationships between physicians and health care administrators, or IRPH. Equivalent terms are physician-hospital relations, doctor-manager relations, physician-health care system relations, physician-administrator relations, doctor-executive relations and physician engagement.

After completing the statistical analyses, I found that senior health care leaders perceived a high quality of IRPH, but midlevel managers did not seem to agree completely with their senior leaders. Nonphysician leaders also perceived a high quality of IRPH, but physician leaders did not seem to agree with the nonphysician leaders. When I considered the seniority of leadership positions and the educational background of leaders, the results were just as interesting: Senior non-MD leaders saw IRPH as "great." But midlevel non-MD leaders saw IRPH as "less than great." Senior MD leaders saw IRPH as "good." But midlevel MD leaders saw IRPH as "less than good."

In other words, a huge gap exists between the opinions of senior nonphysician leaders, who consider IRPH to be of high quality, and their physician colleagues in midlevel management, who consider IRPH to be of low quality. There are reasons physician leaders are not as content as nonphysician leaders in their evaluation of IRPH.

Identifying the Factors that Influence Relationships

I used, with permission, the questionnaire that Thomas Rundall, Ph.D., developed in 2002 for a U.K. study and a smaller-sized U.S. study. However, I revised it slightly and chose a different statistical approach, using factor analysis and dividing the questions into seven variables that could influence how physician leaders and nonphysician leaders rank the quality of doctor-manager relations at their local health care system.

The variables were power; resources; clinical vs. financial decision-making; health technology (including information technology); contracts; professional capability and knowledge; and communication and teamwork. When I assessed the degree of influence of the seven variables (individually as well as simultaneously), the most effective variable for assessing interprofessional relationships, to my surprise, was "communication and teamwork." In other words, in organizations where the teamwork and communication were effective and useful, the leaders rank quality of doctor-manager relations higher compared with organizations in which clinical leaders and nonclinical leaders did not have time for communication.

Defining and Improving Interprofessional Relations

In many countries (including Canada), most media coverage of health care centers on finances and the arguments about them. When responding to such arguments, physician and nonphysician leaders primarily express a desire to establish more effective ways of communication between themselves.  Leaders of clinical and nonclinical disciplines who are involved with patient care want inclusion and shared decision-making, or interprofessionalism.

Clinicians in Canada have learned to respect interprofessional care because they realize that the quality of patient care depends on the level of collaboration among health care providers. Interprofessional relations require being informed and responsible from the planning stages of patient care to the reaching of common goals. Physicians would like to be part of the decision-making process of the health care organization in which they work rather than just receiving notes and memos related to the decisions being made by administrators.

Physician leaders would like to be included in discussions about policies and regulations at their organizations so they can support their colleagues in managing the budget and can share the pride of having a successful health care system. A simple gesture like a thank-you letter to physician leaders for their time and effort, or publishing an online version of the organization's newsletter, can help physicians to feel valued and appreciated. Money is not the answer to all questions, as the study participants specified.

Other suggestions and opinions of the participating leaders are summarized in the resources listed below, but one suggestion is worth repeating here: "Administrators want to meet with physicians during patient care hours. Can managers meet with doctors before 8 a.m. and after 5 p.m.? Can they set up an online meeting so doctors do not lose time [out] of [their] patient care clinics?"

Recognizing the Most Important Stakeholders

I believe health care leaders are the people who are most affected by doctor-manager relationships. Two experiences from my personal life may serve to illustrate this belief.

As soon I walked into the operating room of the hospital where my son was to have surgery on his tonsils, I started praying that the clinical and nonclinical leaders would work well together, communicate effectively, collaborate flawlessly, set aside their differences, and focus on the well-being of my family member lying on the operating room bed.

Another time, when my mother fell on her bed and we had to call 911, I began thinking whether budget issues and administrative policies would hinder the degree of care that a senior like her would receive. So I did not leave the side of her bed for 10 days after she was admitted. I sat and slept beside her while I observed the excellent work of many professionals who shape our health care delivery system.

Are we not the people most affected by the working relationships of doctors and managers? If not us, then who?

Acknowledging Our Mutual Interests

I also believe doctors accept leadership roles because they care about the strength of the health care system. To cite another personal experience:

While my mother was hospitalized, I needed to participate in an annual general meeting as the chairof the communication committee of the American College of Healthcare Executives. At that time, I asked myself why physicians should take on leadership roles when they are not compensated for their work on committees and governing boards. I looked at my mother's bed and I saw the word chair. The answer was right in front of my eyes.

Physicians are willing to take on nonpaying leadership roles because the person lying in the hospital bed could be one of their loved ones. We, clinical leaders and nonclinical leaders alike, are serving those who provide care for our family members and our friends. Acting as chair, committee member, board member, executive member, and in many other positions, physicians accept leadership roles because they are leaders who truly care.

Let us learn together as interprofessional teams of leaders to strengthen health care for ourselves and our loved ones. I believe we will.

Author's note: Many researchers talk about physician-hospital relations and how these relationships can be improved. Some of the best solutions were presented by both clinical and nonclinical leaders who participated in my study.   

More information about the study findings can be found in resources listed below:

  1. http://pqdtopen.proquest.com/pubnum/3583264.html  
  2. www.youtube.com/watch?v=PqVVW-v1qoU
  3. www.ncbi.nlm.nih.gov/pubmed/25850163
  4. http://www.cspexecs.com/assets/cspejournalfall.pdf
  5. http://www.cspexecs.com/assets/cspejournalspring.pdf
  6. http://www.nhlc-cnls.ca/assets/25_Canadian%20national%20view_Samadi-niya.pdf
  7. http://oaccac.com/Who/Conference/Documents/2015%20Presentations/FA07-EffectsOf.pdf
  8. http://oaccac.com/Who/Conference/Documents/2015%20Posters/Factorsthatinfluence.pdf

Atefeh Samadi-niya, M.D., D.H.A. (Ph.D.), C.C.R.P., is a physician and doctor of health administration in the greater Toronto area. She was chosen to present at the 2015 ACHE Congress as well as the World Hospital Congress 2015 (IHF39).