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In the eye of the beholder: mutual obligations and areas of ambiguity in the hospital-physician relationship

Jeroen Trybou UGent, Lieven Annemans UGent and Paul Gemmel UGent (2012) European Academy of Management, 12th Conference, Papers.
abstract
Internationally, many countries are increasing provider accountability for cost and quality of the delivered care. In this challenging environment hospital executives struggle to build effective hospital-physician relations. However, despite the importance of the hospital-physician relationship there has been little research which has examined how physicians and hospital executives describe the terms of their working relationship. This paper seeks to fill this gap by reporting findings of a qualitative study in which we explored the psychological contract between physicians and the hospital they practice at. In-depth interviews with physicians and executives (n=30) of three Belgian hospitals were performed. Our analysis of the transcribed interviews yielded a rich understanding of how physicians and hospital executives interpret and experience mutual obligations and areas of ambiguity within their psychological contract. We found that a distinction should be made between on the one hand administrative obligations (adequate operational support, responsive decision making processes and attractive facilities) and on the other hand professional obligations (clinical excellence and physician autonomous medical decision making). In addition, two areas of ambiguity could be identified reflecting both dimensions of the psychological contract. Firstly, physicians act as independent caregivers generating professional fees. A trade-off exists in their day-to-day interaction with the hospital. Therefore the interpretation about the way the care should be organized differs between executives and physicians. Secondly, hospital prospective financing systems lay the accent on cost-effective care from a societal perspective. In contrast, physicians are remunerated mainly by fee-for-service. The extent to which physicians should take into account the impact that their medical decisions have on the hospital bottom line varies. Our aspiration is that the findings of this study will assist in supporting hospital executives and physicians to build cooperative relationships needed to improve the quality and cost-effectiveness of current health care delivery.
Please use this url to cite or link to this publication:
author
organization
year
type
conference
publication status
published
subject
keyword
Alignment, Hospital Physician Relationships, Integration
in
European Academy of Management, 12th Conference, Papers
pages
22 pages
publisher
Erasmus University. Rotterdam School of Management
place of publication
Rotterdam, The Netherlands
conference name
12th European Academy of Management conference (EURAM 2012) : Social innovation for competitiveness, organizational performance and human excellence
conference location
Rotterdam, The Netherlands
conference start
2012-06-06
conference end
2012-06-08
language
English
UGent publication?
yes
classification
C1
copyright statement
I have transferred the copyright for this publication to the publisher
id
2963229
handle
http://hdl.handle.net/1854/LU-2963229
date created
2012-07-15 10:34:12
date last changed
2013-04-04 11:06:23
@inproceedings{2963229,
  abstract     = {Internationally, many countries are increasing provider accountability for cost and quality of the delivered care. In this challenging environment hospital executives struggle to build effective hospital-physician relations. However, despite the importance of the hospital-physician relationship there has been little research which has examined how physicians and hospital executives describe the terms of their working relationship. This paper seeks to fill this gap by reporting findings of a qualitative study in which we explored the psychological contract between physicians and the hospital they practice at. In-depth interviews with physicians and executives (n=30) of three Belgian hospitals were performed. Our analysis of the transcribed interviews yielded a rich understanding of how physicians and hospital executives interpret and experience mutual obligations and areas of ambiguity within their psychological contract. We found that a distinction should be made between on the one hand administrative obligations (adequate operational support, responsive decision making processes and attractive facilities) and on the other hand professional obligations (clinical excellence and physician autonomous medical decision making). In addition, two areas of ambiguity could be identified reflecting both dimensions of the psychological contract. Firstly, physicians act as independent caregivers generating professional fees. A trade-off exists in their day-to-day interaction with the hospital. Therefore the interpretation about the way the care should be organized differs between executives and physicians. Secondly, hospital prospective financing systems lay the accent on cost-effective care from a societal perspective. In contrast, physicians are remunerated mainly by fee-for-service. The extent to which physicians should take into account the impact that their medical decisions have on the hospital bottom line varies. Our aspiration is that the findings of this study will assist in supporting hospital executives and physicians to build cooperative relationships needed to improve the quality and cost-effectiveness of current health care delivery.},
  author       = {Trybou, Jeroen and Annemans, Lieven and Gemmel, Paul},
  booktitle    = {European Academy of Management, 12th Conference, Papers},
  keyword      = {Alignment,Hospital Physician Relationships,Integration},
  language     = {eng},
  location     = {Rotterdam, The Netherlands},
  pages        = {22},
  publisher    = {Erasmus University. Rotterdam School of Management},
  title        = {In the eye of the beholder: mutual obligations and areas of ambiguity in the hospital-physician relationship},
  year         = {2012},
}

Chicago
Trybou, Jeroen, Lieven Annemans, and Paul Gemmel. 2012. “In the Eye of the Beholder: Mutual Obligations and Areas of Ambiguity in the Hospital-physician Relationship.” In European Academy of Management, 12th Conference, Papers. Rotterdam, The Netherlands: Erasmus University. Rotterdam School of Management.
APA
Trybou, J., Annemans, L., & Gemmel, P. (2012). In the eye of the beholder: mutual obligations and areas of ambiguity in the hospital-physician relationship. European Academy of Management, 12th Conference, Papers. Presented at the 12th European Academy of Management conference (EURAM 2012) : Social innovation for competitiveness, organizational performance and human excellence, Rotterdam, The Netherlands: Erasmus University. Rotterdam School of Management.
Vancouver
1.
Trybou J, Annemans L, Gemmel P. In the eye of the beholder: mutual obligations and areas of ambiguity in the hospital-physician relationship. European Academy of Management, 12th Conference, Papers. Rotterdam, The Netherlands: Erasmus University. Rotterdam School of Management; 2012.
MLA
Trybou, Jeroen, Lieven Annemans, and Paul Gemmel. “In the Eye of the Beholder: Mutual Obligations and Areas of Ambiguity in the Hospital-physician Relationship.” European Academy of Management, 12th Conference, Papers. Rotterdam, The Netherlands: Erasmus University. Rotterdam School of Management, 2012. Print.