Developing partnerships between physicians and healthcare executives.

Using an intensive interview methodology, this study examines factors that developed or destroyed cooperation in 10 physician-administrator management pairs. The data were collected from a six-multihospital system and another large sectarian teaching hospital. The factors studied included preconceptions, experiences prior to the formation of the pair, the emotional relationship between the two partners, and actions taken by one of the parties that affected the work of both. In general, physicians and administrators agreed more about factors promoting cooperation than factors destroying it. Moreover, few partners accurately assessed their counterparts' reactions to steps taken to promote cooperation. Most were unaware of behaviors reducing the willingness of the other to cooperate. Relationships improved or deteriorated based on beliefs by one partner about the other, rather than accurate perceptions of the other's behavior. The study is relevant to Diagnosis Related Groups (DRGs), the new federal financing mechanism for Medicare patients. Recent articles on Medicare's Prospective Payment System (PPS) predict conflicts between physicians and administrators as a result of the DRG program.