Rundall Thomas G, Davies Huw T O, Hodges Claire-Louise
Division of Health Policy and Management, University of California, Berkeley, California, USA.
J Healthc Manag. 2004 Jul-Aug;49(4):251-68; discussion 268-70.
In many developed countries, including the United States and the United Kingdom, the relationships between doctors and hospital managers are strained. The purposes of this article are to examine survey data from the United States and the United Kingdom on doctor-manager relationships and to identify the sources of strain common to both countries as well as those particular to each country's health system. The two countries exhibited many similarities. A very high proportion of respondents from both countries identified external factors-such as governmental budget cuts, pressure from third parties to increase physicians' workload, and the turbulence of the policy environment-as important barriers to improving doctor-manager relationships. Other common sources of strain were concerns over resource availability and the relative power of doctors and managers. Sources of relationship tension particular to each country were also found. Substantial divergence of opinion was expressed with respect to internal factors that affect doctor-manager relationships. Respondents from the United States were more negative than those from the United Kingdom in their ratings of teamwork and communication between doctors and managers, and they were also less likely to have confidence in the medical staff. Respondents from the United Kingdom were more likely to believe that hospital management is driven more by financial than clinical priorities. Managers can implement several strategies to improve doctor-manager relationships, including greater organizational transparency in decision making; more frequent communication between managers and doctors; and more physician involvement in decision making, especially with regard to important resource-related decisions, and in organizational governance.
在包括美国和英国在内的许多发达国家，医生与医院管理人员之间的关系紧张。本文旨在研究来自美国和英国的关于医生与管理人员关系的调查数据，并找出两国共有的关系紧张根源以及每个国家卫生系统特有的根源。两国表现出许多相似之处。来自两国的很大比例的受访者认为外部因素——如政府预算削减、第三方增加医生工作量的压力以及政策环境的动荡——是改善医生与管理人员关系的重要障碍。其他常见的关系紧张根源包括对资源可用性的担忧以及医生和管理人员的相对权力。也发现了每个国家特有的关系紧张根源。在影响医生与管理人员关系的内部因素方面，意见存在很大分歧。美国受访者对医生与管理人员之间的团队合作和沟通的评价比英国受访者更负面，他们对医务人员的信心也更低。英国受访者更有可能认为医院管理更多地受财务而非临床优先事项驱动。管理人员可以实施多种策略来改善医生与管理人员的关系，包括在决策中提高组织透明度；管理人员与医生之间更频繁的沟通；以及让医生更多地参与决策，特别是在重要的资源相关决策和组织治理方面。
