Kaissi Amer
Department of Health Care Administration, Trinity University, San Antonio, TX 78212, USA.
Health Care Manag (Frederick). 2005 Apr-Jun;24(2):165-76. doi: 10.1097/00126450-200504000-00010.
Manager-physician relationships are a critical determinant of the success of health care organizations. As the health care industry is moving toward a situation characterized by higher scarcity of resources, fiercer competition, more corporitization, and strict cost-containment approaches, managers and physicians should, more than ever, work together under conjoint or shared authority. Thus, their relationship can be described as one of high rewards, but also of high risk because of the wide range of differences that exist between them: different socializations and trainings resulting in different worldviews, value orientation and expectations and different cultures. In brief, managers and physicians represent different "tribes," each with its language, values, culture, thought patterns, and rules of the game. This article's main objective is to determine the underlying factors in the manager-physician relationship and to suggest ways that make this relationship more effective. Four different organizational perspectives will be used. The occupational perspective will give insights on the internal characteristics of the occupational communities of managers and physicians. The theory of deprofessionalization of physicians will also be discussed. The structuring perspective will look at the manager-physician relationship as a structure in the organization and will determine the effects of contextual factors (size, task uncertainty, strategy, and environment) on this relationship and the resulting effect on performance and effectiveness of the organization. The culture and control perspective will help detect the cultural differences between managers and physicians and how these interact to affect control over the decision-making areas in the hospital. The power, conflict, and dialectics perspective will shed the light on the conflicting interests of managers and physicians and how these shape the "power game" in the organization. Consequently, a theoretical model of manager-physician relationships that encompasses all these perspectives is developed.
管理者与医生的关系是医疗保健机构成功的关键决定因素。随着医疗保健行业朝着资源更加稀缺、竞争更加激烈、更加企业化以及严格成本控制的方向发展，管理者和医生比以往任何时候都更应在联合或共享权力下共同协作。因此，他们的关系可被描述为回报丰厚，但也存在高风险，因为他们之间存在广泛差异：不同的社会化和培训导致不同的世界观、价值取向和期望以及不同的文化。简而言之，管理者和医生代表不同的“部落”，每个部落都有其语言、价值观、文化、思维模式和游戏规则。本文的主要目的是确定管理者与医生关系的潜在因素，并提出使这种关系更有效的方法。将采用四种不同的组织视角。职业视角将深入了解管理者和医生职业群体的内部特征。还将讨论医生去专业化理论。结构视角将把管理者与医生的关系视为组织中的一种结构，并确定情境因素（规模、任务不确定性、战略和环境）对这种关系的影响以及对组织绩效和有效性的最终影响。文化与控制视角将有助于发现管理者和医生之间的文化差异，以及这些差异如何相互作用以影响对医院决策领域的控制。权力、冲突与辩证法视角将揭示管理者和医生的利益冲突，以及这些冲突如何塑造组织中的“权力游戏”。因此，构建了一个涵盖所有这些视角的管理者与医生关系理论模型。
