Cohn Kenneth, Friedman Leonard H, Allyn Thomas R
Cambridge Management Group, USA.
Front Health Serv Manage. 2007 Fall;24(1):11-26.
In response to a rapidly changing healthcare marketplace, a variety of new business models have arisen, including new specialties (hospitalists), selective care (concierge medicine), and joint ventures (ambulatory surgical centers, specialty hospitals), some with hospitals and others with independent vendors. Since both hospitals and physicians are feeling the squeeze of rising expenses, burdensome regulations, heightened consumer expectations, and stagnant or decreasing reimbursement, the response to global economic competition and the need to improve clinical and financial outcomes can bring physicians and hospitals together rather than drive them farther apart. In response to perceived threats, physicians and hospital executives can engage in defensive reasoning that may feel protective but can also lead to mural dyslexia, the inability or unwillingness to see the handwriting on the wall. The strategies of positive deviance (finding solutions that already exist in the community rather than importing best practices), appreciative inquiry (building on success rather than relying solely on root-cause analyses of problems), and structured dialogue (allowing practicing physicians to articulate clinical priorities rather than assuming they lack the maturity and will to come to consensus) are field-tested approaches that allow hospital leaders to engage practicing physicians and that can help both parties work more interdependently to improve patient care in a dynamically changing environment. Physician-hospital collaboration based on transparency, active listening, and prompt implementation can offer sustainable competitive advantage to those willing to embark on a lifetime learning journey.
为应对快速变化的医疗市场，出现了多种新的商业模式，包括新的专业领域（住院医师）、选择性医疗（礼宾医疗）和合资企业（门诊手术中心、专科医院），有些与医院合作，有些与独立供应商合作。由于医院和医生都感受到了费用上涨、监管繁重、消费者期望提高以及报销停滞或减少的压力，应对全球经济竞争以及改善临床和财务结果的需求可能会使医生和医院走到一起，而不是使它们分道扬镳。面对感知到的威胁，医生和医院管理人员可能会进行防御性推理，这可能会让人感觉有保护作用，但也可能导致“壁画诵读困难”，即无法或不愿意看清形势。积极偏差策略（寻找社区中已有的解决方案，而不是引入最佳实践）、肯定性探究（基于成功，而不是仅仅依赖于对问题的根本原因分析）和结构化对话（让执业医生阐明临床优先事项，而不是假设他们缺乏达成共识的成熟度和意愿）是经过实践检验的方法，可让医院领导者与执业医生互动，并有助于双方在动态变化的环境中更相互依赖地工作，以改善患者护理。基于透明度、积极倾听和迅速实施的医患合作可为那些愿意踏上终身学习之旅的人提供可持续的竞争优势。
