Research Projects

Effective manager-physician relationships and the role of 'trust'

Researchers

Huw Davies, Professor of Health Care Policy & Management, Director of Centre for Public Policy & Management (University of St Andrews), and Associate Director of Social Dimensions of Health Institute (Universities of Dundee and St Andrews),
Claire-Louise Hodges (University of Dundee),
Thomas Rundall (UC Berkeley)

Brief Description

This transatlantic project involves a two-year study of leadership and decision-making between managers and doctors in health services in the US and the UK.

Background

As organisational arrangements for health care evolve, physicians and administrators are forging new relationships. The purpose of this study was (a) to assess how physicians and administrators rate the quality of their working relationships; and (b) to examine areas of convergence or divergence of views about current arrangements.

Study Design

Postal questionnaire surveys were used to assess the views of senior hospital physicians and senior hospital administrators in both the US and the UK. The questionnaires listed statements about the hospital-physician relationship around issues of knowledge, power, understanding, communication, decision-making, resource availability, performance assessment and teamwork, and respondents were asked to use a Likert-scale with options ranging from strongly agree to strongly disagree.

Population studied

In the US, the questionnaire was mailed to senior hospital administrators and physician leaders in 102 hospitals within the VHA West Coast hospital network; in the UK, the questionnaire was mailed nationwide to equivalent senior staff in 221 acute hospital organisations.

Principal findings

In both countries, administrators were more optimistic than physician leaders about the state of hospital-physician relationships, and UK respondents were more satisfied than their US counterparts. Areas of widespread dissatisfaction centred on lack of resources (UK), speed of administrative response (US) and arrangements for effective collaboration (US). Physicians and administrators also diverged on many issues, with physicians being far less likely than administrators to agree that existing resources and their deployment were either sufficient or efficient.

Conclusions

These surveys reveal some important areas of dissatisfaction with the nature of hospital-physician relationships among both senior administrators and senior physicians. They also show significant areas of divergence of view between physicians and administrators.

Implications for Policy

Strong and effective hospital-physician relationships are essential for both the success and reform of health care delivery systems. External factors, such as payment arrangements (US), structural reform (UK) and regulatory frameworks (both countries) can impact deleteriously on internal efforts to build such effective relationships. Nonetheless, there would appear to be much that physicians and administrators can accomplish together, by improving communication and trust, and developing more collaborative and participative cultures.

Primary Funding Source

VHA (West Coast), The Nuffield Trust (London) and The Commonwealth Fund (New York).

Key references

Davies HTO, Hodges CL, Rundall TG. Views of doctors and managers on the doctor-manager relationship in the NHS. BMJ 2003;326:626-8.
Davies HTO, Harrison S. Trends in doctor-manager relationships. BMJ 2003;326:646-9.
Davies HTO, Hodges CL, Rundall TG. Consensus and contention: doctors' and managers' perceptions of the doctor-manager relationship. Br J Hlth Care Man 2003;9(6):202-8.
Rundall TG, Davies HTO, Hodges CL. Doctor-Manager Relationships in the United States and the United Kingdom. Journal of Healthcare Management (in press)