To improve care and efficiency, administrators and docs need to connect

Dig deep beneath the burgeoning problems of spiraling cost and inefficiency, and you'll likely uncover a basic, core problem: the differing assumptions that physicians and administrators make about each other. To improve, we need to rethink how these two groups work together.

I often have witnessed the stylized minuet that goes on between these disparately trained groups over budgets, policy and a myriad of details that are involved in running such a complex organism as a hospital. It's a wonder so many of them function as well as they do.

Many practicing physicians think that administrators, while individually able and sincere, are too focused on bean-counting and bureaucracy. Conversely, executives too often see physicians as professional prima donnas who "just don't understand" the operational and regulatory complexities of running a modern hospital. And believe me; I'm phrasing this delicately.

Of course, both groups are right--up to a point.

Historically there has been a conceptual disconnect between these two groups. Regardless of background, administrators commonly are taught to work in teams, as part of a system, sharing responsibility and employing consensus decision-making; physicians are bred to be the Lone Ranger, solely making important decisions for our patients and assuming personal responsibility for them.

If the people involved at all levels don't have the background to understand what is driving the other players and where those driving ideas came from, only frustration will ensue. And frustration is a very expensive luxury in healthcare.

Hospital administrators come from a variety of backgrounds; law, accounting, public health, and business. They select themselves out by experience, interest and aptitude. Practicing docs, on the other hand, have a common point of view in their training, but there are visible generalities on both sides to compare that can help our understanding.

To truly optimize efficiency, cost control and patient welfare, organized medicine needs to understand that administrative and organizational savvy is not "for them," but for us.

The practice of medicine does not exist in a bubble outside of society's functioning, and physicians need to be trained from the beginning to understand and master the systems that we operate in to be the best doctors for our patients. As in so many other areas of human endeavor, Walt Kelly got it right for healthcare when he had Pogo say "We have met the enemy and he is us." 

Jeffrey Brown, MD, CPE, a practicing physician, is a partner on the Stanford Graduate School of Business Alumni Consulting Team and consults for the California Medical Board