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January 15, 2008



Administrators managing day to day operations, budgetary allocations, strategic planning, while clinicians - predominately MDs and RNs occupying their time with clinical issues places the two sides of any healthcare organization on two different but parallel tracks. This philosophy although may be quite aged, still exists. Typically each side doesn’t fully understand how the global issues of the organization affect each other’s arena of expertise. Each side becomes embroiled in an attempt to reach common ground – the improvement of the organization at their level. A myopic view for sure.

With the advent of insurers withholding imbursement for iatrogenic clinical outcomes it is vital that clinicians at all levels within the organization become integrated. Clinicians more so than other times have a direct affect on an organization’s economy and fiscal standing. Every hospital large or small has finite resources both consumable and non-consumable. A collaborative integration of clinicians into the business of healthcare demonstrates wisdom. The added knowledge for all parties should positively effect resource management and clinical decisions as well as actions, thereby improving quality of care. To be fair a study would need to be completed with administrators, MDs, RNs etc. to see if this type of integration would improve the organization’s service. The key here is healthcare organizational culture and getting buy in from the stakeholders.

Kenneth H. Cohn

Thanks Mike,

As I mentioned in my recent article in Frontiers in Health Service Medicine, Fall 2007, p.24, the paradigm of docs and nurses handling clinical issues and administrators handling finance and operations is broken.

In New Zealand, clinical outcomes improved when managers shifted from a preoccupation to resource management to improving clinical outcomes and physicians and nurses embraced their roles as stewards of community resources to achieve their goals jointly (Malcolm et al. Building a successful partnership between management and clinical leadership: Experience from New Zealand. Br Med Jl 326:653-4, 2003)

Does anyone in the blogosphere know of any successful US outcomes from adopting this approach?

Kenneth H. Cohn

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