Finding a Balance in Healthcare

Problem Statement

The primary goal of the health care sector is to enhance patient health outcomes. Unfortunately, most of the times, the objective is not realized because incentives and structures are not aligned for maximizing population health. Competing interests between care providers and business/financial components of healthcare usually prohibit the alignment. In a simplified explanation, care providers such as different clinicians and nurses usually have contradicting issues with hospital management tasked with overseeing financial/business components that define costs, hospital stays, length of stay, discharge, surgical denials, and emergency department services among others. An imbalance occurs when care providers function separately from hospital managers, whose role is creating and enhancing systems of accountability for the practice of healthcare (Waldman, Smith & Hood, 2006). In essence, a conflict occurs when care providers are focused on delivery of quality health services but are prohibited by the conflicting business model within the hospital system. The health providers believe that the managers are simply bean counters and at the center of their managerial decisions are solely economic rationales. 

Proposed Solutions

The imbalance between health care providers and managers has direct effects on public health. If left unresolved, the issue is likely to override the goals of the Affordable Care Act leading to costly health care and poor health outcomes for the health consumers. In this context, varieties of solutions are necessary for finding a balance between the two conflicting issues. Such include strategies to alternative dispute resolutions and implementation of effective communication within the organization structures. Along with that, transparency on medical decision-making process as well as the involvement of healthcare providers in decisions affecting the health care system should be explored.

Background Information

In the United States, healthcare delivery has undergone a comprehensive transformation in the last several decades. Dramatic changes such as medical technology have occurred among other clinical and administrative areas. However, despite the influx of changes, there is one particular aspect that has refused to change. The conflicting relationship between healthcare providers and hospital managers has continuously remained a regular part in the daily functioning of healthcare settings. In fact, with each passing decade, it seems that the dysfunctional relationship has intensified. In a bid to address this conflict, the United States implemented the Patient Protection and Affordable Care Act (PPACA), as a way of increasing access and improving the quality of care delivery to patients (DuBois, 2013). By implementing the primary goals, the Affordable Care Act aims at reducing health care cost, which is driving variable in the imbalances. At a glance, the conflict between managers and healthcare providers can be understood through the lens of various contributing factors such as educational differences, varying career paths, regulatory oversight, and reimbursement.

Inherent Values

Systematic structural barriers have inherently inhibited the health care system creating an opportunity for conflict of interests between managers and providers of health care. These barriers include but not limited to lack of effective communication, flawed communication structures, and lack of alternatives to dispute resolution.

Resources

Health providers and managers should focus on building better working relationships. Improved and efficient means of communication are essential for both parties to achieve the goals of providing quality care and in an affordable way. Although it may sound unrealistic, healthcare providers can also be re-educated through workshops and conferences to fit within the work environment. Likewise, managers should also undergo various training programs provided by the hospital to nurture a better understanding of what motivates care providers professionally.

Conclusion

Healthcare in the United States is a very complicated and integrated system that involves several stakeholders. For efficient and sustainable change to be achieved, healthcare providers and managers must work together in an environment of mutual respect and empathy. They must discard long-standing stereotypes and misconceptions likely to breed an atmosphere of contempt and focus towards the shared goal of quality and affordable health care.

References

DuBois, S. (2013). Hospitals Face Whole New World Under Health Law. USA Today. Retrieved from: https://www.usatoday.com/story/news/nation/2013/10/20/hospitals-face-whole-new-world-under-health-law/3078353/

Waldman, J. D., Smith, H. L., & Hood, J. N. (2006). Healthcare CEOs and physicians: reaching common ground. Journal of Healthcare Management / American College of Healthcare Executives, 51(3), pp. 183-184.

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