An integrative model of the management of hospital physician relationships

Hospital Physician Relationships (HPRs) are of major importance to the health care sector. Drawing on agency theory and social exchange theory, we argue that both economic and noneconomic integration strategies are important to effective management of HPRs. We developed a model of related antecedents and outcomes and conducted a systematic review to assess the evidence base of both integration strategies and their interplay. We found that more emphasis should be placed on financial risk sharing, trust and physician organizational commitment

In the eye of the beholder: mutual obligations and areas of ambiguity in the hospital-physician relationship

Internationally, many countries are increasing provider accountability for cost and quality of the delivered care. In this challenging environment hospital executives struggle to build effective hospital-physician relations. However, despite the importance of the hospital-physician relationship there has been little research which has examined how physicians and hospital executives describe the terms of their working relationship. This paper seeks to fill this gap by reporting findings of a qualitative study in which we explored the psychological contract between physicians and the hospital they practice at. In-depth interviews with physicians and executives (n=30) of three Belgian hospitals were performed. Our analysis of the transcribed interviews yielded a rich understanding of how physicians and hospital executives interpret and experience mutual obligations and areas of ambiguity within their psychological contract. We found that a distinction should be made between on the one hand administrative obligations (adequate operational support, responsive decision making processes and attractive facilities) and on the other hand professional obligations (clinical excellence and physician autonomous medical decision making). In addition, two areas of ambiguity could be identified reflecting both dimensions of the psychological contract. Firstly, physicians act as independent caregivers generating professional fees. A trade-off exists in their day-to-day interaction with the hospital. Therefore the interpretation about the way the care should be organized differs between executives and physicians. Secondly, hospital prospective financing systems lay the accent on cost-effective care from a societal perspective. In contrast, physicians are remunerated mainly by fee-for-service. The extent to which physicians should take into account the impact that their medical decisions have on the hospital bottom line varies. Our aspiration is that the findings of this study will assist in supporting hospital executives and physicians to build cooperative relationships needed to improve the quality and cost-effectiveness of current health care delivery

Fulfillment of administrative and professional obligations of hospitals and mission motivation of physicians

Background: To be successful, hospitals must increasingly collaborate with their medical staff. One strategic tool that plays an important role is the mission statement of hospitals. The goal of this research was to study the relationship between the fulfillment of administrative and professional obligations of hospitals on physicians' motivation to contribute to the mission of the hospital. Furthermore the mediating role of the physicians' emotional attachment to the hospital and moderation effect of the exchange with the head physicians were considered. Methods: Self-employed physicians of six hospitals participated in a survey. Descriptive analyses and linear regression were used to analyse the data. Results: The results indicate that affective commitment mediated the relationship between psychological contract fulfillment and mission statement motivation. In addition, the quality of exchange with the Chief Medical Officer moderated the relationship between the fulfillment of administrative obligations and affective commitment positively. Conclusion: This study extends our understanding of social exchange processes and mission statement motivation of physicians. We showed that when physicians perceive a high level of fulfillment of their psychological contract they are more committed and more motivated to contribute to the mission statement. A high quality relationship between physician and Chief Medical Officer can enhance this reciprocity dynamic

3D-printing techniques in a medical setting : a systematic literature review

Background: Three-dimensional (3D) printing has numerous applications and has gained much interest in the medical world. The constantly improving quality of 3D-printing applications has contributed to their increased use on patients. This paper summarizes the literature on surgical 3D-printing applications used on patients, with a focus on reported clinical and economic outcomes. Methods: Three major literature databases were screened for case series (more than three cases described in the same study) and trials of surgical applications of 3D printing in humans. Results: 227 surgical papers were analyzed and summarized using an evidence table. The papers described the use of 3D printing for surgical guides, anatomical models, and custom implants. 3D printing is used in multiple surgical domains, such as orthopedics, maxillofacial surgery, cranial surgery, and spinal surgery. In general, the advantages of 3D-printed parts are said to include reduced surgical time, improved medical outcome, and decreased radiation exposure. The costs of printing and additional scans generally increase the overall cost of the procedure. Conclusion: 3D printing is well integrated in surgical practice and research. Applications vary from anatomical models mainly intended for surgical planning to surgical guides and implants. Our research suggests that there are several advantages to 3D- printed applications, but that further research is needed to determine whether the increased intervention costs can be balanced with the observable advantages of this new technology. There is a need for a formal cost-effectiveness analysis