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Discussion: Diagnosis Critical: The Hospital-Physician RelationshipThere is a “love-hate” relationship between hospitals and the physician members of the medical staff. This is due to a high level of mistrust between the medical staff and the management structure of the hospitals. A root cause of the problem is the educational differences between doctors and executives. Doctors are trained to focus on a specific problem as opposed to a more global, holistic perspective that executives are trained in. Thus, it is important to have an understanding of the psychology of physicians to determine the most appropriate leadership and team-building approaches for evolving healthcare organizations.Another unique aspect of the hospital structure is the triad of power that exists. The medical staff, in general, is a self-governing independent body that functions under a set of bylaws. Yet in most states, the hospital board of trustees is liable for the actions of the medical staff, both financially and legally. Therefore, the board must oversee medical staff activities. The hospital administrator/chief executive officer (CEO) must also keep the medical staff happy so the work will be done and the hospital beds utilized.Physicians must continue to adapt to new organizational structures, from small to large group practices, such as accountable care organizations (ACO) and medical practice homes, as well as evolving standards of practice such as evidence-based medicine. All of these factors require physicians to develop new skill sets that many were not initially trained in. Physicians also must become familiar with new complex issues, regulations, and laws, such as the Patient Protection and Affordable Care Act (PPACA) and the Medicare Pay for Performance model. Medical practices face complex legal and regulatory issues, and failure to recognize these issues can to lead to criminal and civil penalties.For the Discussion this week, you will diagnose the causes of relationship success and failure between hospital leadership and medical staff. What “environmental stressors,” such as organizational structure, legal and regulatory demands, and financial responsibilities place a strain on the partnership? What “internal factors,” such as education, personality, and leadership and team-building skills affect the relationship health? What future demands on time, money, and competing obligations can you foresee for the relationship, especially in relation to emerging forms of medical organizations such as ACOs and medical homes, and new practice regimens such as evidence-based medicine and pay for performance structure?

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