Principles of partnership: successfully working with medical staff

20
May 18
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Many health organisations are frustrated by the difficulty they have in engaging doctors in the organisation.  There are frequent complaints from health service executives that doctors do not come to key meetings, do not collaborate on improvements, want to do things their way and stymie change. There are just as many complaints from medical staff about health service executives. These include feeling undervalued and disrespected, having their opinions discounted and wanting them to continually do more for less or for no payment.

It is generally the case that both parties are right in their perceptions as often they are working in parallel universes. The health executives have no understanding of doctors, their training, their motivations, their passions and their perceptions. On the other hand the doctors have no understanding how health systems and services work, the considerable stresses of the health executive and the highly political environment that impacts on today’s health services. Neither party takes to time to really understand the other, or to think of the individuals involved as people. Executives often regard doctors en masse as all being the same and doctors regard the executives as the blockers to good patient care.

Doctors do not need to be engaged in organisational matters to successfully do their work

More enlightened executives talk about engaging medical staff and some even take action to do this. Doctors on the other hand can do their work competently and efficiently without being engaged in organisational strategy and general operations. They are trained as accountable, authoritative and autonomous professionals who need to do the best for individual patients. They move in and out of the health service with considerable freedom. So engaging them is always difficult and the concept of partnership is rarely discussed, often leading to fragmented efforts that are not sustainable in a cultural sense.

The key is building respectful, empathetic and robust relationships both between the disparate groups and with key individuals. The best way to do this is to build a partnership where both sides can equally contribute, where both have responsibilities and rights and where both get to know each other and the environment in which they work.  Building a partnership takes time. Respect needs to be earned and there must be a degree of give and take.

Being aware of the importance of the “What’s in it for me”

Because doctors can care for individual patients with minimal involvement in organisational matters, it is up to the health service to take the initiative in establishing a partnership and showing medical staff that this is in their best interests as well as in the interests of the health service. Doctors are people and respond similarly to other people according to the WIFM (what’s in it for me) principle. This means that the health service executive needs first to understand doctors both as groups and as individuals so that they can demonstrate the WIFM. To regard all doctors as the same is a fallacy and developing this understanding will require time and effort. In addition, building mutual respect takes time and often health executives do not see the value in expending time on this.

However if the focus is on partnership rather than engagement, this means there is an understanding that the relationship is for the long term, requires both parties to contribute equally and that continuous nurturing is needed for sustainable outcomes.  Mutual respect is then built over time between doctors and senior hospital management. There is much more likelihood of success where  doctors are  interested, involved and functioning as supportive participants in driving improved health care systems.  In this way doctors positively influence organisational goals whilst working towards their own individual goals.

Learn How to improve models of care to achieve better patient outcomes at the Mental Health Access & Quality in Emergency Departments, 12th & 13th February 2019, Sydney.

Submitted by Dr Lee Gruner

Dr Lee Gruner

Lee Gruner is President of RACMA and has held senior positions in both public and private health services. Since 1997 Lee has been a consultant in health services and management, particularly involved in organisation-wide continuous quality improvement (CQI), strategic planning, organisational and departmental review of health services, organisation change, clinical risk management and consumer participation mechanisms. She has been an educator at Monash University, for RACMA and the ACHS for over 20 years.

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