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Who should run a hospital: Doctors or nurses?

July 24th, 2014

by Darlene A. Cunha

Recently, I sat in on an interview for a vice president of nursing position at a community hospital. During the interview, the chief hospitalist asked the candidate with a sense of fervor, "Who do you think should be running the hospital, the nurses or the doctors?"

I have to admit I was stunned, given the changes in healthcare and the presence of more nurses in hospital leadership roles. However, he was serious.

The New England Journal of Medicine raised the issue in "The Doctor-Nurse Game Revisited" some 24-years ago. Clearly, we still haven't moved forward. This rigid hierarchy that places physicians firmly in charge, even though nurses regularly offer expert advice about patient care, should be extinct. By engaging in this characteristic behavior, hospitals sacrifice communication, and nurses feel frustrated and dissatisfied with working relationships that devalue their professional worth.


More recently, Thomas H. Lee, M.D., the chief medical officer at Press Ganey and the former network president of Partners HealthCare, and Toby Cosgrove, M.D., the CEO of the Cleveland Clinic, wrote a white paper entitled "Engaging Doctors in the Health Care Revolution."

The opening paragraph states, "Despite wondrous advances in medicine and technology, healthcare regularly fails at the fundamental job of any business: to reliably deliver what its customers need. In the face of ever-increasing complexity, the hard work and best intentions of individual physicians can no longer guarantee efficient, high-quality care. Fixing healthcare will require a radical transformation, moving from a system organized around individual physicians to a team-based approach focused on patients. And yet, many physicians are deeply anxious about the changes under way and are mourning real or anticipated losses of autonomy, respect and income.”

Like many other changes endured over the years in healthcare, the healthcare reform act has undoubtedly pushed many of us into the stages of grief. A number of us are already on this journey. However, we cannot and should not allow any member of the healthcare team to get stuck along the way. In this case, it was clear this physician was stuck in the second stage of grief, the stage of anger. So how do we engage these physicians to accept and embrace change? How do we work together with the shared purpose of providing compassionate care as a team?

As Lee and Cosgrove brilliantly stated, "... engagement requires more than mere cooperation--an agreement not to sabotage--and strives instead for full collaboration in relentless improvement." At the core of any major transformation, must be respect. Respect for the patients, the organization and every member of the healthcare team.

Interdisciplinary collaboration and good communication are crucial to patient safety. In fact, agencies such as the Centers for Medicare & Medicaid Services, Joint Commission on Accreditation of Healthcare Organizations and the Institute for Healthcare Improvement expect healthcare facilities to promote good communication and teamwork to prevent errors and improve patient outcomes.

The good news is this: nurses and physicians who work closely together in a climate of mutual respect, are invested in good communication and collaboration.

Darlene A. Cunha, R.N., is senior healthcare executive, who focuses on population health management and the patient caregiver experience.


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