Why is it Difficult for Doctors and Administrators to Agree?

A problem within our healthcare systems is an often-unrecognised divide between senior administrators/executives and the doctors caring for patients in the very same organisations. Why is this, when all have the best interests of the patient cohort and the institution at heart? What can be done to achieve more understanding and collaboration?

The roadblocks can arise from the way the two groups are trained and how each profession approaches decision-making processes. The obstacles are usually overcome, but resulting in both sides feeling aggrieved. However, occasionally the disagreement can turn into an unhelpful impasse.

If each side understands the other more (and indeed if each side has a greater understanding of themselves), then perhaps the misunderstandings, frustrations, and outright battles can be converted into more collaborative outcomes.

What Influences How Doctors Develop Their Negotiating Style?

In our healthcare system, doctors progress through a competitive environment where individualistic practices naturally come to the foreground. Rapid and decisive thought patterns are valued and uncertainty in action is not. Each doctor will ascend some way through the ranks of a hierarchical and conservative culture reaching higher status (and becoming an advisor or possibly ultimate decision maker). This hierarchy leads to resistance in accepting guidance or opinions from those of lower status.

The medical enculturation and promotion of self-belief, perfectionism, and need to appear all-knowing, can lead to ingrained assumptions where the doctor believes that they know better (or could do a better job) than others in different positions or professions (including executives).

When doctors are involved in group decision making they focus on the outcome, irrespective of the journey taken to get there. Immediate action is valued, after the doctor believes that the correct course is clear and that a decision has been made. Delays at this point create significant frustration for doctors, and these delays can be interpreted as deliberate and disrespectful to their already-invested time.

What Executives Value and the Place of Bureaucracy

In the decision-making process administrators pay great attention to the process. The bureaucratic process relies on canvassing all relevant opinion and seeing a problem from multiple viewpoints. This is , necessarily, a slower initial path, but it can be argued that this style will save later holdups due to previously overlooked factors. The strength of bureaucracy is to look at all issues from different angles and have a more complete understanding of the problem, and avoid neglecting or overlooking any important information.

The weakness of the bureaucratic process is that it is lengthy to the point of potentially becoming bogged-down, with the subsequent loss of the enthusiasm needed to drive the process of change.

Executives will attempt to think in a total-system style which considers patients as a collective, whereas doctors, unsurprisingly, will find it difficult to separate any proposal from how they perceive it affecting individual patient treatment.

Styles of Negotiation

Different negotiating styles between doctors and administrators can also cause obstacles. In any relationship or negotiation an individual can take one of four approaches:

• Competition (I win/You lose)
• Accomodation (I lose/You win)
• Compromise (Lose/Lose – both accept some reduction in position)
• Collaboration (Win/Win)

Unconsciously, and perhaps related to personality type, training, and adoption of medical culture, doctors almost invariably negotiate with a competitive win/lose attitude. When faced with a weak or seemingly losing position, the doctor will default to a lose/lose approach. None of this is surprising when one considers the competitive nature of medical training and practice. However, becoming aware of our own assumptions, behaviours, and challenges may allow us to create a better decision-making pathway.

Strengths of Each Group

Leading into any important decision-making, planning, or negotiation process it is important to recognise the strengths of each group and the value in each approach. Doctors are good at reaching decisions quickly after assessing all currently available information and committing to action. Of course, over many years, doctors often have to bear sole responsibility (including litigation risk) for any patient’s outcome. This obviously influences attitudes and decisions.

Administrators are good at creating inclusive decision making that allows unseen or unappreciated risks and viewpoints to surface, and thereby avoid poor decisions due to haste or lack of breadth in the process.

With greater understanding of seemingly opposed viewpoints, and acknowledgement of our own cognitive styles (with their strengths and challenges), perhaps we will be able to move to a more frequent collaboration between the groups that leads to benefit for all.