Abstract

In response to increasing costs of treatment, governments have shifted formal responsibility for hospitals from physicians to managers. This has forced the latter to introduce control over clinical activities. Some hospitals go beyond monitoring medical processes merely at the level of wards and delve into the clinical activities of individual doctors. The objective of the study is to identify and understand the manner in which hospital managers have been attempting to implement control over the productivity of individual physicians in relation to their day-to-day clinical practice and how clinicians have been responding to their executive actions. This explorative research was carried out in three Polish public hospitals. We conducted interviews with the hospitals’ general managers, medical directors, and physicians. The investigation showed that to some extent, doctors have accepted productivity measures related to the cost of treatment, reimbursement rates, and range of services but at the same time, they have strongly opposed to measurement of the number of patients and the clinical procedures performed by them, especially in the non-surgical department. Managers were unable to engage physicians in the development of quantitative measures which would allow for the objective assessment of their time schedule, even though executives have tried to exploit the conflict between physicians. The defense of professional autonomy concerning clinical workload is given priority by physicians over financial benefits. Physicians have blocked managerial control, simultaneously taking over these methods and incorporating them in self-regulation processes as part of their professional internal assessment. We also found that managers did not focus only on reducing costs while neglecting the quality of treatment, and that clinicians were not solely the intransigent advocates of their autonomy.

Keywords: hospital managers, physician productivity, control measures, professional autonomy, managerial encroachment