Volume 49, Number 4
July/August 2004

I. INTERVIEW

Pat Sodomka, FACHE, executive vice president/chief operating office, MCG Health Inc., Kyle L. Grazier

II. PHYSICIAN-EXECUTIVE RELATIONS
What Doctors Want, Barbara LeTourneau

III. REPLACEMENT FACILITIES
Two Factors in Project Success: A Clear Process and a Strong Team, Fred D. Campobasso and James E. Hosking

IV. HILL-ROM ESSAYS

• After 9/11: Priority Focus Areas for Bioterrorism Preparedness in Hospitals, Jenifer K. Murphy
• Improving Care and Interactions with Racially and Ethnically Diverse Populations in Healthcare Organizations, Duane Reynolds

V. ARTICLE
Doctor-Manager Relationship in the United States and the United Kingdom, Thomas G. Rundall, Huw T.O. Davies, and Claire-Louise Hodges

VI. FELLOW PROJECT
A Nonfinancial Approach to Financial Improvement of Medical Groups Through Advanced Access, Jag S. Gill

Executive Summary
Doctor–Manager Relationships in the United States and the United Kingdom, Thomas G. Rundall, Huw T. O. Davies, and Claire-Louise Hodges

In many developed countries, including the United States and the United Kingdom , the relationships between doctors and hospital managers are strained (Davies and Harrison 2003). The purposes of this article are to examine survey data from the United States and the United Kingdom on doctor–manager relationships and to identify the sources of strain common to both countries as well as those particular to each country’s health system. The two countries exhibited many similarities. For example, a very high proportion of respondents from both countries identified external factors—such as governmental budget cuts, pressure from third parties to increase physicians’ workload, and the turbulence of the policy environment—as important barriers to improving doctor–manager relationships. Other common sources of strain internal to hospitals were concerns over resource availability and the relative power of doctors and managers. On the other hand, sources of relationship strain particular to each country were also found. Substantial divergence of opinion was expressed with respect to internal factors that affect doctor–manager relationships. Respondents from the United States were more negative than those from the United Kingdom in their ratings of teamwork and communication between doctors and managers, and they were also less likely to have confidence in the medical staff. Respondents from the United Kingdom were more likely to believe that hospital management is driven more by financial than clinical priorities. Managers can implement several strategies to improve doctor–manager relationships, including greater organizational transparency in decision making; more frequent communication between managers and doctors; more physician involvement in decision making, especially with regard to important resource-related decisions; and greater physician involvement in organizational governance.