Navigating Dichotomies and Dilemmas; Comment on “Dual Agency in Hospitals: What Strategies Do Managers and Physicians Apply to Reconcile Dilemmas Between Clinical and Economic Considerations?”

Document Type : Commentary

Author

VID Specialized University, Oslo, Norway

Abstract

The complexity within healthcare typically surfaces in tensions between organizational efficiency and professional values when hospital managers and professionals face dilemmas between economic and clinical considerations. Waitzberg et al, based on interviews with managers and physicians working in Israeli and German hospitals, explore strategies to cope with such dilemmas to safeguard both financial sustainability and patient quality. This short commentary provides some follow-up questions in two ways. First, I highlight the importance of nuancing and hybridizing the dichotomies that lead to dilemmas in the hospital context. Second, I discuss how such dilemmas can be highlighted in systematic group reflection which in turn can inform decision-making.

Keywords

References

  1. Waitzberg R, Gottlieb N, Quentin W, Busse R, Greenberg D. Dual agency in hospitals: what strategies do managers and physicians apply to reconcile dilemmas between clinical and economic considerations? Int J Health Policy Manag. 2021. doi:34172/ijhpm.2021.87
  2. Blomgren M, Waks C. Coping with contradictions: hybrid professionals managing institutional complexity. J Prof Organ. 2015;2(1):78-102. doi:1093/jpo/jou010
  3. Kälvemark S, Höglund AT, Hansson MG, Westerholm P, Arnetz B. Living with conflicts-ethical dilemmas and moral distress in the health care system. Soc Sci Med. 2004;58(6):1075-1084. doi:1016/s0277-9536(03)00279-x
  4. Smets M, Morris T, Greenwood R. From practice to field: a multilevel model of practice-driven institutional change. Acad Manage J. 2012;55(4):877-904. doi:5465/amj.2010.0013
  5. Noordegraaf M. From “pure” to “hybrid” professionalism: present-day professionalism in ambiguous public domains. Adm Soc. 2007;39(6):761-785. doi:1177/0095399707304434
  6. McGivern G, Currie G, Ferlie E, Fitzgerald L, Waring J. Hybrid manager–professionals' identity work: the maintenance and hybridization of medical professionalism in managerial contexts. Public Adm. 2015;93(2):412-432. doi:1111/padm.12119
  7. Numerato D, Salvatore D, Fattore G. The impact of management on medical professionalism: a review. Sociol Health Illn. 2012;34(4):626-644. doi:1111/j.1467-9566.2011.01393.x
  8. Albert S, Whetten DA. Organizational identity. In: Cummings LL, Staw BM, eds. Research in Organizational Behavior. Greenwich: JAI Press; 1985. p. 263-295.
  9. Glouberman S, Mintzberg H. Managing the care of health and the cure of disease--Part I: differentiation. Health Care Manage Rev. 2001;26(1):56-69. doi:1097/00004010-200101000-00006
  10. Huffman DM, Rittenmeyer L. How professional nurses working in hospital environments experience moral distress: a systematic review. Crit Care Nurs Clin North Am. 2012;24(1):91-100. doi:1016/j.ccell.2012.01.004
  11. Sirris S. Values as fixed and fluid: negotiating the elasticity of core values. In: Askeland H, Espedal G, Jelstad Løvaas B, Sirris S, eds. Understanding Values Work: Institutional Perspectives in Organizations and Leadership. Cham: Palgrave Macmillan; 2020:201-221. doi:1007/978-3-030-37748-9_11
  12. Hem MH, Molewijk B, Gjerberg E, Lillemoen L, Pedersen R. The significance of ethics reflection groups in mental health care: a focus group study among health care professionals. BMC Med Ethics. 2018;19(1):54. doi:1186/s12910-018-0297-y
  13. Hem MH, Pedersen R, Norvoll R, Molewijk B. Evaluating clinical ethics support in mental healthcare: a systematic literature review. Nurs Ethics. 2015;22(4):452-466. doi:1177/0969733014539783
  14. Epstein EG, Whitehead PB, Prompahakul C, Thacker LR, Hamric AB. Enhancing understanding of moral distress: the measure of moral distress for health care professionals. AJOB Empir Bioeth. 2019;10(2):113-124. doi:1080/23294515.2019.1586008
International Journal of Health Policy and Management
Volume 11, Issue 10
October 2022
Pages 2355-2357

Files

History

  • Receive Date: 27 November 2021
  • Revise Date: 08 May 2022
  • Accept Date: 11 May 2022
  • First Publish Date: 14 May 2022

Share

How to cite

Statistics