The following is an excerpt from an ongoing discussion in the Linkedin group ‘Healthcare Executives Network’. It broaches several problems and approaches that are necessary to understand before finding workable solutions, and could be taken as a preface for a book that delves into the ramifications of each sentence.  The overall discussion has generated an inordinate amount of lucid viewpoints and experienced comments—a pleasant surprise!

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Richard-

In the US healthcare industry, there are multiple agents (physicians, hospitals, HMOs) with different goals. Many alternatives (business structures) are available for some of the agents (physicians). What’s optimal for one group (agent) might not be for another.  The solution (if possible) is through sharing knowledge and clarification of goals.

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The more knowledge, intuition, skill, and imagination of both agents—the greater the feasibility of non-mutually exclusive goals. A deficiency in abilities by one of the agents requires a greater amount of ability by the other in order to clarify and accomplish the essential goals. Of course, certain people have personal goals that will always be mutually exclusive to every other agent’s goals—probably best to not deal with them.

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In the US, lots of independent agents with a multitude of goals and many alternatives makes for lots of divides.  An administrator has not one physician divide- but multiple.  Fewer goals and alternatives is one reason that dealing with groups (radiology, anesthesia, ER) are preferred over individuals by administrators so that many debates are decided within the group before meeting with the groups representative.  Unfortunately, sometimes those individual groups will be dysfunctional and other groups are sought out.  But often the groups have the the legal and social ability to remedy dysfunctional individuals in ways that administrators don’t.

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From your description of work in England, it sounds as though similar conflicts are occurring within a different set of groups, maybe at a level where they are resolved due to fewer alternatives and a smaller subset of goals than in the free wheeling US healthcare market.

Brian