GREAT HEALTHCARE BOARD

Great Healthcare Board

ABSTRACT

This study examines governance of medical administration in a large healthcare organization. Medical Advisory Committees (MAC) are one form of governance used to integrate physicians into the decision making process. We use organizational healthcare as a framework for examining the relationship between MAC members and Medical Administration. Both quantitative and qualitative data was collected. We found that although most of the perceptions of MAC members were similar, there were some significant differences in healthcare perceptions across the MACs in the organization. Our study of this organization indicates that organizational healthcare is a valid framework for examining the relationship of groups

operating in a form other than a typical employer-employee relationship.

Great Healthcare Board

Introduction

The governance of a large healthcare organization is unusually complex compared to most business or government organizations. This is particularly so in Canada where healthcare organizations are government creations, dependent on the government for funding and subject to the demands and expectations of the government of the day. Not only do healthcare administrators operate within the glare of public and political spotlights, the primary group upon which it depends to fulfill its mandate to deliver health care to the public is physicians who are highly mobile, independent contractors.( John, 2006)

In the Canadian system, health administration is tasked with providing and operating the infrastructure for the system in the form of hospitals and other facilities, whereas, physicians are responsible for delivering medical care to the population. Although physicians and healthcare administrators may be united in goals such as optimal patient care, they do not always agree on the mechanisms by which patient care is achieved. Physicians view administrators as being inordinately preoccupied with "the bottom line" causing physicians to feel as though their medical decisions are unnecessarily encumbered by businesslike considerations (Alexander, Morrisey & Shortell, 1986). A major point of contact in the working relationships of health administrators and physicians is through hospitals. According to a three year retrospective assessment of professional satisfaction amongst Canadian physicians just over half of the physicians surveyed reported satisfaction in their relationship with hospitals (Comeau, 2007). While health administrators have the decision-making power to allocate resources and plan service delivery models, collaboration is needed between physicians and these administrators to ensure optimal allocation and use of scarce resources in order to achieve high quality patient care. Integrating physicians into the decision-making process in ways that are efficient and effective for the health care system is a major challenge for Canadian healthcare administration (Smith, Reid & Piland, 1990).

One form of integration that is being used is the Medical Advisory Committee (MAC). The MAC is a governance mechanism that integrates physician representatives with senior healthcare administration decision makers. This governance mechanism provides physicians with a voice in decisions that are important to them. To date the workings of this mechanism have not been explored. The purpose of this paper is to fill part of that gap in our knowledge by examining the relationship between MAC physician members and medical administration in a Canadian ...