Abstract

BackgroundThis study focused on the manager role in the manager-physician relationship, considered from the manager perspective. The aim was to understand how top executives in Swedish healthcare regard management of physicians in their organisations, and what this implies for the manager role in relation to the medical profession. Abbott's theory of professional jurisdiction was used to inform thinking about managerial control and legitimacy in relation to physicians.MethodsData from semi-structured individual interviews with 18 of the 20 county council chief executive officers (CEOs) in Sweden were subjected to qualitative analysis.ResultsThe results show that, when asked about their views on management of physicians, the CEOs talked about "how physicians are" rather than describing their own or their subordinate managers' managerial behaviour or strategies. Three types of descriptions of physicians were identified: 1) they have high status and expertise; 2) they lack knowledge of the system; 3) they do what they want in the organisation. The CEOs seldom reported that general management strategies were used to manage physicians. Instead, they described four types of physician-specific management strategies that were used in their organisations: organisational separation of physicians; "nagging and arguing"; compensations; relying on the physician role. These strategies seemed to reflect pragmatic behaviour on behalf of the managers that helped them to maintain control over physicians in daily work. However, in a longer perspective, they seemed to decrease the legitimacy of the manager role and also contribute to weakening of that role in the organisation.ConclusionsMany CEOs seemed to regard the manager role in their organisations as weak and described difficulties in both taking and defining that role (for themselves or others) in relation to the physician role. Further research is needed to elucidate how managers in healthcare organisations assume the manager role in relation to the medical profession. Studies indicate that lack of clarity concerning manager role authority and responsibility may have negative consequences not only for the working conditions of managers, physicians, and other healthcare professionals, but also for the quality of care.

Highlights

  • ObjectivesIt is important to begin by making a clear distinction: our objective was not to describe the behaviour of individual managers nor to illustrate physicians or physician’s behaviour, but rather to study the manager role that is defined as a social role accompanied by specific responsibilities, disregarding the individuals who during a certain period hold that role [12]

  • This study focused on the manager role in the manager-physician relationship, considered from the manager perspective

  • This study shows that many top managers in Swedish healthcare seemed to regard the manager role in their organisations as weak in relation to the medical profession

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Summary

Objectives

It is important to begin by making a clear distinction: our objective was not to describe the behaviour of individual managers nor to illustrate physicians or physician’s behaviour, but rather to study the manager role that is defined as a social role accompanied by specific responsibilities, disregarding the individuals who during a certain period hold that role [12]. The aim of this study was to understand how the top managers in Swedish healthcare regard management of physicians in their organisations and what this implies for the managerial role in relation to the medical profession

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