Professional Power and Professional Effectiveness: The Power of the Surgical Staff and the Quality of Surgical Care in Hospitals

Abstract

In order to examine some of the determinants of professional effectiveness in professional organizations, a study was conducted relating the power of the surgical organization in hospitals to the quality of surgical care delivered. Data utilized were from approximately 8,000 patients treated by 500 surgeons in 15 short-term general hospitals in the United States. Several measures were employed to assess two aspects of power: (1) the power of the surgical staff and other major role groups within each hospital, and (2) the power of the surgical staff over individual surgeons. Quality of surgical care was measured by mortality and morbidity data, adjusted for differences among patients in pre-surgical condition. Additional variables were introduced to assess surgeon qualifications, hospital characteristics, and features other than power differences which might relate to outcome. Controlling for those variables which did significantly affect adjusted outcomes, regression analyses revealed that the extent of control exercised by the surgical staff over individual surgeons did relate to the quality of care as predicted. However, the power of the surgical staff relative to other groups did not relate significantly to care quality; rather, higher power by the hospital administration was the factor most strongly associated with quality of surgical care.