Abstract
BackgroundThe demands in hospitals for safety and quality, combined with limitations in financing health care require effective cooperation between physicians and managers. The complex relationship between both groups has been described in literature. We aim to add a perspective to literature, by developing a questionnaire which provides an opportunity to quantitatively report and elaborate on the size and content of differences between physicians and managers. Insight gained from use of the questionnaire might enable us to reflect on these differences and could provide practical tools to improve cooperation between physicians and managers, with an aim to enhance hospital performance.MethodsThe CG-Questionnaire was developed by adjusting, pre-testing, and shortening Kralewski's questionnaire, and appeared suitable to measure culture gaps. It was shortened by exploratory factor analysis, using principal-axis factoring extraction with Varimax rotation. The CG-Questionnaire was sent to all physicians and managers within 37 Dutch general hospitals. ANOVA and paired sample T-tests were used to determine significant differences between perceptions of daily work practices based in both professional cultures; culture gaps. The size and content of culture gaps were determined with descriptive statistics.ResultsThe total response (27%) consisted of 929 physicians and 310 managers. The Cronbachs alpha's were 0.70 - 0.79. Statistical analyses showed many differences; culture gaps were found in the present situation; they were even larger in the preferred situation. Differences between both groups can be classified into three categories: (1) culture gaps in the present situation and not in the preferred, (2) culture gaps in the preferred situation and not in the present, and (3) culture gaps in both situations.ConclusionsWith data from the CG-Questionnaire it is now possible to measure the size and content of culture gaps between physicians and managers in hospitals. Results gained with the CG-Questionnaire enables hospitals to reflect on these differences. Combining the results, we distinguished three categories of increasing complexity. We linked these three categories to three methods from intergroup literature (enhanced information, contact and ultimately meta cognition) which could help to improve the cooperation between physicians and managers.
Highlights
The demands in hospitals for safety and quality, combined with limitations in financing health care require effective cooperation between physicians and managers
The complex cooperation based on differences in professional cultures between physicians and managers combined with the fact that both groups are working within the same organizational setting, can be seen as an intergroup conflict setting [15]
With an ANOVA we show that the CG-Questionnaire is able to reveal culture gaps between physicians and managers in Dutch hospitals
Summary
The demands in hospitals for safety and quality, combined with limitations in financing health care require effective cooperation between physicians and managers. More and more quality initiatives are being promoted in the public domain These quality initiatives usually do not take professional standards into account and often lead to an increasing influence of managers over quality and efficiency measures that influences the work done by physicians. We wanted to study the differences between physicians and managers quantitatively; when collecting our data we asked for perceptions of daily practices which were based on Schein’s third culture layer: values and beliefs. The complex cooperation based on differences in professional cultures between physicians and managers combined with the fact that both groups are working within the same organizational setting, can be seen as an intergroup conflict setting [15]. Intergroup literature provides methods to enhance cooperation in intergroup conflict situations [22,23,24,25]
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