Dual Agency in Hospitals: What Strategies Do Managers and Physicians Apply to Reconcile Dilemmas Between Clinical and Economic Considerations?

• DOI: 10.34172/ijhpm.2021.87
• Publication Date: 2021-09-30T05:27:31Z
• Authors: Ruth Waitzberg; Nora Gottlieb; Wilm Quentin; Reinhard Busse; Dan Greenberg
• Keywords: Thematic Analysis

Hospital professionals are "dual agents" who may face dilemmas between their commitment to patients' clinical needs and hospitals' financial sustainability. This study examines whether how hospital balance or reconcile economic considerations in decision-making two countries with activity-based payment systems.We conducted 46 semi-structured interviews managers, chief physicians practicing five German Israeli hospitals 2018/2019. We used thematic analysis identify common topics patterns of meaning.Hospital report many situations which incentivizes proper treatment, aligned. is the case when efficiency can be improved, eg, by curbing unnecessary expenditures specializing certain procedures. When misaligned, have developed a range strategies that contribute balancing competing considerations. These include 'reshaping management,' such as better planning entire course treatment improvement coding; 'reframing decision-making,' involves working averages developing tool-kits for decision-making.Misalignment does not necessarily negative implications, if manage them. Context important determining reconciled not. Reconciling fragile easily disrupted depending on context. Creating decision-making, advance, averages, having interdisciplinary teams think together about ways improve help mitigate professionals.