Benefits of Health Administration Education for Physicians

From deans at academic medical centers to chief medical officers at health plans and hospitals, increasing numbers of health care leaders recognize the necessity of providing basic health administration education to clinical service providers. There appear to be three reasons.

1. First, physicians are becoming uninformed stakeholders in large-scale health reform debates. Of course this is not true of all physicians, but not nearly enough are educated about the elements of the debate.
2. Second, physicians are frequently powerless in the negotiations over health system reform and health care delivery arrangements. In the worst sense, they have become victims of ambitious designers.
3. Last, physicians themselves feel trampled by regulators, by health-care executives, by health insurers, and by lawyers. Their personal result is low job satisfaction and too frequently a desire to "get out ."

We believe that providing information about health administration and policy to physicians has advantages. The over arching advantage is to provide a common language to be used by planners, physicians, insurers, and government agencies, and to provide physicians with insight into the “mind set” of the other “actors” who must solve the health care equation. The following are several specific advantages to providing education to physicians regarding health administration management and policy.

Co-Design and participation: Physicians need to be involved in health system reform and future health care system development because they are key stakeholders in the system. They are the front-line effectors that provide basic care to patients. All we have learned about systems design tells us that we must have the central stakeholders participate in the design of any large-scale changes if we are to expect agreement with the change.

Expert advice: When redesigning medical and health care system processes, we see an immediate need to bring into the design work those participants that know most about care delivery structures, processes and outcomes. As we struggle with a bureaucratic, and in many areas troubled health-care system, we need experts who are familiar with every aspect of health care delivery. Physicians need to be involved because we need their knowledge of the strengths and weaknesses of the present health care delivery system.

Values: One health administration core principle is that values should be built into design and redesign processes. Physicians have long complained that those policy and management leaders who are engineering health delivery changes have neglected the core values related to patient care. The designers are thought to be distanced from the actual delivery of care and, thus, too far removed from the values that have brought physicians into this caring profession.

Consensus: We are always searching for agreement regarding design changes. Whenever proposals are floated - for reimbursement changes, for quality of care review, for new standards - we find that many professional groups are at odds. Successfully implementing change becomes nearly impossible. Without involvement in the development of competing proposals there is little chance that physicians will support drastic changes of any sort.

Psychological climate: When physicians are educated about the structure and process options in health-care delivery, we will begin to change the psychological climate that has physicians feeling abused and used. With education about design principles and health systems options, physicians can become more proactive, taking assertive stances in the interest of patients and clinical care teams. The psychology literature tells us that the most damaging psychological state is to be found in a feeling of helplessness. The proposed education provides physicians with the tools for change that would be helpful in alleviating the current situation in which physicians feel that they are being set upon by all sides-by regulators, by consumer advocates, by insurers, and by litigants.

Practicality: Physicians are used to being practical about clinical care interventions. Although physicians can enjoy conceptual and “blue sky futures” discussions as much as any other professional group, they know that, in their daily lives, they must help a patient get well in a practical way. Involving physicians in the redesign of local state and national health care processes will mean that we can expand what we can do because we will have "practical professionals " at our side. Their presence in the discussions will both restrain open-ended thinking about massive change and, at the same time, expand practical solutions.

Commitment: When physicians understand the rationale for change and the outcomes to be expected they will become committed to policies that they know are necessary - policies that will move us forward. But, as importantly, this commitment will be derived from knowledge leading to understanding of the process and structure of the requisite health system change. This understanding will be generated, in part, by education and, in part, by participation as a co-designer of system changes.

James T. Ziegenfuss, Jr. PhD is professor of management & health care systems at, Pennsylvania State University.

Joseph W. Sassani MD, MHA is professor of ophthalmology and pathology at Milton S. Hershey Medical Center at Pennsylvania State University.