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The changing power equation in hospitals.

J M Rayburn¹, L G Rayburn

¹School of Business Administration, University of Tennessee at Martin 38238, USA.

Journal of Hospital Marketing

|December 8, 1996

Summary

Physicians maintain dominant power in U.S. hospitals despite changes from federal payment systems and accounting. True cost containment requires addressing physician services, not just administrative or financial shifts.

Area of Science:

Healthcare Management
Organizational Behavior
Health Economics

Background:

The U.S. hospital power dynamic involves physicians, administrators, and accountants.
Understanding power shifts is crucial for healthcare policy and organizational effectiveness.

Purpose of the Study:

To analyze the evolution and current state of the power balance within U.S. hospitals.
To examine the influence of physicians, administrators, and accountants on hospital decision-making.
To discuss the social policy implications of these power struggles.

Main Methods:

Literature review on authority, power, influence, and institutional theory.
Analysis of the historical development of professional power (physicians, accounting, administration).

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Examination of the hospital power equilibrium and its changes.

Main Results:

Physicians' power stems from their indispensable clinical judgment and patient care decisions.
Federal prospective payment systems and case-mix accounting redistribute power, increasing accountants' influence.
Hospital administrators derive power from formal organizational authority.

Conclusions:

Physicians are expected to remain the dominant force in hospital power dynamics.
Significant cost containment is unlikely without changes impacting physician services.
The study highlights the complex interplay of professional autonomy, financial control, and administrative authority in healthcare settings.