The changing power equation in hospitals.

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).
• 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.