U.S. hospitals mired in bureaucracy: 10 roadblocks to change

Given the dot.com revolution in health care, advancing medical technology, and dissatisfaction with managed care, fundamental change is the order of the day in U.S. hospitals. Some hospital leaders are responding effectively to these new century challenges. But too many only tinker with existing systems, hoping to get by with choices that are comfortable, conventional, and convenient. Meanwhile, the sharks of dwindling public confidence and lost political support circle ever closer. The vice president of medical affairs (VPMA) is positioned at the vertex of disparate organizational, interpersonal, and external forces and can lead the way in recognizing and removing common roadblocks delaying needed change. External obstacles include: (1) Too much regulation; (2) too many attorneys; and (3) theatrical local TV newscasts. Internal factors include: (4) A natural fear of change; (5) arguing when we do not really disagree; (6) Cake Committee management mentality; (7) over-aggressive downsizing; (8) natural conflict in choosing a health care ethic; (9) the past; and (10) lack of trust. Hospital leaders need to effectively act, not just think, "outside the box."