A culture of expertise, not conflict

Browman, Snider and Ellis propose that managers act as catalysts to institute structures for the negotiation of differences between managers and clinicians, primarily around the perceived trade-offs between quality care and resource allocation. Evidence-based medicine and evidence-based management are required to level the playing field, so that quality of care will not suffer "at the expense of the business agenda which is easier to measure and manage." But implementation of evidence-based management and evidence-based medicine depends on the quality of knowledge production and the ability to adapt general knowledge to particular organizations. Agreement on guidelines for evidence-based management is problematic and complicated by the nature of management research itself. Rather than the metaphor of the negotiating environment, which assumes an adversarial relationship between management and clinicians, a more fruitful metaphor is the expert environment, which assumes a collaborative relationship between the two. Management should not only be a catalyst for change but should also assume the responsibility of cultivating clinical and managerial expertise at all levels of the organization, from custodian to surgeon.