The intensive care unit medical director as manager. Impact on performance

This article examines the impact of greater management involvement by the medical director on efficiency of bed allocation in the intensive care unit (ICU) or critical care unit. Managerial involvement is modeled using a principal components approach in terms of perceived supervision, conflict resolution regarding bed allocation at critical times, extent of control over treatment, and employment status. Using data from a 1991 survey of 2,879 ICUs in 1,706 hospitals conducted by the Society of Critical Care Medicine, two equations reflecting efficiency--the ICU occupancy rate and the presence of misallocated ICU patients--were estimated. It was found that greater involvement by medical directors in the day-to-day management of the ICU significantly reduces the average occupancy rate in ICUs and also the probability of patients misallocated to the ICU, suggesting superior resource allocation in ICUs as a result. These results also suggest that the managerial impact of the medical director is greater in ICUs in high-occupancy hospitals.