Doctor autonomy linked to technology resistance and reduced health care quality

MILWAUKEE — Researchers suggest that President Obama’s $80 billion in stimulus funds allocated to health information technology and improved health care quality may be ineffective if physicians do not feel a strong attachment to their employers. Physicians who feel detached from their employers are least likely to prescribe appropriate medications to their patients and adopt health information technology, particularly when they are strongly encouraged to do so by their management.

“Detached physicians will have sicker patients and will be less tech savvy,” says UW–Milwaukee Assistant Professor David Hekman. “Because physicians in general value their autonomy and are taught to be independent in medical school, implementing these advancements through their employers may be particularly difficult.”

Physicians’ resistance to prescription guidelines and information technology is partly to blame for the more than 100,000 patient deaths resulting from medical errors and poor communication each year. “Many hospitals are piles of highly skilled people who have minimal coordination or integration, and our findings indicate physicians need to feel strongly connected to their organizations for health care quality to improve,” Hekman says.

The researchers identified attached physicians as those who reported saying ‘we’ when talking about their employing organization and ‘they’ when talking about the medical profession. “In other words, patients will probably get the best care from physicians who wear the company T-shirts instead of white coats,” says Hekman.

The study, authored by Hekman and three colleagues, is set to appear in Journal of Applied Psychology and follows some 200 physicians employed by a large HMO in the Pacific Northwest. Attached physicians in the study sent a greater number of messages to their patients through a newly implemented electronic health information system. These effects remained even when taking into account physicians’ age, familiarity with technology, and experience.

Nearly 20 percent of the physicians had not even logged on to the system two years after roll-out, despite encouragement from organizational leaders and the majority of their patients. “For the most part, these resistant physicians were the ones who reported feeling least attached to their employer,” says Hekman.

A second study based on the same sample, and forthcoming in the June issue of Academy of Management Journal, found detached physicians were less adherent to national prescription guidelines and less diligent in terms of the number of questions they asked each patient. These disconnected physicians performed even worse when they were encouraged to perform well by management.

“Health care organizations apparently can do nothing right for detached physicians and they can do nothing wrong for the attached ones,” says Hekman. “Physicians with a strong attachment to their employer perform well whether they are encouraged to do so or not; but detached physicians generally perform poorly and perform even worse when they feel encouraged or pressured by management.”

The authors’ advice to health care administrators dealing with detached physicians is to take the focus off the organization and instead focus physicians on threats — from competitors and diseases. “If a competing health care provider is offering better care or is more high-tech, or if physicians realize their behaviors are potentially putting patients at greater risk of disease, they will become more attached,” says Hekman.

(CONTACT: David Hekman, 414-229-6296, [email protected])

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