Question

Describe the changing nature of society in the medical period

Answer 1

Do such major developments as the rise of investor ownership, the growth of multi-institutional systems (in which many important decisions are not made at the local level), and growing competitiveness in health care affect the ability of physicians (and other patient care staff) to influence standards of care in institutions where they admit, treat, or refer patients? This chapter examines two means by which such influence takes place—through the physician's ability, to alter referral or admitting patterns and through mechanisms by which physicians, nurses, and other patient care staff participate in decisions that shape institutional policies or operations.

Decision Making in Hospitals

In Medical Institutions, Decisions About Patient Care And Administrative Matters Or Institutional Policies Are Not Independent Of Each Other (Shortell, 1983). Cumulatively, Physicians' Decisions To Admit Or Discharge Patients And To Order Particular Services Al-Feet Many Matters Typically Defined As ''Administrative." Because The Amount Of Discretion And Judgment That Are A Defining Characteristic Of Professional Work Make It Impossible For Anyone Else To Organize And Supervise In A Detailed Way The Performance Of Professionals, Control Over Their Work In Organizations Is Typically Exerted Via The Power To Allocate Resources (Freidson, Forthcoming). (In Addition, Anecdotes Suggest That Hospital Privileges Are Increasingly Being Used As A Mechanism Of Control.) Although Physicians Are Responsible For Patient Care Decisions, Institutional Management And Resource Allocation Decisions Made By Administrators, Managers, Or Trustees Have Profound Implications For Patient Care.