Hospital directors between clinical staff and administration: how to lead a joint discussion

Why two camps emerge

In a hospital, clinicians may see purchasing restrictions as indifference to patients, while administrators may see them as a necessary response to the hospital’s constraints. When the discussion becomes an exchange of accusations about doctors’ lack of discipline or administrators’ failure to understand treatment, information needed for a decision gets lost. A clinician sees a patient’s sudden deterioration; administration may also see staffing and purchasing constraints. Interviews with 24 managers from three regions of Sweden described tensions of this kind between clinical work and administration. Some managers reinforced the divide by identifying exclusively with their own group. This is a qualitative account of responses to conflict, not an estimate of how often it occurs in Polish hospitals.

Two sets of responsibilities in one hospital

A starting point is to ask both sides to name the requirements they are actually responsible for. When considering an additional on-call shift, clinical staff can explain how having someone available affects patient care, while administration can explain what the change means for staffing and continuity of hospital operations. Broad references to quality and cost then give way to the specific consequences of each choice. It is also worth separating matters that can be agreed at the meeting from constraints neither side can change on its own. The result is not two competing lists of demands but a fuller picture of one decision. It does not remove differences, but it helps establish what else needs to be learned.

Authority and credibility do not always go together

Even when clinicians and administrators agree on the problem, the person tasked with finding a solution may lack the authority to approve concessions. In the Swedish interviews, administrative managers described a lack of credibility and formal power to act; tasks bridging the two groups sometimes fell to people with a limited mandate. Before the meeting, the director should therefore check who can make the final decision and who can only gather views. Authority to sign a purchase order does not confer knowledge of a change in a patient’s condition, just as clinical experience does not remove financial limits. Recognising both boundaries helps prevent an apparent agreement that cannot be put into practice.

When a dispute over a solution becomes a dispute about people

A dispute over a solution can easily become a dispute about people when, instead of discussing equipment that was unavailable at a specific time, participants start saying, “They always make things difficult.” The director can then ask them to describe the incident, its consequences and the available options, without making generalisations about an entire professional group. A meta-analysis of team studies associated both task conflict and relationship conflict, on average, with poorer performance and satisfaction; the association between task conflict and performance was less negative when task conflict was less closely entangled with relationship conflict. This does not prove that every substantive disagreement helps or harms. It does give reason not to let judgments about the other side’s intentions replace discussion of the decision.

How a director bridges the two perspectives

The director can start with a simple check for understanding: ask clinicians and administrators to describe the other side’s constraint in their own words, then ask whether the description is accurate. Only after that confirmation is it worth negotiating options. It helps to record clinical needs, administrative constraints, the scope for a joint decision and possible consequences for the patient in one place. The director can acknowledge both concerns without attributing bad intentions: a delay in clinical action may harm a patient, while an unplanned expense affects what other departments can do. The director should not promise their own professional group a win before examining the consequences. Their role in this discussion is to ensure that both perspectives are understood.

Shared criteria for choosing a solution

Once the two sides understand each other’s constraints, they need the same criteria for assessing options. For the issue at hand, they should agree on what patient safety, continuity of care, cost and staff workload mean, rather than assume everyone understands those terms in the same way. They can then compare two feasible solutions against one list of criteria, starting with urgency for the patient while also considering feasibility and the impact on other services. If the choice requires a compromise, they need to say what the hospital is giving up and who has the authority to approve it. It is also worth recording the conditions for an exception, so the next urgent case does not reopen a dispute about which rules apply.

What to check after reaching an agreement

An agreement ends the discussion, but not the matter. It should be recorded who is responsible for implementing the decision, who will check its effects and when it needs to be discussed again. On the next shift, it is worth checking whether the required medicine, equipment or staff member was actually available, rather than merely ordered or scheduled. Both sides should then hear what worked and what needs adjusting. A meta-analysis of research on roles associated role ambiguity with poorer job performance; the association between role conflict and performance was small. These are associations, not proof that recording responsibilities alone will improve outcomes. A clear division of tasks does, however, make it possible to check whether the joint decision was carried out.

A dispute over a shift or a purchase can easily turn into criticism of the other group. It helps to discuss the consequences of a decision, check who has the authority to act and agree on shared criteria.

Empatyzer in discussions between hospital clinical staff and administration

After a dispute over the schedule of services, a hospital director can use Empatyzer to prepare a meeting between clinicians and administrators. In a conversation with Em, the director describes one decision and asks for questions that will bring out its consequences for both groups, rather than entrenching two separate positions. A comparison with the department may reveal differences in preferred ways of agreeing decisions, while the organisational culture view may point to different expectations of collaboration. The director can then use Em in team mode to prepare a message both groups will understand: one that sets out the two perspectives and asks a shared question about what is needed to implement the decision safely. Micro-lessons can help participants practise paraphrasing the other side’s position before responding. A discussion prepared this way still requires people who know the patients’ circumstances, the hospital’s constraints and the limits of their own authority; the tool helps frame questions and messages but does not settle the dispute for them.