Professional doctors know best when it comes to running first-rate hospitals

By James Palmer Source:Global Times Published: 2013-3-6 17:48:03

If there's one issue that unites doctors all over the world, it's a hatred of paperwork.

The profession is bedeviled by administrative duties that require reams of forms for every patient, not to mention the logistical nightmare of running large hospitals.

In dealing with the day-to-day work of managing medical institutions, the trend has been to bring in professional administrators to handle the bureaucracy, theoretically freeing up doctors for the medical duties they've studied so long to master.

Yet in practice, the growing numbers of administrators have proven more burden than help for many hospitals. Doctors all over the developed world frequently complain of the growing costs of nonmedical staff.

In Britain's NHS, the number of administrators has grown to the degree where a quarter of all staff have no involvement with patient care.

But the biggest complaint from doctors has generally been when nonmedical staff are put in charge of a hospital, rather than a senior physician.

They argue that trained doctors have a better grasp of the real needs of their colleagues and patients, and that the MBA training most administrators have might be suited to businesses, but not professional institutions.

This has been strongly borne out in a recent paper from labor scholar Amanda Goodall, which finds a staggering 25 percent difference in quality in US hospitals between those run directly by doctors and those run by nonmedical professionals.

If you want better healthcare, the lesson is clear: Put the doctors in charge. Goodall only looked at chief executives, not other administrators, and partnerships with trained managers may be helpful at other levels.

But her studies in other fields show that the lesson of professional leadership applies more widely. She found, for instance, that universities do better when scholars, not managers, are given the top jobs.

Both medicine and academia are highly dense fields which may prove opaque to outside managers.

A trained doctor or scholar is more likely to have the wisdom, the specific experience, skill, and subtlety, to comprehend a problem than an outsider trained to perceive things only in terms of raw, understandable figures.

There's a powerful lesson here for China, where both hospitals and universities are weighed down by bureaucratic behemoths.

Because of the peculiarities of political administration, the vast majority of power within both the medical and educational establishments is in the hands of nonprofessionals. And many Chinese universities have three or four staff for every teacher or researcher.

The stated political priority in schools is already qu xingzhenghua, "de-bureaucratization." But the problem is that implementing this policy is in the hands of, well, the bureaucrats. And getting them to reduce their own numbers, in a country where vested interests find it hard to surrender power, is a herculean task.

Chinese hospitals are equally burdened by administration, but they're also bedeviled by corruption.

Over-subscription of drugs, pseudo-scientific and expensive quackery, and dirty deals with equipment or pharmaceutical firms are common. 

Putting trained doctors in charge, sworn to uphold the Hippocratic Oath and put the needs of patients first, would go a long way toward improving not only professional performance but also ethical standards.

But that means tackling another endemic problem in Chinese medicine: the lack of professional training for doctors. Shockingly, over 80 percent of "doctors" in Chinese hospitals lack an MD, and are trained only to bachelor's, or, if patients are lucky, master's level.

This under-training, in comparison to developed countries where the MD is a basic requisite, has to be resolved before standards can be raised across the board.

China wants to be a first-rate power, and to reach a developed standard of living. But for Chinese institutions to compete on a global level, they're going to have to ditch the cruft of bureaucracy, and turn power over to the professionals.

The author is a copy editor with the Global Times.

Posted in: Viewpoint

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