So, my counter would be, there's a difference between an admin getting involved in a patient's plan of care (which is clearly inappropriate) and an admin who is dealing with something like patient satisfaction scores, which is care related but also affects the business side. HCAHPS sucks, we all know that, but it's directly tied to reimbursement, so we all have to care about it. I'm never going to tell an individual doctor "here's exactly what I expect you to do with patient care" but that doctor also needs to understand that what they do affects the entire hospital. Sometimes we get so focused on our piece of the puzzle that we can miss the forrest for the trees.

An example I'll give you is with the pain management portion of the survey. Clearly, the questions are vague and the easiest way to quickly raise scores would be to throw narcs at everyone. That's also clearly the wrong answer in terms of doing what's best for the patient. So we put together a multidisciplinary team and we work on fine tuning and, to some degree at least, standardizing the hospital pain management policy. That involved things like a strict no narc refill policy in the ED, and then a no narc policy for chronic pain in the ED. In both those situations we had pushback, like from some of the ED physicians who felt like we were taking away their autonomy, and then from primary care docs who wanted their chronic patients to have an alternative if they weren't available, etc. We also required scripting from the nurses and doctors regarding the pain policy. Then we moved on to the hospitalists and worked on the rest of the providers who have privileges with us regarding stricter pain policy rules and then the floor and unit nurses, and so and so on.

We also gave the task of ensuring if monitoring compliance and enforcing the policy to the individual areas, with serious violations reviewed by a multidisciplinary review board. Yes, a noncompliant doctor might get spoken to by an admin, but only based on the results of the review board, which is made up of clinicians.

Every single step of the way (and still to this day) we got pushback despite the fact that these policies were developed hand in hand with their clinical peers. It's good policy, that promotes safe effective care while still be responive enough to deal with unusual patient situations. It's also raised our scroes quite a bit, enough that we're anticipating extra money that's going to purchase some seriously needed equipment upgrades. It's not popular policy, but it's clinically sound, and it's effective from a business perspective.

Would a veteran MD, with no understanding of the business side of the house fully understand the financial impact that a CMS penalty would have on a hospital? For us, a penalty wouldn't force us to close tge doors but it would mean no raises for our staff and other budget cuts. With all the pushback we get about anything to do with HCAHPS, my guess is no. So no, I don't think they shouldn't be allowed to overrule admins. I think their input is extremely valuable and necessary for running a successful hospital, and I think there's a great benefit to admins with clinical backgrounds (Though I'm admittedly biased there) but an MD is not inherently the better choice to be making high level decisions about how a hospital runs.

I get that some hospitals aren't as thoughtful as mine, and really do just want you to throw narcs at the patients and that sucks. The only thing I can say to that is, A. I'm sorry because I know that really sucks and B. Try to bring them a better solution. I know it shouldn't necessarily be your job but if they're only focused on the loss of revenue, you have to provide them with a solution that fixes that problem too. You can't just say "fuck the scores" because the scores have consequences for everyone. You have to approach it as "how can we fix the scores AND do what's best for the patient". It is possible, it just takes a shit ton of hard work.

Sorry for the novel, just trying to illustrate that these things are a lot more complex then they might initially seem and there really aren't any easy answers. At the end of the day patients are best served by all of us working together, using our strengths to try and achieve the best running hospital that allows clinical staff to focus on giving the best care. It's actually funny, most of my friends are clinical staff of one kind or another and they bitch about "the admins" to me all the time. When I point out that I'm an admin, they say "Oh but your different". The truth is, I'm really not. Most admins are decent people who want to do the right thing for patients, we just tend to focus more on the system as a whole than the individual encounters.