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The purpose of this paper is to apply the image theory to the hospital context in order to add a perspective into the known complex relationship between physicians and hospital managers. This insight can enrich current intervention schemes used in health care to facilitate organisational change.

In this paper, the image theory of Alexander et al. on the known complex intergroup context of physicians and hospital managers is applied. The theory is operationalised in relative status, power, and goal incompatibility.

The data show the three variables are highly relevant and representative. Hospital managers see physicians as higher in professional status and power, and having different goals. Physicians see hospital managers to have higher power, lower status, and different goals. The study validates the applicability of the image theory in the Dutch hospital context. This results in a questionnaire suitable for performing a quick scan on the strength and direction of intergroup stereotyping within hospital organisations.

Data from the questionnaire give the opportunity to have insight in the way physicians and hospital managers perceive each other. This insight helps to focus attention on bottlenecks and possibilities in enhancing the co‐operation between physicians and hospital managers. Research on the relationship between physicians and hospital managers is scarce and mostly of a qualitative nature. This paper is executed in both qualitative and quantitative way, which enables us to empirically and statistically validate the data. The resulting questionnaire is applicable on an organisational intergroup level, while the focus in the extant literature is mostly on the interpersonal or intragroup level.

The aim of this research is to uncover issues that inhibit patients' satisfaction and loyalty and identify factors that could enhance customer retention by government hospitals in the United Arab Emirates (UAE). The mediating impact of outpatient satisfaction on service quality, word of mouth (WoM), hospital image, outpatient–physician relationship and outpatient loyalty were tested.

The sample data used to test the hypotheses were drawn from a pool of patients served by a government healthcare agency in Abu Dhabi. Questionnaires were provided to 418 participants using methods such as short message service, e-mail and face-to-face delivery. The data were analyzed using SmartPLS 3.3.2 software.

The results indicate that service quality, WoM and outpatient–physician relationship positively impact outpatient satisfaction and indirectly effect outpatient loyalty; that hospital image positively impacts outpatient satisfaction and loyalty and has a partially mediating effect on loyalty; that waiting time satisfaction has no effect on outpatient satisfaction and no moderating effect on the outpatient satisfaction–loyalty relationship and that switching cost has a positive effect on loyalty but no moderating effect on the outpatient satisfaction–loyalty relationship.

The first limitation of this study concerns the fact that only patients who had previously been served by these hospitals' outpatient units were included. Furthermore, the research was not able to obtain extensive findings related to the various factors that negatively impacted patient satisfaction and loyalty among all of the departments of government hospitals, such as inpatient care and emergency care.

Centered on the findings from this research, increasing switching costs would prevent patients from switching to other healthcare providers. Therefore, it has the potential to create a false loyalty or a hostage customer (Jones and Sasser, 1995). Additionally, making patients feel connected to their treatment plan and engaged in their care by developing a tool to maintain their enthusiasm about their health is important. It is therefore recommended that government hospital care providers and management consider providing online tools that patients can use to self-manage their care.

The results regarding patients' satisfaction level suggest several areas for improvement. The first pertains to waiting area entertainment and comfort because patients indicated that there is not enough entertainment or ways to pass the time when waiting for services. In addition to enhancing the entertainment and comfort of waiting areas, government hospital staff should maintain contact with patients who are waiting to ensure that they are aware of the time they will spend. Another area for improvement is the parking lot. During summer, patients prefer to walk less in the sun, which causes them to seek parking closer to the door. Government hospital management should consider different methods for transporting patients closer to the door, such as golf carts or valet services.

This is the first study to investigate the mediating impact of outpatients' satisfaction between its antecedents and loyalty in the UAE. These results provide an improved understanding of the factors influencing patient choices and establish more accurate methods for increasing patient loyalty to retain more patients.

Researchers recommend a reorganization of the medical profession into larger groups with a multispecialty mix. We analyze whether there is evidence for the superiority of these models and if this organizational transformation is underway.

We summarize the evidence on scale and scope economies in physician group practice, and then review the trends in physician group size and specialty mix to conduct survivorship tests of the most efficient models.

The distribution of physician groups exhibits two interesting tails. In the lower tail, a large percentage of physicians continue to practice in small, physician-owned practices. In the upper tail, there is a small but rapidly growing percentage of large groups that have been organized primarily by non-physician owners.

While our analysis includes no original data, it does collate all known surveys of physician practice characteristics and group practice formation to provide a consistent picture of physician organization.

Our review suggests that scale and scope economies in physician practice are limited. This may explain why most physicians have retained their small practices.

Larger, multispecialty groups have been primarily organized by non-physician owners in vertically integrated arrangements. There is little evidence supporting the efficiencies of such models and some concern they may pose anticompetitive threats.

This is the first comprehensive review of the scale and scope economies of physician practice in nearly two decades. The research results do not appear to have changed much; nor has much changed in physician practice organization.

A physician–nurse relationship is a complex, professional and shared-decision-making process, which is an important predictor of high-quality patient care. The purpose of this paper is to explore the attitude of the physician–nurse relationship in Southern Lebanon hospitals.

A descriptive institutional cross-sectional study was conducted among different departments of three hospitals in Southern Lebanon using a validated Jefferson Scale of Attitude.

In sum, 89 physicians and 245 nurses accepted to participate. The nurses’ mean age was 32 and the physicians’ was 44. The mean score was found to be 46 for all participants, with significantly higher scores noted among nurses compared to physicians (48 vs 43, respectively) and higher scores among females compared to males (48 vs 46, respectively). However, the study scored no significant difference in relation to the degrees attained by nurses and the participants’ years of experience. The majority had agreed that the shortage in the nurses’ staff affects proper patient care delivery. One fourth of the physicians disagreed that nurses should be considered as a collaborator and colleague. Therefore, more work is required to improve this collaboration.

There is a complex relationship normally displayed by physicians and nurses, which cannot be easily interpreted and analyzed. Physicians and nurses may have given socially desirable responses while filling the questionnaire. Even more, this study was conducted in Hospitals in Southern Lebanon, and it would be nice to extend this study to include further hospitals in other regions in Lebanon as well.

Nurses had higher scores toward collaboration, with females scoring higher than males. However, overall scores are considered to be lower compared to other countries. Thus, more efforts should be done on improving this communication among nurses and physicians, through promoting inter-professional undergraduate and postgraduate education training toward more effective communication.

Quality of patient care would be improved if more work is done on improving the collaboration between physicians and nurses, and this was shown to be required as per study results.

There is a gap in literature assessing this important topic which is the collaboration and attitude of nurses and physicians toward their relationship in Lebanon. It is extremely important that efforts should be taken in order to determine the type of nurse–physician relationship in every local context as this relationship affects quality of patients’ care.

The hospital–physician relationship (HPR) has been the focus of many scholars given the potential impact of this relationship on hospitals’ ability to achieve socially and organizationally desirable health care outcomes. Hospitals are dominated by professionals and share many commonalities with professional service firms (PSFs). In this chapter, we explore an alternative HPR based on the governance models prevalent in PSFs.

We summarize the issues presented by current HPRs and discuss the governance models dominant in PSFs.

We identify the non-equity partnership model as a governance archetype for hospitals; this model accounts for both the professional dominance in health care decisions and the increasing demand for higher accountability and efficiency.

There should be careful consideration of existing regulations such as the Stark law and the antikickback statue before the proposed governance model and the compensation structure for physician partners is adopted.

While our governance archetype is based on a review of the literature on HPRs and PSFs, further research is needed to test our model.

Given the dominance of not-for-profit (NFP) ownership in the hospital industry, we believe the non-equity partnership model can help align physician incentives with those of the hospital, and strengthen HPRs to meet the demands of the changing health care environment.

This is the first chapter to explore an alternative hospital–physician integration strategy by examining the governance models in PSFs, which similar to hospitals have a high reliance on a predominantly professional staff.

Prior studies have shown that physician-led hospitals have several advantages over non-physician-led hospitals. This study seeks to test whether these advantages also extend to periods of extreme disruptions such as the COVID-19 pandemic, which affect bed availability and hospital utilization.

The authors utilize a bounded Tobit estimation to identify differences in patient satisfaction rates and in-hospital utilization rates of top-rated hospitals in the United States.

Among top-rated US hospitals, those that are physician-led achieve higher patient satisfaction ratings and are more likely to have higher utilization rates.

While the COVID-19 pandemic generated greater demand for inpatient beds, physician-led hospitals improved their hospitals’ capacity utilization as compared with those led by non-physician leaders. A longitudinal study to show the change over the years and whether physician Chief Executive Officers (CEOs) are more likely to improve their hospitals’ ratings than non-physician CEOs is highly recommended.

Recruiting and retaining physicians to lead hospitals, especially during disruptions, improve hospital’s operating efficiency and enhance patient satisfaction.

The paper reviews prior research on physician leadership and adds further insights into the crisis leadership literature. The authors provide evidence based on quantitative data analysis that during the COVID-19 pandemic, physician-led top-rated US hospitals experienced an improvement in operating efficiency.

Recognition of the importance and difficulty of engaging physicians in organisational change has sparked an explosion of literature. The social identity approach, by considering engagement in terms of underlying group identifications and intergroup dynamics, may provide a framework for choosing among the plethora of proposed engagement techniques. This paper seeks to address this issue.

The authors examined how four disparate organisations engaged physicians in change. Qualitative methods included interviews (109 managers and physicians), observation, and document review.

Beyond a universal focus on relationship-building, sites differed radically in their preferred strategies. Each emphasised or downplayed professional and/or organisational identity as befit the existing level of inter-group closeness between physicians and managers: an independent practice association sought to enhance members' identity as independent physicians; a hospital, engaging community physicians suspicious of integration, stressed collaboration among separate, equal partners; a developing integrated-delivery system promoted alignment among diverse groups by balancing “systemness” with subgroup uniqueness; a medical group established a strong common identity among employed physicians, but practised pragmatic co-operation with its affiliates.

The authors cannot confirm the accuracy of managers' perceptions of the inter-group context or the efficacy of particular strategies. Nonetheless, the findings suggested the fruitfulness of social identity thinking in approaching physician engagement.

Attention to inter-group dynamics may help organisations engage physicians more effectively.

This study illuminates and explains variation in the way different organisations engage physicians, and offers a theoretical basis for selecting engagement strategies.

The purpose of this paper is to test and measure the outcome of a community hospital in implementing the Affordable Care Act (ACA) through a co-management arrangement. RQ1: do the benefits of a co-management arrangement outweigh the costs? RQ2: does physician alignment aid in the effective implementation of the ACA directives set for hospitals?

A case study of a 350-bed non-profit community hospital co-management company. The quantitative data are eight quarters of quality metrics prior and eight quarters post establishment of the co-management company. The quality metrics are all based on standardized national requirements from the Joint Commission and Centers for Medicare and Medicaid Services guidelines. These measures directly impact the quality initiatives under the ACA that are applicable to all healthcare facilities. Qualitative data include survey results from hospital employees of the perceived effectiveness of the co-management company. A paired samples difference of means t-test was conducted to compare the timeframe before co-management and post co-management.

The findings indicate that the benefits of a co-management arrangement do outweigh the costs for both the physicians and the hospital (RQ1). The physicians benefit through actual dollar payout, but also with improved communication and greater input in running the service line. The hospital benefits from reduced cost – or reduced penalties under the ACA – as well as better communication and greater physician involvement in administration of the service line. RQ2: does physician alignment aid in the effective implementation of the ACA directives set for hospitals? The hospital improved in every quality metric under the co-management company. A paired sample difference of means t-test showed a statistically significant improvement in five of the six quality metrics in the study.

Previous research indicates the potential effectiveness of co-management companies in improving healthcare delivery and hospital-physician relations (Sowers et al., 2013). The current research takes this a step further to show that the data do in fact support these concepts. The hospital and the physicians carrying out the day-to-day actions have shared goals, better communication, and improved quality metrics under the co-management company. As the number of co-management companies increases across the USA, more research can be directed at determining their overall impact on quality care.

This chapter reviews and integrates the empirical literature on the influence of organizational factors on hospital financial performance. Five categories of organizational characteristics that research has addressed are identified and examined as part of the review: ownership, governance, integration, management strategy, and quality. With some exceptions, our review reveals a general lack of consistency and conclusiveness across studies in each area. Exceptions were found in the areas of governance (e.g., physician participation and board processes) and integration (e.g., horizontal system centralization). Despite the lack of conclusive findings across studies, our review suggests substantial opportunities for future work, including opportunities for qualitative and exploratory work. Additional implications for theory and management are discussed.

To examine the major factors affecting patients' perception of cumulative satisfaction and to address the question whether patients in Egypt and Jordan evaluate quality of health care similarly or differently.

A conceptual model including behavioural dimensions of patient‐physician relationships and patient satisfaction has been developed. As the empirical research setting, this study concerns three hospitals in Egypt and Jordan. The survey instrument in a questionnaire form was designed to achieve the research objectives. A total of 48 items (attributes) of the newly developed five quality dimensions were identified to be the most relevant. A total of 224 complete and usable questionnaires were received from the in‐patients.

Hospital C has above‐average total and dimensional qualities and patients are the most satisfied in accordance with all dimensions of services. Hospitals A and B have under‐average total qualities as the majority of patients are not satisfied with services. Comparing hospitals A and B, in the majority of dimensions (with the exception of Q5), the quality in hospital B is higher than in hospital A. Patients' satisfaction with different service quality dimensions is correlated with their willingness to recommend the hospital to others. A cure to improve the quality for health‐care services can be an application of total relationship management and the 5Qs model together with customer orientation strategy.

The result can be used by the hospitals to reengineer and redesign creatively their quality management processes and the future direction of their more effective health‐care quality strategies.

In this research a study is described involving a new instrument and a new method which assure a reasonable level of relevance, validity and reliability, while being explicitly change‐oriented. This study argues that a patient's satisfaction is a cumulative construct, summing satisfaction with five different qualities (5Qs) of the hospital: quality of object, processes, infrastructure, interaction, and atmosphere.