There are things that are not visible in financial statements, but that determine the fate of an organization much more strongly than numbers. One such factor is the relationships between the people who make up the system.
In the case we analyzed from the US, the financial crisis was only an external manifestation. Inside the hospital, something else was happening – a deep conflict between doctors and administration. This conflict did not arise suddenly. It was formed gradually, as is often the case in complex systems.
Doctors felt that management did not understand their reality. That decisions were made without taking into account clinical practice, that the focus was shifting to finances, not to the patient. Management, in turn, saw the other side: a lack of economic thinking, an unwillingness to consider the limitations of the system, resistance to change.
These are two logics that arise naturally in any medical system. But the problem begins where they stop interacting.
In that hospital, this led to very concrete consequences. Doctors started leaving. With them, patients left. With patients, revenues. And at some point, the financial problem was no longer the cause, but the effect. It was the collapse of the system as a whole.
The turning point came when the approach to management changed. Doctors were no longer considered as a separate “part” that performs its function. They began to be included in the decision-making system. Not declaratively, but in essence. They began to see the financial picture. Understand how the system works. Influence processes. And along with this, their role changed. From performer to participant. It was not an easy process. But it was he who restored connections within the system.
When I look at Ukrainian hospitals, I see that this gap still exists today. We have already changed the funding model through the National Health Service. But the role of the doctor in the system has remained almost unchanged.
In most cases, the doctor does not have access to complete information about how the hospital works as an economic system. He is not included in the process of making management decisions. His work is measured by clinical indicators, but is not linked to systemic efficiency.
And this creates a paradox.
It is the doctor who forms the main product of the system – medical service. But is not a full-fledged part of the management of this system. In such a model, conflict becomes inevitable. And this conflict is not resolved through administrative decisions. It is resolved only through a change of roles.
When the doctor begins to understand the system, and management begins to listen to the doctor, space for joint movement arises.
This is no longer a question of a single hospital. It is a question of an approach to the entire healthcare system!
Without this connection, any financial model will remain unstable.