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Healthcare organizations depend on managers to build effective peer relationships to manage complex patient needs. Today, top management is fighting the many headed monster Hydra from Greek Mythology. The organization is steeped in conflict between peers. But, as soon as one problem is resolved, two more have grown in its place. These appear to be personal conflicts, but instead follow patterns of dysfunction. This book provides the conceptual frameworks for identifying these and for developing peer to peer relationship competence in the healthcare organization.




Communication theory affirms that a phenomenon must be viewed from a wide enough perspective in order to make sense of it. For example, an aging patient with chronic illness may face health challenges but may also be battling with loneliness and a sense of isolation. Patients’ problems are broader than the scope of the organizations that treat them. Patients need professional relationships to cross the boundaries of departments and entire organizations in order to create a wide enough perspective to meet their needs.
Jennifer Landau, Elio Borgonovi

1. The Peer to Peer Relationship: The Blended Relationship

As health problems get more complex and people live longer, people’s health problems no longer fit neatly into the services provided by one division of the organization. An oncology patient can become diabetic. An obese patient can experience diabetes and heart disease. Problems of multi-dimensional chronic illness require services from different departments, even if the person experiencing these problems and receiving these services is one and the same.
Jennifer Landau, Elio Borgonovi

2. Managing the Relationship with Patients

“Illness is the night-side of life, a more onerous citizenship. Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick. Although we all prefer to use only the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place”.13
Jennifer Landau, Elio Borgonovi

3. The Non-cooperative Game, the Nash Theory of Equilibrium and Healthcare Management

In his Nobel prize winning work, John Nash observed relationships from a mathematical and economic perspective. He was interested in relationships not only between people, but between organizations, and countries. In the previous chapters, this book has observed relationships between people in organizations, Nash observed what he termed transactions between parties. He called the relationships that developed from the observation of these transactions “games”. Game theory studies relationships from a different perspective, and uses different terms to describe the same issues. Briefly, in translation, games are relationships, transactions are agreements and actions, parties are the actors in the relationship.
Jennifer Landau, Elio Borgonovi

4. Trust and Rational Choice

The previous chapters — on person-role blended relationship, the doctor-patient relationship, and healthcare management as a non-cooperative game — have identified the specific nature of healthcare management and the importance of communication theory, negotiation and cooperation among professionals, patients and their families. Another way of looking at these themes, in order to shed new light on healthcare management is to consider the importance of trust and rational choice.
Jennifer Landau, Elio Borgonovi

5. Building Relationships on the Model of Trust

This chapter will examine a practical application of the trust model. By building trust it is possible to disclose and learn about the real problems in healthcare management, for patients and physicians. This chapter describes a research project that was designed to build trust with informers and researchers alike, in order to learn about healthcare issues. The research model used the concept of trust not only to design the research question and questionnaires but to support the data collection process itself. This chapter will describe a study in Italy that investigated the communication process between patients and their oncologists over QoL issues. It will describe the importance of the trust model in designing research when patient participation is necessary.
Jennifer Landau, Elio Borgonovi

6. Managerial Competence: Peer to Peer Relationship Management Skills

The previous chapters have identified aspects of the healthcare organization that render the management function in this context an area of specialization with specific critical issues. The implication of the analysis is that management experience in other sectors and management tools need to be modelled and adapted to meet the healthcare challenge. In this chapter, the specific characteristics of the healthcare organization will be translated from characteristics that qualify the organization as special to the characteristics that make the management role special. The competence necessary for the healthcare manager will be explored. Two managerial roles will be identified: the healthcare professional and the manager.
Jennifer Landau, Elio Borgonovi

7. Conclusions: Management Education

As the population lives longer patients need to receive multi-disciplinary responses. If the organization is unable to build peer to peer relationships, patients are managing their own care. One out of two chronic patients is non-compliant. This is detrimental to providing appropriate care and to controlling its costs. The greatest opportunities for healthcare managers lie in making existent services appropriate, of high quality, and cost effective.
Jennifer Landau, Elio Borgonovi


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