Relationship-Centered Administration: Basic Principles and Examples from a Community Hospital

The transformation of clinical practice known variousl y as “patient-centered care” (1), “the biopsychosocial model” (2), and most recently “rel ationship-centered care” (3) has been concerned with bringing a personalized, partnership-orient ed approach to medical care. To date, scholarship in this area has focused on the clinical e ncounter (how patients, families and clinicians communicate and work together), and on education in the health professions (how to teach this collaborative approach, especially through experiential l earning and reflection). In this chapter, we consider the application of the key principles of rela tionship-centered care in a third context: the management and administration of health care organizations. Organizations exert profound effects on individuals that a re seldom fully recognized. Most health care organizations create work environments th at are at odds with the values of relationship-centered care. They value control and oper ate in an impersonal and bureaucratic fashion. (4) In such environments, clinicians trying to work with their patients in a personal, collaborative manner find themselves continually swimming against the current. On the other hand, where core elements of relationship-centered car e are reflected in organizational principles and practices, these same practitioners are more like ly to incorporate relationship-centered process into their clinical work. (5) There is evidenc e to suggest that such environments improve clinical performance (5;6) and the satisfaction of both patients and staff. (7;8) We begin by considering the principles of relationship-c entered administration (RCA) in more detail and reviewing a list of basic administrativ e tasks. Next we explore the intersection of these two areas by considering several examples from o ne administrator’s practice in the Department of Medicine of a medium-sized community hospital. Finally we offer some comments on the implications and limitations of relationship-ce ntered administration.