Construct Clarity in Physician-Hospital Alignment: The Need for Precision in Definition, Measurement, and Management; Comment on “Alignment in the Hospital-Physician Relationship: A Qualitative Multiple Case Study of Medical Specialist Enterprises in the Netherlands”

Document Type : Commentary

Author

Management Department, Opus College of Business, University of St. Thomas, Saint Paul, MN, USA

Abstract

The study by Ubels and van Raaij highlights the importance of alignment in hospital-physician relationships and the challenges in understanding, measuring, and managing it. Despite extensive research on alignment, drawing precise conclusions about its nature, drivers, and outcomes is difficult due to construct clarity and construct validity issues. This commentary focuses on clarifying these issues and the problems they create for hospitals attempting to manage alignment, as well as for scientific inquiry in this area. These issues involve the need to specify more clearly the essential nature of alignment and how it is distinct from other constructs such as engagement. It also involves demarcating alignment from the structures, arrangements, or processes intended to foster it, as well as from its outcomes. Improved precision in these areas will enable the development of more reliable and valid measures, thereby supporting hypothesis testing, theory building, and the identification of best practices. 

Keywords


  1. Ubels S, van Raaij EM. Alignment in the hospital-physician relationship: a qualitative multiple case study of medical specialist enterprises in the Netherlands. Int J Health Policy Manag. 2023;12:6917. doi:34172/ijhpm.2022.6917
  2. Jensen MC, Meckling WH. Theory of the firm: managerial behavior, agency costs and ownership structure. J Financ Econ. 1976;3(4):305-360. doi:1016/0304-405x(76)90026-x
  3. Wiseman RM, Cuevas‐Rodríguez G, Gomez‐Mejia LR. Towards a social theory of agency. J Manag Stud. 2012 Jan;49(1):202-22. doi:1111/j.1467-6486.2011.01016.x
  4. Burns LR, Alexander JA, Andersen RM. How different governance models may impact physician-hospital alignment. Health Care Manage Rev. 2020;45(2):173-184. doi:1097/hmr.0000000000000214
  5. Shortell SM, Alexander JA, Budetti PP, et al. Physician-system alignment: introductory overview. Med Care. 2001;39(7 Suppl 1):I1-8.
  6. Brinsfield CT, Priore RJ, Wehbi NK. Physician-hospital alignment: a definition and framework grounded in physicians' perception. Health Care Manage Rev. 2024;49(1):74-84. doi:1097/hmr.0000000000000388
  • Receive Date: 11 June 2024
  • Revise Date: 16 September 2024
  • Accept Date: 18 September 2024
  • First Publish Date: 22 September 2024