This book focuses on good hospital care systems. It describes how professionals can work together with hospital executives to create better practice environments, thus improving outcomes for their patients.

Excerpts from Chapter 10, Reconciling Power, Profit and Service:

The Professional Imperative

Over the past thirty years, we have learned more than we ever wanted to know about the management of hospitals. But what we've really learned is what we already knew: that the primary purpose of the hospital cannot be monetary. When the product is penicillin, pre-natal care, an emergency tracheotomy tray or hospital care, then the business enterprise is unique.

Hospital patients are by no means customers in the ordinary sense. It is absurd to assume that an ordinary business transaction is taking place when the one buying is doubled over with a gallbladder full of stones or has a child bleeding from a gunshot wound. To view hospital service as an ordinary commodity, to refer to the sick and injured as mere market share, is not acceptable in a humane society.

We are also re-learning that it is illogical for health care professionals to become hired hands of industries that operate only for profit. Health professionals are distinguished from others by an orientation to service. They focus on theory, research and practice, but their single most distinguishing feature must necessarily be altruism. The most logical arrangement is one in which they themselves are the hirers of business managers, not the reverse.

...(Yet,) when nurses or physicians tell you that they are required to practice according to a lower standard, they are wrong. What is true is that they agree to practice this way. When they say that they have lost autonomy, what they really mean is they have relinquished it.

...it is the practitioner who is culpable. Only when nurses and physicians accept this unequivocably, taking full responsibility for their own practice, will they be able to deal effectively with this issue.

Excerpts on nurse/physician collaboration:

With dwindling, inconsistent nursing staffs in many hospitals, physicians have less substantive collaboration with hospital bedside caregivers. Even excellent nurses cannot practice well within poor systems, and it is a natural consequence that doctor-dictate behavior sets in.

Physcians may not even take note of which nurse is assigned to their hospitalized patient because they have learned from experience that on some hospital units there is often little value in consulting the nurse. In a system that consistently lends itself to poor nurse/physician teamwork, many physicians understandably accept nursing care as little more than a series of tasks and a means of having their own orders carried out. It is not because they do not want the benefit of more professional collaboration with nurses but because they are accustomed to working without it.

Creating Hospitals We Can Trust describes the system that best lends itself to superior physician/nurse collaboration.