The Secret of Medical Management

The secret of medical management lies in the control of the patient care process. Most administrative effort is misdirected as it is aimed at supporting the patient care process without helping to control it. It is suggested that administrative effort should be concentrated on utilization review and quality assessment. A review of the research on group practices does not support the myth of physician autonomy in hospitals and prepares the way for administrators to join in controlling patient care. The technology of utilization control is well-developed but underused. Much of quality assurance (QA) activity in hospitals is pointless. Monitoring and control by clinical department heads could be accomplished more efficiently if the QA process were formalized. This requires developing a problem identification system. Tabulations could be produced summarizing activity by department or by physician. A system for surveillance of aggregate data can be the core of an efficient and effective patient care control system.