Physician–hospital manager relationships: A second-order confirmatory factor analysis

Interprofessional collaboration between physicians and hospital managers can influence hospital resource use and the quality of care. This study examined the latent structure of interprofessional relationships as perceived by physicians and hospital managers. Data were collected from 279 physicians and hospital managers working in six hospitals. Interprofessional relationships were assessed using the Canadian National Study of Interprofessional Relationships between Physicians and Hospital Administrators scale, originally developed by Rundall et al. and subsequently modified by Samadi-niya. A second-order confirmatory factor analysis was conducted to evaluate the measurement model. The model showed an overall acceptable fit to the data (χ²/df = 3.55, RMSEA = .096, CFI = .96, NFI = .94, IFI = .96, RFI = .94, NNFI = .96). Four first-order dimensions explained the overarching construct of interprofessional relationships: role capability, teamwork, and relative power; adequacy of patient care resources and technology; financial arrangements between hospitals and physicians and communication; and hospital financial survival and clinical priority. This study demonstrates that the relationship between physicians and managers is complex and contingent upon organizational factors, clinical factors, relational factors, and financial factors. Policies intended to promote collaboration need to focus on physician leadership, financial factors, communications, and hospital sustainability versus clinical priorities.