A ‘stethoscope’ for the physician manager—conditions for clinical accountability in the nordic setting

An increasing interest in requiring clinical accountability, i.e. direct economical and managerial involvement of physicians, can be witnessed in the US and the UK, representing two extremes on the axis of private versus public service provision. The development is also taking place in the Nordic countries alongside a ‘decentralisation’ of financial and managerial decision making to smaller units. The essay discusses possibilities to introduce clinical accountability on the Nordic scene. As a background to the anlaysis, clinical accountability is defined in terms of production targets, budget limits and preset standards of quality of care. Arguments for not using clinical outcome as result measure are presented. The product analogy is suggested as a means for the physician manager to control both clinical policies and resource management. The conclusion is that the possibilities to introduce clinical accountability in the Nordic countries probably are better than in the US or UK, for the following reasons: physician attitudes, interpreted indirectly by shown interest in management training are not unfavourable; the organisational structure with physicians in a line organisation gives the financially accountable Department Head professional as well as managerial authority; management policy stressing decentralisation increases autonomy and stimulates interest to involve in management; product control information is readily available through reliable information systems. Obstacles are also identified. Finally it is argued that the organisation structure found in Nordic countries enables clinical accountability still preserving clinical freedom in the singular doctor patient relation.