Physician–hospital alignment: A definition and framework grounded in physicians’ perception

Abstract

The alignment of physicians’ interests with those of their hospital has garnered considerable interest in recent years, in part because of their central role in health care expenditure and patient outcomes. However, the systematic study of physician–hospital alignment is currently impeded by a lack of construct clarity. This is evidenced by research that conflates the actions intended to create alignment with alignment itself. It is also evidenced by a variety of different definitions, conceptualizations, and measures in the literature, most of which are confounded with constructs that are something other than alignment (e.g., commitment, trust). Critical Theoretical Analysis We draw on agency theory and person–organization fit to define physician–hospital alignment as a physician’s perception that their financial incentives, goals, and values and those of their hospital are mutually supporting and reinforcing rather than in conflict with one another. Advance To better understand the nature of the construct and to help guide future research, we present an integrative framework grounded in physicians’ perceptions. Practice Implication Our definition and framework set the stage for improved construct validation and more systematic study and management of physician–hospital alignment.