title: The Changing Health Care Landscape and Implications of Organizational Ethics on Modern Medical Practice.
abstract: BACKGROUND
  Medicine is rapidly changing, both in the level of collective medical knowledge and in how it is being delivered. The increased presence of administrators in hospitals helps to facilitate these changes and ease administrative workloads on physicians; however, tensions sometimes form between physicians and administrators.
  
  
  METHODS
  This situation is based on perceptions from both sides that physicians obstruct cost-saving measures and administrators put profits before patients. In reality, increasing patient populations and changes in health care are necessitating action by hospitals to prevent excessive spending as health care systems become larger and more difficult to manage. Recognizing the cause of changes in health care, which do not always originate with physicians and administrators, along with implementing changes in hospitals such as increased physician leadership, could help to ease tensions and promote a more collaborative atmosphere. Ethically, there is a need to preserve physician autonomy, which is a tenet of medical professionalism, and a need to rein in spending costs and ensure that patients receive the best possible care.
  
  
  CONCLUSIONS
  Physicians and administrators both need to have a well-developed personal ethic to achieve these goals. Physicians need be allowed to retain relative autonomy over their practices as they support and participate in administrator-led efforts toward distributive justice.
authors.affiliation: Cushing Neurosurgical Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Castlen
authors.affiliation: Cushing Neurosurgical Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Cote
authors.affiliation: Neurosurgery Department, The Haga Teaching Hospital, The Hague, Haaglanden Medical Center, The Hague, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Wouter A
authors.initials: WA
authors.lastname: Moojen
authors.affiliation: Department of Neurosurgery, University Medical Center, Utrecht, The Netherlands.
authors.forename: Pierre A
authors.initials: PA
authors.lastname: Robe
authors.affiliation: Department of Neurosurgery, Üsküdar State Hospital, Istanbul, Turkey.
authors.forename: Naci
authors.initials: N
authors.lastname: Balak
authors.affiliation: Copenhagen Neurosurgery, Neuroscience Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Jannick
authors.initials: J
authors.lastname: Brennum
authors.affiliation: Department of Neurosurgery, Neuroscience Institute, St. Rita Medical Center/Mercy Health, Lima, Ohio, USA.
authors.forename: Mario
authors.initials: M
authors.lastname: Ammirati
authors.affiliation: Department of Neurosurgery, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Tiit
authors.initials: T
authors.lastname: Mathiesen
authors.affiliation: Cushing Neurosurgical Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Neurosurgery, University Medical Center, Utrecht, The Netherlands. Electronic address: M.L.D.Broekman-4@umcutrecht.nl.
authors.forename: Marike L D
authors.initials: MLD
authors.lastname: Broekman
mesh_terms: D003299:Cooperative Behavior; D004991:Ethics, Institutional; D004992:Ethics, Medical; D006801:Humans; D010820:Physicians
keywords: Administration; Ethical climate; Hospital; Leadership; Organizational ethics; Quality management