
Krisna Hospital provides secondary and tertiary healthcare services to its patients. The hospital is committed to providing patient-centered care, which resulted in introducing a new position as a patient care executive (PCE). This professional is in close contact with patients and families to help physicians spend more time on medical aspects and less time on communication with patients. Patient retention, as well as revenue, increased, but the hospital is also witnessing an increasing turnover rate among physicians. Due to a significant deficit of high-profile physicians in India, losing a high-skilled practitioner is a serious problem to be addressed as hospitals try to attract talent. Discussions with the staff make it clear that the clash between PCEs and physicians is one of the primary reasons for leaving. This paper includes a brief analysis of the problem and a solution to ensure the sustainable development of the healthcare facility by improving the quality of care.
Phycological Contract Breach at Krisna Hospital and Ways to Address It
One of the issues the physicians employed at Krisna Hospital find influential is the psychological contract breach. It has been found that psychological contract breach has serious adverse effects on employee job satisfaction (Collins and Beauregard, 2020). The practitioners expect to be trusted professionals influencing patients’ health-related decisions. However, this expectation is not met as PCEs appear to be the central figures who affect patients’ behaviors and decisions. At that, trustful relationships between the doctor and the patient are the basis of patients’ adherence to treatment regimen and, as a result, patient outcomes (Cánovas et al., 2018; Hefner et al., 2018; Chandra, Mohammadnezhad, and Ward, 2018). The fact that patients are willing to communicate with PCEs rather than physicians and follow the recommendations of the former can be seen as an influential factor contributing to the breach of the psychological contract.
One of the causes of this serious problem, leading to the high turnover among physicians, is the existing patterns of sources of power in the hospital. PCEs are responsible for maintaining proper communication between the physician and the patient. However, they are more than that as they become the major source of information and support for patients. These professionals exercise expert and referent power regarding patients’ decision-making process. These types of power encompass trust and proper relationships based on the belief in the person’s expertise and positive personal attitude (admiration, close connection, and so on) (Håvold and Håvold, 2019). These types of power are critical in healthcare settings as patients feel vulnerable and need support and empathy in addition to expertise and clinical care.
At the same time, physicians’ source of power is associated with their position within the healthcare facility (legitimate) and their expertise (limited expert power). At Krisna Hospital, physicians are completely responsible for patient treatment, and their authority is not expected to be questioned by PCEs (which happens quite often). Patients also understand that doctors have the necessary expertise, but in many cases, people choose to follow the recommendations of PCEs whose expertise is valued more than that of physicians. Patients trust PCEs rather than their doctors, which has negative effects.
To address the psychological breach and improve communication between patients and doctors, it is necessary to design detailed sets of responsibilities for both positions. These responsibilities should be clear to physicians and PCEs, who should collaborate rather than compete. It is critical to creating teams consisting of physicians, a PCE, and other healthcare professionals. PCEs should stick to the treatment plan and provide recommendations consistent with these plans, ensuring proper communication between the medical staff and patients.
Main Reasons for Resisting the PCE Program
As mentioned above, the psychological contract breach is one of the primary reasons for resisting the PCE program at the healthcare facility. Physicians believe that patients should follow their recommendations while people often disregard them and follow PCEs’ advice instead. However, PCEs have no deep medical knowledge, which can have negative patient outcomes, according to Krisna Hospital physicians. Disrupted communication is a serious reason that makes physicians resistant to the program. These practitioners and PCEs do not communicate properly, which creates two lines of communication instead of one single approach developed by the healthcare team. , the lack of communication skills in doctors can also be an issue to be addressed. They can be too concerned with the medical aspect and forget about such domains as empathy and patient psychological and emotional needs (Kee, Khoo, Lim, and Koh, 2018; Pascual-Ramos et al., 2021). The hospital administration should consider launching a training program aimed at improving communication skills for physicians. Team-building incentives (following the creation of teams of physicians and PCEs) should also be implemented.
A Viable Solution: A Plan to Implement the PCE Program
To improve the situation and decrease the turnover rate at the hospital in question, it is possible to use Lewin’s theory of change widely employed in the healthcare setting. This theory of change implies three stages: unfreezing, changing, and refreezing (Bamberg and Schulte, 2019). During the first phase (unfreezing), it is essential to make all the stakeholders aware of the issue and involved in the process of change (Beasley, Grace, and Horstmanshof, 2020). The urgency of the problem should be discussed during regular meetings, and the panels should be held in three variants: physicians, PCEs, and both groups together.
The stage of change will also involve weekly discussions because miscommunication or even the absence of such is an apparent issue. The practitioners should share their concerns and suggestions regarding the improvement of provided quality. It is critical to make sure that both, PCEs and physicians, are equally committed to the organizational goals (one of which is the provision of patient-centered care). Physicians and PCEs should discuss their responsibilities and the need to hold a single line based on the developed treatment plan when communicating with patients.
The stakeholders should agree to use this approach and ensure that patients receive recommendations based on physicians’ decisions and treatment plans. If PCEs (based on patients’ fears, concerns, personal beliefs, and so on) have doubts regarding some choices physicians make, these professionals need to discuss the treatment plan and develop a single communication line. Some training is required for both PCEs and physicians with a focus on conflict management and empathy. Empathy and conflict management skills are some of the major skills medical staff should have to provide high-quality care (Petrocchi et al., 2019). This training will be the core of the implementation change process, and regular meetings will be the platform to facilitate the change. The refreezing phase will involve the development of the corresponding protocols and new job descriptions. Regular meetings and evaluation incentives (surveys) will be mentioned in these protocols.

In conclusion, it is necessary to state that miscommunication between physicians and PCEs, as well as these stakeholders’ unwillingness to collaborate, is the primary reason for the increased turnover rate among physicians. Lewin’s model of change can be the framework to address the issue. The effort to improve the situation will encompass regular meetings and training for PCEs and physicians. Bringing these practitioners together is the key to improving the quality of care and employee job satisfaction.