Emerging Role of Palliative Medicine Physicians is Straining Hospice Relationships

I've been intrigued recently by the spate of articles and seminars concerning themselves with the relationships between physicians and hospitals. Of course, hospital-medical staff relationships have been contentious for years, and consultants advising hospital executives on the most effective ways to align physician objectives with hospital goals is hardly a recent development. So, what do I find intriguing? That similar concerns are surfacing with greater frequency among hospices and palliative medicine physicians, as hospices build their medical staffs and expand the role of physicians within the hospice's clinical and administrative activities.

What we're seeing can best be described as role drift, where there is a disconnect between what the physician sees as his/her role, and what the executives and/or other clinical staff see as the physician's role. Such role drift is magnified in those palliative care organizations where resources are strained. I don't mean to oversimplify, but one will generally find fractious relationships in organizations where the HPM physician does not have:
-Clear roles, responsibilities, expectations and accountabilities
-Well-established performance measures and standards
-Performance management system that tracks performance and offers feedback.

I'm curious to hear your experiences, and what methods you've used to build a high-performing hospice medical staff.