Addressing Administrative Harm for Better Health Care Outcomes with Insights from a Clinician

Health care systems face pressures to optimize operational efficiency while delivering high-quality patient care. However, the increasing divide between administrative and clinical domains has introduced a critical challenge. Administrative harm is often overlooked, stemming from unilateral decision-making processes that prioritize organizational goals over patient-centric considerations. This directly impacts both care delivery and workforce morale.

Walter O’Donnell, MD, a seasoned clinician and assistant professor of medicine at Harvard Medical School (HMS), advocates for corporate leaders to engage meaningfully with clinical teams to address this pressing issue. By understanding its root causes and collaborating closely with clinical teams, corporate leaders can create a health care environment that benefits everyone—from patients to providers.

Understanding Administrative Harm

Administrative harm emerges when top-down decisions inadvertently obstruct care delivery or stain clinicians. According to O’Donnell, the growing complexity of health care organizations has exacerbated the issue, driving a wedge between administrative and clinical spheres.

“We operate in parallel worlds that don’t always intersect,” he reflects. Many corporate leaders may not always have the full visibility into the day-to-day challenges clinicians face, but bridging this gap is possible and incredibly valuable.

Bridging the Gap Through Education and Exposure

To close this gap, O’Donnell advocates for immersive learning experiences. He suggests, “Staffing the desk at a busy clinic or rounding in the ICU without your CEO badge can offer fresh perspectives.” Experiencing these environments firsthand allows leaders to better understand the daily realities clinicians navigate.

A parallel can be drawn to the experience of the Uber CEO who, after struggling to understand why drivers were reluctant to return post-COVID, was advised by his Director of Operations to personally drive an Uber and ride a delivery bike. Initially resistant, he ultimately spent months experiencing the daily challenges of his workforce. 

“He learned a tremendous amount by being there moment by moment,” O'Donnell notes.

This model of leadership, where decision-makers actively engage in frontline operations, is directly applicable to health care. Just as the Uber CEO gained insight into systemic inefficiencies affecting drivers, health care executives can better grasp administrative harm by directly witnessing its impact on clinicians and patients.

Corporate training programs that incorporate these experiences—alongside case studies of administrative decisions gone awry—can prepare leaders to anticipate and mitigate unintended consequences. These efforts not only build empathy but also lead to more informed and impactful leadership.

Collaborative Models That Work

Effective collaborations between clinical and corporate leaders can reduce administrative harm by aligning decision-making processes with patient-centric objectives. O’Donnell highlights a promising example from recent research in JAMA Internal Medicine, the “policy to override policies.” This approach enables clinicians to make real-time decisions when rigid administrative rules hinder care delivery. 

For instance, a team enabled administrators and clinicians to jointly review cases where policies, such as requiring a photo ID for procedures, created barriers. By introducing structured, interdisciplinary reviews, the organization minimized delays in patient care while maintaining administrative oversight. 

To replicate such success, corporate leaders could implement decision-making frameworks where clinicians and administrators jointly evaluate policies quarterly. These reviews ensure policies stay relevant, practical, and aligned with care priorities.

Challenges in Effective Collaboration 

While the benefits of collaboration are clear, significant barriers remain. One major obstacle is the lack of psychological safety in many health care organizations. O’Donnell references a JAMA Internal Medicine study revealing that only 20% of clinicians feel comfortable raising concerns about administrative issues. 

Cultivating an environment where feedback is not only encouraged but also acted upon is necessary to overcome this challenge. Regular dialogue between administrators and clinicians is another potential solution, leading to mutual understanding and trust. Publicly recognizing contributors who help improve policies can reinforce a culture of openness.

As O’Donnell asserts, “Everyone should understand both sides of the issues because we’re all in this together.” O’Donnell emphasizes the need for leaders to track the outcomes of their policies, including their effects on staff morale, turnover, and patient care.

Operational and Clinical Impacts 

The consequences of administrative harm extend beyond abstract concepts, affecting both operational and clinical domains. On the operational side, inefficiencies stemming from administrative policies can lead to increased clinician turnover, reduced morale, and greater difficulty retaining experienced staff. Tracking these trends, he notes, would provide administrators with actionable insights to address systemic issues. 

Clinically, administrative harm can undermine the capacity of frontline workers to provide optimal care. O’Donnell recounts how shortages of essential medications, such as those used to treat shock, often leave clinicians scrambling to find alternatives without sufficient support. 

This strain not only compromises patient outcomes but also can intensify burnout and moral injury among health care workers. 

Working Toward a Collaborative Future 

To address administrative harm, corporate leaders must embrace a more collaborative, transparent approach. By embedding themselves in clinical environments, actively listening to frontline staff, and establishing joint decision-making frameworks, leaders can help bridge the gap between administrators and clinicians.  

“The more we engage, the clearer these challenges become,” Dr. O’Donnell stresses. “And the more we can work together to solve them.” 

Corporate leaders specializing in health care have an unparalleled opportunity to drive meaningful change. They can create systems that balance efficiency with compassionate, patient-centered care by championing interdisciplinary collaboration and accountability. As administrative harm becomes more widely recognized, the path forward lies in a unified commitment to teamwork and transparency.