Hospital medicine is operating in a period of significant transformation, shaped by consolidation, evolving payment models, regulatory pressures, and increasing patient complexity. These forces influence clinical and administrative leaders alike and frame the context in which administrative decisions are made.
In this activity, we will introduce the concept of administrative harm—the adverse consequences of administrative decisions within healthcare that directly influence patient care and outcomes, professional practice, and organizational performance—and explore how system-level pressures can create distance between decision-making and frontline care. Through perspectives from operational, policy, and physician leadership, we will examine how broader forces such as reimbursement changes, payer dynamics, and organizational structures shape decisions, and how limited shared context can contribute to unintended downstream effects.