The new management team.

There is no better place to instill the necessary sense of cooperation and collaboration than the top. If top management, both physician and nonphysician, can establish a suitable working relationship, and communicate both the necessity for and success of the relationship throughout the organization, breakdowns in cooperation and collaboration are far less likely to occur. Shared responsibility and decision-making at the upper levels can be a laboratory for their use in other organizational locations. The partnership between clinical and administrative leadership is more important now than ever before. Medical group practices are an ideal setting for testing a new form of shared management that will help to rid organizations of the confrontational and adversarial attitudes that have too long characterized relationships among managers and clinicians in our health care organizations and institutions.