Half-cen­tury on ...

Ed­u­ca­tors must train bet­ter health­care man­agers

Modern Healthcare - - Opinions Commentary - Sa­muel Levey

Nearly 50 years ago, Ger­hard Hartman, Thomas McCarthy and I pub­lished our 1961 sur­vey of all grad­u­ate pro­grams in hospi­tal ad­min­is­tra­tion in ex­is­tence in the United States and Canada.

The study was pub­lished in the Feb. 16, 1962 is­sue of Hos­pi­tals, the jour­nal of the Amer­i­can Hospi­tal As­so­ci­a­tion. There were 16 pro­grams, and their en­tire out­put of mas­ter’s grad­u­ates from their in­cep­tion at the Uni­ver­sity of Chicago in 1934 un­til 1961 was 3,120. Given ide­o­log­i­cal dif­fer­ences among ed­u­ca­tional leaders in hospi­tal and health ad­min­is­tra­tion, it was not sur­pris­ing that new pro­grams emerged in dif­fer­ent parts of the uni­ver­sity rather than in a sin­gle lo­cus such as the busi­ness school or school of pub­lic health. Three uni­ver­si­ties (Columbia Uni­ver­sity, North­west­ern Uni­ver­sity and the Uni­ver­sity of Min­nesota) ac­counted for nearly one-half of the grad­u­ates.

Health man­age­ment as a pro­fes­sion has ad­vanced greatly dur­ing the past sev­eral decades, and grad­u­ates of mas­ter’s de­gree pro­grams have gen­er­ally ex­pe­ri­enced lit­tle dif­fi­culty in lo­cat­ing place­ments. Just last year the Com­mis­sion on Ac­cred­i­ta­tion of Health­care Man­age­ment Ed­u­ca­tion, or CAHME, re­ported that there were more than 3,400 full-time stu­dents en­rolled in ac­cred­ited mas­ter’s de­gree pro­grams and ap­prox­i­mately 2,000 stu­dents en­rolled on a part­time ba­sis. Eighty-two ac­cred­ited pro­grams were part of uni­ver­sity colleges of pub­lic health, busi­ness, al­lied health, pub­lic pol­icy and other units.

There is lit­tle in­for­ma­tion about the num­bers and ca­pac­ity of nonac­cred­ited and on­line pro­grams that have grown rapidly in re­cent years and whose grad­u­ates find their way into health man­age­ment.

The Bureau of La­bor Statis­tics has fore­cast that de­mand for man­agers in health ser­vices will ex­pand to 328,800 in 2018 from 283,500 in 2008, an in­crease of 16%. While this pro­jec­tion is mod­est, it in­di­cates that growth rates will be higher than the av­er­age for all oc­cu­pa­tions. In­cluded in this count are grad­u­ates of health man­age­ment pro­grams at the bac­calau­re­ate and mas­ter’s lev­els as well as in­di­vid­u­als with clin­i­cal back­grounds and en­trants from other dis­ci­plines who have joined the health man­age­ment work­force. Dis­ag­gre­gated fig­ures by ed­u­ca­tional level or back­ground are not avail­able.

What fac­tors ac­counted for the growth of health­care man­age­ment and should we be con­cerned about fu­ture need and de­mand? The ma­jor­ity of the early pro­grams fo­cused nar­rowly on the train­ing of hospi­tal ad­min­is­tra­tors. The 1954 re­port of the Com­mis­sion on Uni­ver­sity Ed­u­ca­tion in Hospi­tal Ad­min­is­tra­tion, Uni­ver­sity Ed­u­ca­tion for Ad­min­is­tra­tion in Hos­pi­tals, en­cour­aged the de­vel­op­ment of grad­u­ate pro­grams with a strong pref­er­ence for in­cor­po­ra­tion of busi­ness cour­ses within the cur­ricu­lum. The prin­ci­pal ob­jec­tive of the re­port was to en­cour­age uni­ver­si­ties to de­velop pro­grams to staff hos­pi­tals with well-qual­i­fied hospi­tal ad­min­is­tra­tors. At that time, the tremendous growth of the health­care in­dus­try with a large need for man­age­rial tal­ent could not have been fore­seen. Then, the na­tional health bill was less than $25 bil­lion, or less than 5% of gross na­tional prod­uct.

Clearly, pro­duc­tion of health ser­vices man­agers mush­roomed far be­yond the ex­pec­ta­tions of the founders of the ed­u­ca­tional pro­grams. Some ed­u­ca­tors of that era were con­cerned that pro­grams were al­ready grad­u­at­ing too many stu­dents with mas­ter’s de­grees. In the early 1960s, health­care was re­garded as a “cot­tage” in­dus­try, and Wall Street lacked in­ter­est. In 1961, when our ar­ti­cle was pub­lished, no one could have fore­seen the Lyn­don John­son pres­i­dency and the pas­sage of Medi­care and Med­i­caid. Th­ese pro­grams un­leashed an avalanche of de­mand for health­care ser­vices and corre- spond­ingly for trained man­agers. This is ex­em­pli­fied by the fact that the to­tal work­force grew dur­ing the 1970s by 23% while health­care em­ploy­ment jumped 55%.

The ques­tion re­mains—how many highly skilled man­agers are re­quired in hos­pi­tals and health or­ga­ni­za­tions to achieve and main­tain ex­cep­tional per­for­mance and se­ri­ous cost con­tain­ment? This is a qual­i­ta­tive ques­tion that is ex­tremely dif­fi­cult to an­swer—per­haps a search for health­care man­age­ment’s holy grail. Un­for­tu­nately, no re­li­able bench­marks are avail­able for gov­ern­ing boards and C-suites, nor are em­pir­i­cal stud­ies of ad­min­is­tra­tive in­ten­sity avail­able that could help us to ad­dress this ques­tion. Ad­min­is­tra­tive in­ten­sity can be de­fined as the ex­tent to which re­sources are al­lo­cated to the man­age­ment of out­put. This in­cludes such ac­tiv­i­ties as co­or­di­nat­ing the work of oth­ers, de­ci­sion­mak­ing and en­sur­ing con­form­ity with or­ga­ni­za­tional goals and ob­jec­tives.

Most pro­fes­sion­als who have wit­nessed the sig­nif­i­cant changes in health­care over the past sev­eral decades rec­og­nize that lead­er­ship and man­age­ment in health­care are a more daunt­ing as­sign­ment than in the hal­cyon days that pre­vailed through most of the 20th cen­tury. Trans­for­ma­tion is one of the watch­words of an in­dus­try in tran­si­tion that faces large is­sues of in­for­ma­tion sys­tems, out­comes mea­sure­ment, staffing pat­terns, ed­u­ca­tional re­quire­ments and dis­rup­tive or grad­ual change. Man­age­ment has be­come more spe­cial­ized, and the range and depth of the cur­ricu­lum in mas­ter’s pro­grams ac­cred­ited by the CAHME has grown to in­clude en­hanced em­pha­sis on fi­nance, eco­nomics, in­for­ma­tion sys­tems, quan­ti­ta­tive meth­ods and strate­gic plan­ning. Pro­grams are beginning to ad­dress the vi­tal is­sue of com­pe­tency as­sess­ment, also a dif­fi­cult set of tasks.

Ex­pec­ta­tions for ex­traor­di­nary per­for­mance will in­eluctably con­front fu­ture health­care man­agers where con­tin­ual im­prove­ment is the watch­word. Ev­ery or­ga­ni­za­tion is dif­fer­ent, and this must be fac­tored into the equa­tion for ac­qui­si­tion and men­tor­ing of man­age­rial tal­ent. We must work as­sid­u­ously to ex­pand the pool of highly qual­i­fied ap­pli­cants for our ed­u­ca­tional pro­grams in health ser­vices man­age­ment.

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