Half-century on ...
Educators must train better healthcare managers
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.