HCAD 8006 Week 5 Position Post Example

Week 5 Discussion: Does General Management Theory Apply to Health Care?

Management Theory Imported From Other Industries Transfers Badly Into Health Care, on Three Grounds, With One Exception Conceded

Management theory developed in manufacturing and other industries transfers badly into health care, and the reasons are structural rather than cultural. I rest the case on three grounds.

First, the outcome a health care manager is accountable for is produced jointly by people who do not report to that manager. A plant manager directs the people who make the product. A hospital manager oversees nurses and staff but not, in most American hospitals, the physicians whose decisions determine much of what happens to a patient. Glouberman and Mintzberg (2001) described the field as split among four worlds, curing, caring, controlling and community, whose members answer to different loyalties, and the manager inhabits only one of them. Theories that assume a manager can redesign work by directing the people who do it begin from a premise that does not hold.

Second, the measurement infrastructure was built for billing, not for control. Manufacturing methods depend on measuring the process at each step. Health care's most complete data record what was billed, which is why Iezzoni (1997) warned that administrative data reflect their payment purpose and capture clinical reality only partly. A method that assumes accurate process measurement inherits data that were never designed for it.

Third, professional authority sits outside the organizational hierarchy. Clinical judgment is licensed by the state and governed by professional norms, not by the employer's chain of command. When a management method conflicts with clinical judgment, the method usually loses, and often should.

I concede one exception. Where work is genuinely under managerial control and well measured, such as supply chains, scheduling and transport, imported methods can transfer well. Radnor et al. (2012), reviewing lean in health care, found that much of its application has been limited to such process tools rather than the whole-system change lean promises, which I read as evidence for my position: methods transfer where health care resembles other industries and stall where it does not.

Reply to Arvid

Arvid, you argue against my position by pointing to the success of checklists in surgery, a method borrowed from aviation. That is a strong example, and I should take it seriously. I would note, though, that it fits my concession more than it refutes my claim. A checklist works in the operating room because the team is co-located, the steps are discrete and the surgeon has agreed to the protocol. Those are the conditions under which professional authority and managerial method align. Glouberman and Mintzberg (2001) would place the operating room squarely in the cure world, where a single team controls the work. Does your example extend to settings where the team is dispersed across organizations?

Reply to Leilani

Leilani, you agree with me but go further, arguing that health care needs its own management theory entirely. I would stop short of that. The problem is not that general theory is useless but that its assumptions must be checked against health care's structure before use. Radnor et al. (2012) show lean succeeding at the process level, which suggests adaptation rather than replacement. A health-specific theory would also face the problem that health care is not one industry; a primary care practice and an academic medical center differ as much as either differs from a factory.

References

Glouberman, S., & Mintzberg, H. (2001). Managing the care of health and the cure of disease: Part I. Differentiation. Health Care Management Review, 26(1), 56-69. https://doi.org/10.1097/00004010-200101000-00006

Iezzoni, L. I. (1997). Assessing quality using administrative data. Annals of Internal Medicine, 127(8, Pt. 2), 666-674. https://doi.org/10.7326/0003-4819-127-8_Part_2-199710151-00048

Radnor, Z. J., Holweg, M., & Waring, J. (2012). Lean in healthcare: The unfilled promise? Social Science & Medicine, 74(3), 364-371. https://doi.org/10.1016/j.socscimed.2011.02.011