Synopses & Reviews
Synopsis
Mintzberg begins in part 1 by confronting myths about health care, including the following:
We have a system of health care.
Health-care institutions can be fixed with more heroic leadership.
The health-care system can be fixed by more administrative engineering.
The health-care system can be fixed by more categorizing and commodifying to facilitate more calculating.
The health-care system can be fixed with increased competition.
Health-care organizations can be fixed by running them more like businesses.
Part 2 examines how health care is organized, in relation to what we know about differentiation, separation, and integration in organizations and systems in general.Mintzberg shows that in health care, the inclination has been to do an awful lot more differentiating than integrating. This has resulted in all sorts of excessive separations: curtains across the specialties, sheets over the patients, and walls and floors between the administrators. The favored form of organizing health care the professional organization is the source of its great strength as well as its debilitating weakness.
Part 3 then offers guidelines to reframe the core components of health care: strategy, organization, scale, ownership, management, and the system itself. For example, managing has to be about care more than cure, and organizing has to favor communityship over leadership, collaboration over competition.
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Synopsis
Managing the Myths of Health Care
Bridging the Separations between Care, Cure, Control, and Community
Health care is in desperate need of an overhaul: its costs have been rising for decades far faster than its results. In this sure-to-be controversial book, leading management scholar and iconoclast Henry Mintzberg turns his attention to reframing the management and organization of health care.
Mintzberg begins by describing various myths of health care, notably that this "system" is failing. It's hardly a system, but where it puts its effort, it is succeeding remarkably: we are living longer thanks to the many advances in treatments. But the current system is expensive, and we don't want to pay for it. So the administrators, in governments and insurance companies alike, have been intervening to fix it, mostly by cutting costs. And here is where we find a good deal of the failure.
The problem is not management per se but a form of remote-control management that has become too prevalent. Detached from the operations yet determined to control them, it reorganizes relentlessly, measures like mad, promotes a heroic form of leadership, favors competition where more cooperation is needed, and pretends that health care should be managed like a business.
There are also problems with how health care is organized. Every organization differentiates its work into component parts and then integrates these into unified wholes. But as Mintzberg points out, in health care, the predominance of differentiating over integrating has encouraged all sorts of excessive separations: "consulting" physicians who barely talk with one another, a preoccupation with evidence at the expense of experience and with researching cures for diseases while failing to investigate their causes, and the reducing of persons to "patients" and communities to "populations."
Behind all this lies a professional form of organizing that is the source of health care's great strength as well as its debilitating weakness. Professionals, and often administrators as well, categorize whatever they can so they can apply standardized practices. When the categories fit, this approach works wonderfully well. When they do not--say, a "patient" falls between the categories--it fails. Even more damaging can be the misfit between managers and professionals, as they pass each other like ships in the night.
After the diagnosis, Mintzberg offers the remedy. He shows how the management of health care can be reframed by engaging more than detaching--that is, caring more than curing (heretically, like nursing). And management can be distributed beyond just those people called managers--for example, to facilitate the organic emergence of strategies from the base rather than having them handed down from "the top." Health-care organizations can be reframed by encouraging collaboration to transcend competition and "communityship" to transcend leadership.
The overall message of Mintzberg's masterful analysis is that care, cure, control, and community have to work together, within health-care institutions and across them, to deliver quantity, quality, and equality simultaneously.
Synopsis
"Health care is not failing but succeeding, expensively, and we don't want to pay for it. So the administrations, public and private alike, intervene to cut costs, and herein lies the failure."
In this sure-to-be-controversial book, leading management thinker Henry Mintzberg turns his attention to reframing the management and organization of health care.
The problem is not management per se but a form of remote-control management detached from the operations yet determined to control them. It reorganizes relentlessly, measures like mad, promotes a heroic form of leadership, favors competition where the need is for cooperation, and pretends that the calling of health care should be managed like a business.
"Management in health care should be about dedicated
and continuous care more than interventionist and episodic cures."
This professional form of organizing is the source of health care's great strength as well as its debilitating weakness. In its administration, as in its operations, it categorizes whatever it can to apply standardized practices whose results can be measured. When the categories fit, this works wonderfully well. The physician diagnoses appendicitis and operates; some administrator ticks the appropriate box and pays. But what happens when the fit fails--when patients fall outside the categories or across several categories or need to be treated as people beneath the categories or when the managers and professionals pass each other like ships in the night?
To cope with all this, Mintzberg says that we need to reorganize our heads instead of our institutions. He discusses how we can think differently about systems and strategies, sectors and scale, measurement and management, leadership and organization, competition and collaboration.
"Market control of health care is crass, state control is crude, professional control is closed. We need all three--in their place."
The overall message of Mintzberg's masterful analysis is that care, cure, control, and community have to work together, within health-care institutions and across them, to deliver quantity, quality, and equality simultaneously.