Henry Mintzberg - Managing the Myths of Health Care: Bridging the Separations Between Care, Cure, Control, and Community

BRIDGING THE SEPARATIONS BETWEEN CARE, CURE, CONTROL, AND COMMUNITY

HENRY MINTZBERG

Managing the Myths of Health Care

Copyright 2017 by Henry Mintzberg

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First Edition

Paperback print edition ISBN 978-1-62656-905-8

PDF e-book ISBN 978-1-62656-906-5

IDPF e-book ISBN 978-1-62656-907-2

2017-1

Production Management: Michael Bass Associates

Cover/Jacket Designer: Dan Tesser / Studio Carnelian

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EXHIBITS

BOXES

FIGURES

This book is written for everyone engaged in health care: clinical and other professionals, managers, and policy makers, to be sure, but also the rest of us, as people beyond patients. (When I exercise to care for my health, am I a patient?)

I have written this book in an easy style, to make it accessible to specialists and laypeople alike. All of us need to better understand the strengths and shortcomings of this system called health care. We can start by asking ourselves if the labels system and health care really describe what constitutes mostly a collection of treatments for diseases.

All over the world, people rail on about the failings of their health care. Yet we are living longer, thanks to the many advances in these treatments. In other words, where it focuses its attention, this field is succeeding, not failing, sometimes astonishingly. But it is doing so expensively, and we dont want to pay for it. So the administrators of our health care, 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.

Is management, therefore, the problem? Many health care professionals believe so. I dont. Health care cannot function without management, but it can certainly function without a form of management that has become too common. I call it remote-control management because it is detached from the operations yet determined to control them. It works badly even in business, from where it has come. In health care, it reorganizes relentlessly, measures like mad, promotes a heroic form of leadership, favors competition where there is the need for cooperation, and pretends that this calling should be managed like a business. The more of all this we get, the more dysfunctional health care becomes.

All of this is the subject of of this book, called Myths, to open up perspectives. As you can see, it is somewhat polemical in nature, although most of the conclusions are backed up by evidence and illustrations from experience, a number of these in the supporting footnotes.

Part II, called Organizing, serves as a bridge between Parts I and III, by considering how we organize in general and for health care in particular. In general, we differentiate work into component parts and then integrate these parts into unified wholes. In health care, however, there tends to be a lot more differentiating than integrating, and this has encouraged all sorts of excessive separations: consulting physicians who barely talk with each other; a preoccupation with evidence at the expense of experience; the researching of cures for diseases while failing to investigate their causes; persons reduced to patients and communities reduced to populations. And in the administration of health care, there are those walls and floors that separate managers from each other and from the professionals.

Behind all this lies a particular form of organizing that dominates the delivery of health care services. To understand it, turn on its head much of what you know about conventional organizing. For example, here strategy and leadership do not so much descend from some metaphorical top as emerge from the base; bigger is not inevitably better; and many of the most successful institutions are neither private nor public.

This professional form of organizing is the source of health cares great strength as well as its debilitating weakness. In its administration as in its operations, it categorizes whatever it can, in order to apply standardized practices whose results can be measured. When the categories fit, this works wonderfully well. The physician diagnoses appendicitis and operates; the government or insurance company ticks the appropriate box and pays. But what happens when the fit fails? For example, who cares for the patient who falls between the categories, say, with some form of autoimmune illness that medicine has yet to prototype? Or how about the patient who fits the category but is ignored as a person, and so does not respond adequately to the treatment? Even more damaging can be the misfit between managers and professionals, as they pass each other like ships in the night, the managers in their hierarchy of authority, the professionals in their hierarchy of status.

This takes us to of the book, called Reframing, about how to achieve the necessary integration, so that heath care can function more like the system it is thought to be. Its management can be reframed as engagement rather than detachmentor, if you like, as caring more than curing. (Dare I say, like nursing more than medicine?) And it can be seen as distributed beyond just those people called managers. Thus strategies, rather than descending immaculately conceived from some metaphorical top, can be seen to emerge from the base as professionals in the operations learn their way to new forms of care and cure.