Managing the Myths of Health Care: Bridging the Separations between Care, Cure, Control, and Community

Berrett-Koehler Publishers
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“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.
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About the author

Henry Mintzberg is the Cleghorn Professor of Management Studies at McGill University and the recipient of twenty honorary degrees from universities around the world. He is the author of nineteen books, including Rebalancing Society.

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Additional Information

Publisher
Berrett-Koehler Publishers
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Published on
May 15, 2017
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Pages
272
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ISBN
9781626569072
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Language
English
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Genres
Business & Economics / Management
Medical / Administration
Medical / Health Care Delivery
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Content Protection
This content is DRM protected.
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Available on Android devices
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If the furious debate around the state of healthcare in the US has led to any consensus, it’s that the system should be delivering better quality for less cost than it does. The truth is that our healthcare system is a sprawling mix of competing interests in which those of the patient are valued least. Too much discussion has devolved to simplistic scapegoating, and too few comprehensive, constructive solutions have been offered. It’s time for a fresh vision.

In straightforward language, Healthcare at a Turning Point: A Roadmap for Change outlines a new market-based business model that aligns industry financing mechanisms with the goals of prevention, improved quality, and reduced costs. Drawing on more than 25 years of cross-industry consulting experience, the authors: Articulate a market-based vision of the industry Examine past efforts to reduce costs, their failures and their unanticipated consequences Spotlight perverse incentives that distort the way the healthcare system operates and make it less than it could be Present concrete recommendations for change within the healthcare delivery, insurance, pharmaceutical, device and diagnostics sectors Explain the changes that employers, consumers and policy makers can make to create a more customer-responsive system that delivers more value

For all the uncertainty in the current environment, there is also a rare opportunity to fundamentally redefine who wins in this market. Healthcare at a Turning Point provides guidance to executives ready for that contest as well as a roadmap for change.

 Hospitals have long relied on the heroics of one brilliant nurse or doctor to save the day. Such heroics often result in temporary workarounds and quick fixes that leave not only patients and quality care at risk, but also increase costs. This is the story of an organization breaking that habit. Like a growing number of healthcare organizations around the world, ThedaCare, Inc. has been using lean thinking and the principles of the Toyota Production System to improve quality of care, reduce waste, and become more reliable. But lean thinking was incompatible with ThedaCare’s old top-down, hero-based system of management. Kim Barnas, former SVP of ThedaCare, shows us how she and her team created a management system that is stable and lean, to spur continuous improvement.

Beyond Heroes shows the reader, step by step, how ThedaCare teams developed the system, using the stories of its doctors, nurses and administrators to illustrate. The book explores each of the eight essential components of the lean system, from front-line problem solving with the scientific method to daily team huddles and creating standard work for leaders all the way to the top of an organization. Finally, the author introduces four executives from healthcare systems across North America who have implemented ThedaCare’s system and share the lessons they learned along the way.

Beyond Heroes is not just a call to action or an argument for a better healthcare system. It is a necessary roadmap through the rocky terrain ahead, one that healthcare leaders can customize to their special needs.

Enough of the imbalance that is causing the degradation of our environment, the demise of our democracies, and the denigration of ourselves. Enough of the pendulum politics of left and right and paralysis in the political center. We require an unprecedented form of radical renewal. In this book Henry Mintzberg offers a new understanding of the root of our current crisis and a strategy for restoring the balance so vital to the survival of our progeny and our planet.

With the collapse of the communist regimes of Eastern Europe, Western pundits declared that capitalism had triumphed. They were wrong—balance triumphed. A healthy society balances a public sector of respected governments, a private sector of responsible businesses, and a plural sector of robust communities. Communism collapsed under the weight of its overbearing public sector.

Now the “liberal democracies” are threatened—socially, politically, even economically—by the unchecked excesses of the private sector.

Radical renewal will have to begin in the plural sector, which alone has the inclination and the independence to challenge unacceptable practices and develop better ones. Too many governments have been co-opted by the private sector. And corporate social responsibility can't compensate for the corporate social irresponsibility we see around us “They” won't do it. We shall have to do it, each of us and all of us, not as passive “human resources,” but as resourceful human beings.

Tom Paine wrote in 1776, “We have it in our power to begin the world over again.” He was right then. Can we be right again now? Can we afford not to be?
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