Tuesday, November 11, 2008

What is Not Taught About "Leadership in Healthcare"

One of our scouts forwarded me a link to the curriculum from an MBA program from the distinguished Yale School of Management designed especially for would-be health care leaders. The program is entitled "MBA for Executives: Leadership in Healthcare."

Here are the required courses, in alphabetical order:
- Competitive Strategies
- Corporate Finance of Biotechnology
- Economic Analysis
- Enhancing Negotiation Skills
- Entrepreneurial Business Planning
- Field Studies in Healthcare Management
- Financial Accounting
- Financial Management
- Financial Reporting
- Healthcare Policy, Finance & Economics
- Hypothesis Testing and Regression
- Independent Study
- Integrated Leadership Perspective
- Law & Management
- Leadership
- Managerial Controls
- Marketing Management
- Operations Management
- Policy Modeling & Decision Analysis
- Probability Modeling & Statistics Estimation
- Quality Management
- Services Marketing: Strategies for Nonprofits & For-Profits
- Strategic Environment Management
- Valuation I and II
- Visiting Scholars Program

The link provides more detailed course descriptions.

So what is missing? There seem to be two obvious areas that are not taught.

The first is health care. There are only two courses in this curriculum on "healthcare policy" and "healthcare management." There descriptions are as follows:

Field Studies in Healthcare Management

The Field Studies Program is a year-long combination of integrative coursework and hands-on, faculty-mentored consulting to active healthcare organizations. It serves as a capstone for the MBA-E, bringing together skills learned in the classroom with knowledge and perspective gained from the Visiting Scholars to explore their application in a variety of healthcare settings. The coursework covers funds flow and value creation in the healthcare system, competitive and cooperative strategies in the world of healthcare, managerial controls in the healthcare setting, designing and refining operating processes in healthcare, current applications and issues in healthcare information technology, and managing transformational change in a healthcare setting. Past consulting projects have included reducing order-to-report cycle time for a diagnostic imaging department, coordinating and cross-checking diagnostic and therapeutic processes across different clinical departments, strategic planning for a community-based HIV/AIDS care program, developing a clinical quality management plan, capacity planning for a new nursing unit, and strategic and financial analysis of different adoption alternatives for a newly-introduced artificial vertebral disk.

Healthcare Policy, Finance & Economics
Teaches students critical skills in analyzing and working within the healthcare industry. The first portion of the course focuses on the Economic and Financial drivers of the domestic healthcare system, including private and public financing and delivery models. In the latter portion of the course, the students learn about current issues of importance to this $1.4 trillion industry. The course is part didactic/part seminar style and includes significant team projects and presentations.

Thus, these courses seem to have little if anything to do with the care of actual patients. Furthermore, there are no courses that seem to have anything to do with biology or biomedical science, or with the practice of medicine or nursing.

The second area missing is ethics, particularly the business ethics of health care. There are simply no courses even remotely related.

As we have discussed before, since the 1980s, the health care professions have been systematically dis-empowered, with the goal of breaking up the "physicians guild," while bureaucrats, managers, and executives have taken over health care. A quick perusal of the curriculum meant to train top level health care executives at an elite US university suggests that such executives may be completely untutored in biology, medicine and nursing, and of how patients actually receive care. Furthermore, such executives may not receive even rudimentary training in ethics, despite the severe problems we have documented on Health Care Renewal with the business ethics of health care, and the effects of such problems on patients and society.

We need to rethink the advisability of having health care controlled by bureaucrats, managers and executives, especially in an era marked by widespread arrogance, greed and foolishness among even the top executives of our most prestigious industries (finance in particular). If we must continue some control by such people, at the least they should be educated in biology, the values of health care professionals, the context in which patients actually receive care, and the ethics of business applied to health care.


MedInformaticsMD said...

Ethics in business schools may be an oxymoron. The need for domain knowledge for leadership in healthcare has long ago been deemed unnecessary as well. If you've managed McDonald's, you can manage global pharma.

I found Yale in particular to have its own ethically challenged culture, as do many other universities in an era when morals are taught to be "relative", in other words, relative to the whims of those in power.

This is sad but true, and it will probably not improve until the system really implodes and hits bottom, much as we are seeing in the financial sector now.

Jim Sabin said...

This is an especially sad story, since a deeply understood engagement with ethics is probably the single most important "tool" for successful management and leadersip. The curriculum as you outline it is about health care as an industry. Health care as a calling, which is how patients, employees and wider society judge our organizations, is stunningly absent.