Monday, August 24, 2009

NY Times Proclaims Anyone Can Run a Health Care Organization "with a Little Studying Up"

Last week, the NY Times published a somewhat breathless article on the wonderful opportunities available in health care management. Health care management seems to be the one area that is growing during the "great recession."

Health care may be a costly drag on the economy, but it’s still a great place to find a job.

Midcareer managers and other workers have been migrating to health care jobs for years, of course. Now, with the recession, the lure is even stronger.

The article suggested managing health care organizations does not require knowing much about health care.

'The demand for talented leaders in health care is only going to go up,' predicted Jane Groves, a senior vice president at Integrated Healthcare Strategies, an executive search and consulting firm in Kansas City, Mo. 'All that demand can’t and shouldn’t be filled by people already working in health care.'

The article supplied success stories of health care managers who came from unrelated fields, without any actual experience giving care, or knowledge of biomedicine. For example,

Frank Pinkowsky worked as a manager at DuPont for 24 years before taking a position as senior vice president for human resources at the Guthrie Clinic in Sayre, Pa. 'Don’t underestimate the value of what you learned working for someone else,' he advised.


'We just recently recruited a vice president for human resources from the supermarket industry,' said Mike A. Helm, a senior executive at Sutter Health, a hospital chain with 45,000 employees in Northern California. Sutter hires 20 to 30 executives a year.

At most, becoming a top healthcare executive only requires some course-work on health care management, perhaps on-line rather than in a classroom. Again, no real experience giving care, or knowledge of medicine or biology is required. For example,

Colin Ward, a 37-year-old Baltimore hospital executive, also successfully switched careers, leaving ESPN after eight years of producing sports broadcasts. 'I felt like I wanted to be contributing in some other way,' he said.

After 11 months of graduate classes in the Johns Hopkins Bloomberg School of Public Health and a year as a paid apprentice at a Baltimore hospital, he had a master’s degree in health science and management.

Mr. Ward stayed at the hospital, Lifebridge Health, for three more years and in 2007 moved to his current post at the Greater Baltimore Medical Center in Towson, Md., as director of corporate strategy.

In general,

Many managers with experience in fields like human resources, finance and marketing find a welcome in health care, with a little studying up. Online courses, books, journals and professional magazines provide material.

The article argued that managing health care information technology also does not require any real knowledge of actual health care.

The Obama administration’s $19 billion 10-year campaign to promote electronic medical records opens another huge opportunity, said Dr. Blackford Middleton, a technology research expert at Partners Healthcare in Boston. An estimated 40,000 to 160,000 additional health information professionals could be needed, he said.

The industry trade association, known as Himss [sic] for the Healthcare Information and Management Systems Society, offers an array of online courses that can help technology workers move into health care.

The article did allow

Health care does, of course, have its own jargon and a host of complex challenges. Managers have to know how to deal with doctors, nurses and professional groups, as well as with regulators.

But perish the thought that health care executives who have to deal with lesser species like doctors, nurses and other professionals have to understand much about what these lowly folks actually do.

Somehow, the lessons from the bankrupt automobile companies led by executives with business degrees but no real knowledge of or interest in automobiles and how they are made, and from failed finance companies which sold complex financial derivatives that their executives did not understand do not seem to obtain.

It does all have a certain degenerate, bubble about to burst odor. The notion is the health care boom is so intense that anyone can run a health care organization.

We did find out that anyone can run an automobile company or finance firm too. The results just may not be so pretty.

Is it any wonder that in this climate, people with no understanding of the health care mission are running health care organizations, and soon the organizations are run in conflict with that mission?

As we have said before, to really reform health care, we need health care leaders who actually understand health care, and support its values. But the bubble may have to burst before many people learn that lesson. For now, there is too much money to be made.


InformaticsMD said...

Having posted many times on the issue of "expertise not needed" relative to HIT, the mother of all statements on management of Health IT has to be this from about 10 years ago:

From an article in the journal “Healthcare Informatics”:

I don't think a degree gets you anything," says healthcare recruiter Lion Goodman, president of the Goodman Group in San Rafael, California about CIO's and other healthcare MIS staffers. Healthcare MIS recruiter Betsy Hersher of Hersher Associates, Northbrook, Illinois, agreed, stating "There's nothing like the school of hard knocks." In seeking out CIO talent, recruiter Lion Goodman "doesn't think clinical experience yields [hospital] IT people who have broad enough perspective. Physicians in particular make poor choices for CIOs. They don't think of the business issues at hand because they're consumed with patient care issues," according to Goodman.

One wonders just how many "from the school of hard knocks" HIT leaders were pushed by these recruiters onto healthcare organizations, and the harm such leadership may have done to healthcare and to patients.

Christine 77 said...

Reading this is absolutely frightening. Promoting non-related professionals to the healthcare field is a total contradiction to what our country claims to be achieving. It is disappointing to think that this may be the approach taken while the healthcare system continues to reflect a deficit in the quality of services provided.

Anonymous said...

I know snark and outrage get attention in the blogosphere, but how about a little reality check. Mr. Ward, for example, coupled an undergraduate degree and 8 years of business experience with a rigorous 2 year program of study at one of the best universities in the world, including a full year in which his education took place in a health care setting.

Yes, there are plenty of fly-by-night programs out there, but that's not a good example of one.

Roy M. Poses MD said...

Anonymous, it is true that Mr Ward did take the trouble to get a health care related degree and do a hospital-based internship. But the article furnished several other examples of people who apparently jumped into health care without any health care related education or experience. It also suggested that people could get highly paid health care management jobs with no more than a little "studying up," possibly only through on-line course work, or even just from reading books or journals. Finally, it is not clear from the article whether Mr Ward's internship involved direct patient care, or was restricted to the management suite.

The point of the article, and my posting, was that people without health care experience or education are being recruited for responsible health care management positions. It was not that no one in health care management knows anything about health care.

It is disturbing enough that apparently at least a substantial minority of health care management has no experience in the "real world" of health care. It is more disturbing that health care organizations are enthusiastically recruiting executives without formal education or real world experience in actually caring for patients.

InformaticsMD said...

I believe the issue is ideological, regarding one's views on the need for rigorous expertise in complex biomedical fields.

The business school view seems to be if you've run McDonald's, you can run anything. (Pfizer took that to heart - literally.)

In other words, some have a world view that formal education and experience in biomedicine is unnecessary for leadership roles.

I disagree for reasons stated in my many posts in this blog, e.g., here.

InformaticsMD said...

Also see:


This problem of putting those without adequate experience and expertise in leadership has become commonplace if not universal.

Anonymous said...

No, Dr. Poses, the article provided just two examples of individuals without extensive health care experience or education (and two examples of people who did seek further health care education). And one of those two without education had more than two decades of business experience in a scientific field. I'd humbly suggest that bringing someone into an organization with a fresh and different perspective can sometimes have enormous benefits. Health care loses much if it does not attempt to learn from other industries, and one of the best way to learn is to infuse some talented people from those other industries into your organization. No doubt this must be done with care, but it can provoke much needed change.

I should also add that the article does not suggest that you can run a health care organization with a little "studying up". It confines that comment to some narrow areas of management--finance, HR, and marketing to be specific. These are areas where there are many skills and concepts that transfer readily.

I would also add that you chose not to investigate what Hopkins teachers--just a short virtual hop to their pages. Like most graduate degrees in this field, they often include coursework on a hospital site in clinical issues taught by physicians and nurses; and I guarantee you that students get an extensive onsite experiential education during the fellowship year (or two in some cases). Even undergraduates in health administration are required to get 400 hours of experience in a health care setting prior to their degree completion.

Finally, in a world with 10% unemployment, there is enormous talent sitting on the sidelines now. With the worker shortages and huge challenges in health care, I'd say it's management malpractice if a current health care organization is not sorting through those individuals, recruiting the talented ones, and trying to train them as they begin their career in health care.

In short, I thought your read and reaction to the article was one-sided and knee jerk. A more careful read, complemented by an investigation of the field would have provided some necessary balance.

Anonymous said...

This issue runs into the larger debate concerning health care reform. Last night while watching what passes for news I was struck by a liberal's position that universal health care will eliminate illness and thus improve productivity. I fail to see the relationship between the flu, and other maladies such as gall stones, diabetes, bad knees, etc., and insurance. People are still going to become ill, insurance or not.

On another show, on a different network, this person was promoting taxing sugar products since people will no longer be obese, we will lower medical cost. Simple, right? Neither person addressed the high cost of end of life care.

So here we have two people with national platforms promoting health care policy with straw man arguments and not even a basic concept of cause and effect, all defended with political rhetoric.

So, in this brave new world everyone who is a talk radio host, or political strategist, is now an instant expert on health care policy, the associated cost, and the medical mechanisms needed to make this system work. All because anyone can be a manager in the medical field.

Steve Lucas

Roy M. Poses MD said...

Anonymous, true, the article only used two examples of people recruited as health care executives who had no obvious experience in health care or biomedical science.

The article did not suggest that either of these two had "business experience in a scientific field," whatever that means.

Your comments about "what Hopkins [Bloomberg School of Public Health] teaches" appear tangential. The article did not identify what courses Mr Ward took. The school offers a wide variety of courses, some more relevant to the actual provision of health care than others. Note that many people in clinical health care believe the concerns of public health are somewhat remote from their world. Furthermore, the school also teaches health care management (in the business sense), which may be more or less related to actually providing health care.

It is true that the Masters degree program in health administration does require a residency. It is described in this way. "They become members of an organization’s executive management team and work on important assignments, make meaningful contributions and learn valuable lessons in how health care works." Excuse me, but as a physician, being the member of "an organization's executive management team" seems far removed from actual clinical care. Some hospital executives may actually show up on the wards, emergency department, operating rooms, etc, and may even have some idea of what goes on there. Others may never leave the management suite for the clinical care areas. Simply requiring a "residency" among hospital or other health care organization executives does not imply any familiarity with actually giving health care.

Again, a have no objection to fresh viewpoints in health care. The issue is not whether it is a good idea to get a few talented people from outside of health care into health care management. The issue is whether it is a good idea for the majority of ever more top heavy health care management teams to have little experience in or knowledge of giving health care, or of biomedical science, and little identification with the core values of clinicians.

Finally, my role in discussing this article was to provide a counter-weight to a rather uncritical bit of reporting that seemed to obviously favor hiring former supermarket executives and the like to run health care organizations. I did not see any attempt in the NY Times article to ask whether recruiting such people is a good idea.

Abby said...

I think that Paul Levy, CEO, of BIDMC has, on the whole, done a really good job turning that place around from financial catastrophe. And he clearly cares about medical care. His no central line infection campaign is a tribute to that.

I think that his previous experience was in water management (I haven't been able to find his resume.)

Roy M. Poses MD said...

Abby, sure, but Mr Levy is exceptional in many ways.

Christine 77 said...

Okay so this sounds like it is turning into a knit picking conversation. I think that yes, there are some great leaders who can come into the health care arena with no previous health care experience. I will not deny that people from a varied background can offer new refreshing ideas.

However, as a health care provider, I am a little concerned about bringing in an overwhelming amount of these leaders into running health care systems for the same reasons provided by MedInformatics MD. Real life clinical experience is absolutely crucial in recognizing potential areas of improvement. Without that, I believe that it would be quite difficult to gain the a thorough vision on how to move the delivery of health care in a productive and efficient direction.

I am not saying that all the leaders within the system need to have clinical experience but I think that a significant percentage of them do. Mixing in other professionals of other backgrounds is fine but having leaders with clinical experience do offer valuable insight because they have an understanding of what is happening frontline.

InformaticsMD said...

Wasn't this issue basically settled in the Flexner report of 1910?

-- SS

Anonymous said...

Dear Dr. Poses:

First, I suggest you look into what it is DuPont does. It has something to do with science.

Second, the article clearly identifies that Mr. Ward completed a master's degree in health science and management, which if you google Hopkins and those terms pops you right into their web site, where you can learn more about their curriculum.

Frankly, requiring top health care executives to be clinicians both deprives us of some great clinicians at the patient's bedside and guarantees organizations lack critical business skills. The best organizations neither insist that their managers be clinicians nor force their clinicians to be managers. Instead, they create teams of managers and clinicians who collaborate and share their expertise.

Roy M. Poses MD said...

Anonymous, some of what DuPont does has to do with science, and some doesn't. It is not clear whether the person who came from DuPont worked their in a biomedical scientific capacity, or did something else.

If you bothered to read my comment above, you might have realized that I already have read a bit about the Bloomberg Public Health School. However, the NY Times article did not explain the details of Mr Ward's education there, and in particular, did not discuss whether his internship involved any clinical, as opposed to management experience.

Our dysfunctional health care system is already driving many excellent clinicians in primary care and cognitive specialties out of business. I don't think moving a handful into management would make the shortages in these fields much worse.

I have nothing against a truly collaborative management team which includes health care professionals and "pure" managers. I wonder how many such teams exist? I suspect those that do work within some smaller community hospitals.

And finally, let me repeat below some of my remarks to "anonymous" (perhaps the same person who commented above) on this post:

I did suggest that the leadership of health care organizations should have knowledge of health care, have direct experience in health care, and be committed to certain core values. That does not necessarily require that every or even most health care leaders be licensed health care professionals, although I believe it would help if some were.

People with purely business backgrounds can acquire knowledge about health care (e.g., through course work), experience in health care (e.g., through an internship involving direct patient care, not just sitting in the management suite), and can publicly commit to patient welfare ahead of corporate profits and personal enrichment.

It's just that not many have done so.

And I suspect some would be quite threatened even by this idea.

InformaticsMD said...

Regarding DuPont:

At Wilmington Rotary ca. 1997, the (nonmedical) CEO of DuPont was asked (by yours truly) how he intended to transform DuPont from a primarily chemical-based company to a genomics-oriented drug discovery company, as he'd promised to do. His answer? "I will become an expert in genomics."

How well did that work out, exactly?

Also, DuPont's (nonmedical) CIO Bob RIdout was on the Christiana Care health IT board advisory committee I attended as CMIO. When I gave a presentation on the complexities of biomedical data and terminologies compared to other domains, complicating development of HIT that could support clinician cognitive processes, I was lectured about how that was not true, and how "medical data was like anyone else's data."

That admonition did not help in convincing other board members to invest in the extra resources to have health IT "done well."

Two top leaders, no biomedical experience, being part of the problem, not part of the solution in biomedicine.

-- SS

InformaticsMD said...

Anonymous also wrote:

"Frankly, requiring top health care executives to be clinicians both deprives us of some great clinicians at the patient's bedside and guarantees organizations lack critical business skills."

Frankly, this is nonsense.

This person clearly believes clinicians as a monolithic group lack substantive business skills, a rather harsh and narrow minded stereotype. In fact, the backgrounds of physicians vary widely. I, for example, have expertise not only in computer science, but also in dealing with safety issues in public transit systems. And ran a department with a $13 million annual budget and 50+ employees. Many other physicians have myriad leadership skills.

I can also add that the marine-like grueling training of medical residents and postdocs generates far more resilience and practice in making tough decisions under duress than most business people gain from b-school.

It is not a stereotype, however, to claim that non-medical business professionals lack clinical skills.

-- SS