Managing the myths of health care : bridging the separations between care, cure, control, and community / Henry Mintzberg.

Format:

Book

Author/Creator:

Mintzberg, Henry, author.

Language:

English

Subjects (All):

Health services administration.

Medical policy.

Health planning.

Physical Description:

262 pages

Edition:

First edition.

Place of Publication:

Oakland, CA : Berrett-Koehler Publishers, Inc., [2017]

Summary:

"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.

Contents:

Part I Myths

1 Myth #1: We have a system of health care 11

2 Myth #2: The system of health care is failing 15

Suffering from Success 16

More for Less? 18

3 Myth #3: Health care institutions, not to mention the whole system, can be fixed with more heroic leadership 23

The Position of Heroic Leadership 24

The Person as Heroic Leader 27

The Quest for a Regular Leader 27

4 Myth #4: The health care system can be fixed with more administrative engineering 29

Fads, Fallacies, and Foolishness 30

Re-engineering the Health Care Factory 32

When in Doubt, Reorganize 34

Use Pretend Markets When You Can't Get Away with Real Ones 40

Merge Like Mad 42

The Myth of Scale 43

Keeping the Baby 49

5 Myth #5: The health care system can be fixed with more categorizing and commodifying to facilitate more calculating 51

Categorization for Commodification for Calculation 52

Beyond, Across, and Beneath the Categories 53

Some Myths of Measurement 61

Analyst, Analyze Thyself 72

6 Myth #6: The health care system can be fixed with increased competition 75

Is American Competition the Model? 75

Porter and Teisberg on the "Right Kind" of Competition 78

Does Competition Necessarily Foster Innovation? 80

Is This Really About Competition? 83

The Cost of Competition 84

Cooperation, Not Individualization 85

7 Myth #7: Health care organizations can be fixed by managing them more like businesses 87

Herzlinger on this Business of Health Care 88

When Being a Business Is Bad for our Health Care 90

When Acting Like a Business is hardly Better 92

Health Care as a Calling 94

Summing Up the Fixes 96

8 Myths #8 and #9: Overall, health care is rightly left to the private sector, for the sake of efficiency and choice. Overall, health care is rightly controlled by the public sector, for the sake of equality and economy 99

The Great Divide? 100

Beyond Crude and Crass 102

Welcome to the Plural Sector for the Sake of Quality and Engagement 103

Plural Ownership and the Commons 105

Plural, Public, or Private? 108

Engagement and Communityship in the Plural Sector 110

Disengagement in the Plural Sector 112

Part II Organizing

9 Differentiating 117

The Specialized Players of Health Care 117

The Quadrants of Health Care 119

The Practices of Health Care 122

10 Separating 127

Curtains across the Practices 127

Sheets over the Patients 139

Walls and Floors between the Administrators 142

11 Integrating 145

Mind the Gaps 145

The Mechanisms of Coordination 150

Forms of Organizing 152

Part III Reframing

12 Reframing Management: As distributed beyond the "top" 169

13 Reframing Strategy: As venturing, not planning 173

14 Reframing Organization: As collaboration transcending competition, culture transcending control, communityship transcending leadership 181

Enough of the Separations 181

Enough of the Controls 182

Enough of the Obsession with Leadership 182

Enough of all that Competition 184

Toward Collaboration 184

Toward Communityship 185

Culture for Collaboration and Communityship 188

15 Reframing the Practice of Managing: As caring before curing 189

Leadership Embedded in Management 189

Heroic Leadership or Engaging Management? 192

Choosing the Flawed Manager 195

Co-management 196

Who Should Manage Health Care? 198

16 Reframing Scale: As human beyond economic 205

17 Reframing Ownership: As plural and common alongside public and private 207

Roles for the Private Sector 208

Roles for the Public Sector 209

Roles for the Plural Sector 210

18 Reframing Health Care Overall: As a system beyond its parts 213

Promoting a Systems Perspective 214

Downloading the Whole of Health Care into each of its parts 220

Connecting the parts 226

Attaining Cooperative Autonomy 233.

ISBN:

9781626569058

1626569053

OCLC:

961161015

Publisher Number:

99972579977