Breaking down the myths of health-care management

Managing the Myths of Health Care

By Henry Mintzberg

Berrett-Koehler, 262 pages, $34.95

Health care is about serving people. Yet it is being managed badly, with serious consequences to patients, argues celebrated McGill University management professor Henry Mintzberg. He calls it an epidemic: Managing without soul, which is common in organizations throughout society, including health.

"Many managers these days seem to specialize in killing cultures, at the expense of human engagement," he writes in his new book, Managing the Myths of Health Care.

"Leadership programs these days too often leave people with a distorted impression of management: Detached, generic, technocratic. Technocratic detachment is bad enough – numbers, numbers, numbers. The worst of it is also mean-spirited, by bullying people and playing them off against each other."

You won't hear words like those in most discussions of health care. Indeed, usually we hear numbers or ideological critiques. But inside hospitals, as patients or staff, we see the reality of his words.

Mr. Mintzberg highlights several damaging health care myths we harbour:

• We have a health-care system: Mostly, he argues, we have a collection of disease cures. If we had a system, all elements would be working together. “Even the various medical specialties often have difficulty working with each other, let alone with nursing, community care and management,” he writes.
   
• The system of health care is failing: Mr. Mintzberg argues the opposite. In most places in the developed world, the treatment of disease is succeeding, often spectacularly. The problem is it does so expensively and we don’t want to pay for it. Health care is suffering from success more than failure.
   
• Health-care institutions – and, indeed, the whole system – can be fixed with more heroic leadership: Mr. Mintzberg has long derided the notion that leaders are heroes on top of organizations, sending out orders for their (supposedly empowered) minions to follow. That grandiose thinking leads to leaders detached from the reality of their organization. In health care, it’s augmented by the division between managers and professionals, such as physicians. “Health care does not need superior leaders, domineering managers, or haughty professionals. Enough of ‘us’ and ‘them,’” he insists.
   
• The health-care system can be fixed with more administrative engineering: Reorganizing and driving change from the top hasn’t worked and won’t. Much of the significant change has to come from the ground up, not top down, let alone from so-called experts who have never practised health care.
   
• The health-care system can be fixed with more categorizing and commodifying to facilitate more calculating: Measurement is big these days, but Mr. Mintzberg is jaundiced about where it leads us. “Certainly we have to measure what we can; we just cannot allow ourselves to be mesmerized by measurement – which we often are,” he says. As for the efficiency we often seek through measurement in health care, do you also seek out restaurants that are efficient? No, you prefer quality.
   
• The health-care system can be fixed with increased competition: In the United States, he says, where that belief is the strongest, competition has done more harm than good in health care. We need more co-operation, not competition.
   
• Health-care organizations can be fixed by managing them more like businesses: Mr. Mintzberg counters, “I suspect that, like most people, I no more want my hospital to act like a stock market corporation than I want it to act like a government bureaucracy.”
   
• The last two myths contradict each other, reflecting a health-care divide: Over all, health care is rightly left to the private sector, for the sake of efficiency and choice. Over all, health care is rightly controlled by the public sector, for the sake of equality and economy. In fact, Mr. Mintzberg argues both private and public sectors have a role to play, as does, crucially, what he calls the plural sector, often known as the third sector or not-for-profits, which includes most hospitals in Canada and the United States, and vital organizations such asMédecins Sans Frontières.

The book opens by laying out those myths and then addresses them in detail, offering well-thought-out alternative course of action and, as always with Mr. Mintzberg, laced with ample doses of humour (such as that you can't create managers in an MBA classroom but can instill hubris). It's worth reading for its unusual perspective for anyone concerned about health care and obviously by people in health care.

Harvey Schachter is a Kingston, Ont.-based writer specializing in management issues. He writes Monday Morning Manager and management book reviews for the print edition of Report on Business and an online column, Power Points. E-mail Harvey Schachter.