As a graduate student who will finish a master's of health administration degree in May, I was amused by Michael Romano's recent cover story on curriculum changes to programs such as the one that I am completing ("Masters of the universe," Jan. 19, p. 6).
The concern that education lacks relevance to the real world is neither new nor limited to our field. The core competencies that were listed are important, but I find few ideas more relevant than "on the job experience." I am fortunate to be part of a program that encourages students to work in healthcare while attending school, and schedules classes accordingly. Additionally, more healthcare organizations that want to benefit from well-trained leaders should offer fellowships and internships.
Whether we redefine curriculum by core competencies or not, graduates will remain unprepared unless they are given the opportunity to practice what they have learned before they are dispatched to the field.
HCA Midwest Division
Kansas City, Mo.
... demands of job changing ...
As a 1977 graduate of the University of Florida master's program in health services administration, I was especially interested to note that one of the suggestions now being made is to add a residency in the second year of healthcare administration programs.
The University of Florida had a residency requirement while I was a student but dropped it. While my residency was only six months and I had over five years' healthcare administration experience at the time, I found the residency to be an extremely valuable learning tool that helped prepare me for the "real world" of healthcare administration when I finished my studies.
Everyone in this business would agree that it has changed dramatically in the past 30 years and perhaps even more so in the past 10. When I was a student my classmates and I all aspired to be hospital administrators. Now students are leaving the programs to work in healthcare management jobs that didn't even exist in the early 1980s.
While it may be difficult and challenging for academicians to work within guidelines and parameters, the splendid isolation that so many work in now makes necessary the standardized curricula and outcomes measures to give assurance to potential employers that the students coming from those programs have the necessary skills to do the jobs for which they apply.
It is also up to those of us who are senior healthcare executives to motivate, challenge and mentor those who follow us so they are prepared to accept the mantle of leadership when we are gone.
Administrator Shriners Hospital for Children-Spokane (Wash.)
... field lacks core knowledge ...
The long-held fallacy under which the American College of Healthcare Executives and the Accrediting Commission on Education for Health Services Administration operate is that health administration is a profession. I suspect that this quest to be a profession emanates historically from our perceived need to have professional parity with physicians. The foundation of any profession is the existence of a unique core body of knowledge that is the foundation for the education and practice in the applicable field.
Health administration lacks such a body of knowledge. Health administration applies knowledge from management, political science, sociology, economics and other disciplines. That is not to say that true professions do not borrow knowledge from other disciplines, but rather that they have a core body of knowledge upon which the profession is built.
One only has to review the scholarly articles published over the years on healthcare policy and delivery-whether in the ACHE's own journal or others-to see that most of the authors have their degrees from disciplines other than health administration and are applying those disciplines in their research in the healthcare setting.
Furthermore, there is no other field in which managers consider themselves to possess a unique body of knowledge that constitutes a profession, or we would have equivalents of the ACHE in many industries, and in fact they do not exist.
We could better define the educational needs of future healthcare executives if we drop the pretense of being a profession. It certainly would not in any way detract from the dedication, knowledge and skill of the many healthcare executives I have come to know and respect over many years in healthcare administration.
President and chief executive officer
Englewood (N.J.) Hospital and Medical Center
... no `transformation' needed ...
Thanks to Michael Romano for bringing to our attention the waste of money and time expended by the National Center for Healthcare Leadership and its top executive, Marie Sinioris, to "transform" MHA programs for future healthcare execs.
MHA professors at the University of Pittsburgh meet every year to constantly change the program to meet modern conditions. We graduates of that program are proud of our degree. There is no academic program that does not suffer from the huge changes over time. We grads are asked every year for suggestions for improvement.
We should not be spending a million dollars to write criticism-send that money to the MHA programs and foster more research. Thank you for letting an old grad have his say.
Executive vice president (retired)
Hospital Council of Western Pennsylvania
... and ACHE is doing just fine
Michael Romano's story highlights the arrogance and redundancy of the National Center for Healthcare Leadership. Interestingly, other articles in the Jan. 19 issue support this observation.
The American College of Healthcare Executives is on the forefront of critical issues concerning the future of healthcare management. Your page 10 article titled "The right thing to do" highlighted changes in the ACHE's ethics code that enhance and clarify its affiliates' responsibility and ethical expectations. And the ACHE coverage on page 28 described how ACHE's upcoming Congress on Healthcare Management will help prepare its members to successfully address leadership and governance challenges in the next 10 years.
It is ludicrous to think that merely changing the curriculum of graduate school programs will improve future leadership. Graduate programs teach people skills so they can enter a given field; they do not preordain leaders. Those of us who have been in the field for a while know that you develop leadership skills over time by integrating the best of what you've learned from other people with your own values and instincts. While you can teach about leadership, leaders develop over time, and there is no substitute for experience or the guidance of a respected mentor.
While the National Center for Healthcare Leadership wants to develop "key competencies" and "outcomes" as part of a national standard for healthcare management, the ACHE's diplomate exam includes an evaluation of 10 core competencies. Its fellowship projects require candidates to identify and define problems, collect and analyze data, propose and evaluate solutions and communicate all this effectively in articulate theses and case studies. This might explain why half of the ACHE's fellows are CEOs. For these reasons, I was pleased to see that the ACHE is patiently sharing its expertise in healthcare leadership with Marie Sinioris and her colleagues at the NCHL.
Chief executive officer
CentMass Association of Physicians
Hearts in the right place
I read with interest your "Survey says" article (Jan. 19, p. 16) regarding the proposed CMS patient satisfaction survey. Obviously the vendors have a vested interest in this project, but you failed to give them the credit they are due. They fully support the quality initiative and are striving to address public reporting in a simple, effective and efficient manner.
There is no need, however, to disrupt the extensive infrastructure that has been established to support the 80% of hospitals that currently measure patient satisfaction and improve service quality.
Essentially the goal of the vendors is to offer a low/no cost solution using the infrastructure already in place. By creating a shorter but appropriate question set and embedding it in existing surveys, the need for public reporting can be met with very minimal disruption, saving hospitals million of dollars annually.
President and chief executive officer
Advertise lower premiums instead
I read with interest that Kaiser Permanente is launching a $40 million advertising campaign to lure back customers in many Western states, including where I live in Colorado (Modern Healthcare's Daily Dose, Jan. 21). It's too bad they didn't save the big expense and deliver what consumers really want-reasonable pricing.
My family's policy-two 43-year-old adults, two children, all healthy and rarely using the policy-jumped almost 70% last year. What did they expect consumers to do?
Holloway & Hyde Communications
Nurse credentials law needed
I recently read your cover story about the New Jersey nurse who has admitted killing patients ("Killer credentials," Dec. 22/29, 2003, p. 6) and I really can appreciate the comments about the difficulty in getting references from other hospitals for nursing staff.
I have been a manager for eight years and there have been employees who I would not have hired if I could have received information about competency and credibility during the interview process. You gain very little insight from dates of service alone.
I hope that through legislation we will begin to protect the safety of patients and not the character of potential employees. It is ridiculous that we worry more about being sued for defaming someone's character then giving out important information to another hospital that might hire an unsafe practitioner.
Mary Elliott Strickland
Nash Health Care Systems
Rocky Mount, N.C.
Different system, familiar issues
As America debates health system reform, I wanted to share some of my thoughts on another system.
As a Canadian I realize that I benefit from my government-run healthcare system but I also see its flaws. The doctor and patient relationship no longer exists. I visit my health professional and it is no longer easy to carry on a normal conversation. The authority of my physician is clearly defined. Also, trying to fix every health problem is another issue. What about prevention or dealing with a health concern rather than simply diagnosing illness?
I don't enjoy being rushed when I have a list of health issues to discuss with my doctor. There are many concerns that can be improved upon such as making sure that the patient is satisfied, that the doctor is not just writing a prescription to make the patient happy and is concerned about the patient's concerns.
We are all consumers of the medical system. Some people use healthcare more than others. Seeing that the healthcare system benefits individuals is important. Trying to understand this system can be difficult.
Undergraduate student in gerontology and health studies
Behind the index
My thanks to Washington Bureau Chief Jeff Tieman for his Jan. 12 story on the wage-index issue ("Waging war," p. 10). I want to bring information to your attention that you may not have been aware of at the time the piece went to press.
The article specifically mentioned St. Alexius Medical Center in Bismarck, N.D., as one of two hospitals that would benefit from being considered part of the Fargo, N.D., metropolitan service area. The other-not named in the article-is Medcenter One Health Systems. In the article, you quoted Richard Tschider, the chief executive of St. Alexius and stated that Tschider helped draft some of the wage index language in the Medicare bill.
Tschider may well have made some suggestions, but for the record, the lion's share of the work, time and congressional persuasion was done by James Cooper, Medcenter One's president and chief executive officer. I doubt that Tschider made any trips to Washington on the matter. Cooper, meanwhile, made this subject a battleground since taking the reins as CEO two years ago.
Cooper actively engaged this topic on all fronts: in the local community, with the state government, hospital associations and the state's congressional delegation. He traveled to Washington, sent faxes and made calls. He was the driving force in making this legislative change happen.
Corporate medical director
Medcenter One Health Systems