Healthcare management is at a seminal juncture. The field can advance dramatically or languish and regress. It's up to leaders in academia and on the front lines of managing to analyze what is happening and to take timely action.
The art and science of managing healthcare organizations have experienced several milestones throughout their history: the early formulation of the field; its professionalization through graduate education and individual credentialing processes; the transition from hospital administration to health administration; and major changes in the skill or knowledge base for competent practice in the latter part of the 20th century.
Each of these milestone eras involved concerted action by practitioners and academics to push things forward-something that is in short supply today. Through visits to Association of University Programs in Health Administration-member programs and other contacts with faculty members and practitioners, it seems to me that the categories have little contact with and, in some cases understanding of, the other. Academics may be busy with their own careers, while practitioners are faced with the demands of managing and leading in turbulent, fast-moving environments.
Although the preoccupations of both groups may be understandable, the result has had harmful effects on the field. Through contact with both groups, it is also striking how often each views the other in ways quite different from how the groups view themselves. There are notable exceptions, but the pattern is sufficiently prevalent to justify concern. Quality research in this area would be illuminating. In the meantime, to the extent that there is a gap, the needs of the field require that it be closed.
A number of organizations, including AUPHA particularly, are actively engaged in closing the gap. This has resulted in a strong base of knowledgeable, committed academics and practitioners. But this base must be expanded substantially to effectively address the critical factors in helping our field meet the fast-changing needs of healthcare.
Fortunately, healthcare leaders and managers have done much good work to identify the core competencies necessary for effective performance. Unfortunately, the various forms and conclusions of this good work have not been consolidated or codified into a generally accepted set of skills and knowledge.
Such a skill set could be applied to the accrediting and credentialing processes. That would allow employers, trustees and the public to know that a credentialed person leading their healthcare organizations meets the test of possessing requisite core competencies. This need not be a cookie-cutter approach or a mandate. Additional competencies could be applied freely by various parties.
The nature of the process of analyzing and distilling the competencies involved would be crucial to the outcome; among other advantages, it would bring academics and practitioners together in an organized fashion.
Along with setting competencies for practice, a defining hallmark of a profession lies in its values. The founding visionaries of our field set into place very clear core values: service to humanitarian enterprise, devotion to quality, mentoring and high ethical standards. Events of the past two decades have given rise to concern that adherence to core values has been waning, that the field is in danger of losing its ethical coherence. Some call it merging into the general corporate world. Others call it the industrialization of medicine. As keepers of the flame, practitioners and academics have a mandate to reinforce our core values through methods geared to the 21st century.
Key leaders in practice and academia have initiatives well under way to re-engineer teaching practices in undergraduate and graduate education. One outcome of this work, along with that of core competencies, would provide a means for demonstrating the superiority of tailored educational programs in healthcare management over general management. Three areas of needed study are:
* Analysis of experiential learning. The historic mainstay, the administrative residency, has declined steadily from being a very prominent component of career preparation. Methods must be found to revitalize this critical learning resource for the future.
* Integrating educational experiences. During a recent policy roundtable by the Joint Commission on Accreditation of Healthcare Organizations, it was stunning to have acknowledged that there is virtually no coordination or collaboration nationally among educators in medicine, nursing, pharmacy and health administration. Their graduates practice in settings where teamwork among health professionals is crucial to success, yet there appears to be precious little recognition of such in current teaching and accreditation methods.
* Updating teaching processes to reflect changes in healthcare. Careers in physician office practice, organ donor centers, hospice operations, and managed care are examples of practice settings emerging in the late 1980s and 1990s that are now well-recognized.
It will take creative means to ensure core competencies are acquired. These might include a substantial increase in practitioners returning to teach; uncompensated residencies, which might expand the pool of available positions; and a move to mostly electronic accreditation processes. Such ideas, along with timely action, are only possible through a renewed partnership of practice and academia that mobilizes new energy to strengthen healthcare management in its service to the public.
Jeptha Dalston will retire on June 30 as president and CEO of the Association of University Programs in Health Administration, Arlington, Va.