“We're perhaps more open than we otherwise would have been,” she says. “Sometimes people say healthcare is changing so rapidly, well that's the only thing we've ever known. It's easier for us to be comfortable with that change.”
Garry Scheib, COO of the University of Pennsylvania Health System, agrees. “It's not only change, it's the pace of change” that can be a challenge for veteran executives who may rely too heavily on prior experience and adopt a strategy “because we've always done it,” he says.
The University of Pennsylvania system more than a decade ago began hiring two administrative fellows each year in an effort to build up its management depth. The program seeks to recruit candidates with some business or healthcare experience, says Scheib, who works with fellows and says he has found them “well-prepared, willing and helpful.”
New graduates think more broadly about healthcare than perhaps industry veterans do, says Rick Majzun, vice president of strategic operations and planning for St. Louis Children's Hospital and preceptor for fellowships.
“I took one public health course,” he says. But increasingly, new graduates are entering the workforce with a grasp of population health and a network that extends beyond hospitals into community organizations and public agencies.
Majzun says he is frequently impressed with novice managers' communication skills. Less well-developed is their ability to work with physicians and nurses, a skill he says should be developed early in the graduate programs. “The earlier you can do it, the better you get and the more comfortable you get,” he says.
Greta Gilbode, an administrative coordinator for perioperative services in her second year as an administrative fellow with the University of Pennsylvania system, says graduate school helped to improve her business acumen as she changed careers from healthcare marketing to management.
But work experience as a fellow has proved to be “the most valuable thing for my career,” says Gilbode, who earned a master's in business administration with a concentration in healthcare from St. Joseph's University in Philadelphia. On the job is where she learns to manage operations.
“That's something I think you can't learn in the classroom,” she said.
Universities with graduate business programs tailored to healthcare turn to alumni in the workforce and faculty who conduct research or participate in public policy debates to keep abreast of changes in the market that should be incorporated in the classroom, school officials say. But with significant market changes under way, the industry will likely “pull the educational programs along to catch up,” says Daniel Zismer, an associate professor and director of graduate studies in healthcare management at the University of Minnesota.
Zismer says consolidation of hospitals and payers and increasing financial risk for hospitals under new payment models will require greater knowledge that's more common to public health issues such as population-health management, social psychology of behavior, epidemiology and how best to effectively care for patients over time.
That has also squeezed time for courses that are increasingly less relevant, he says, such as lessons in hospital affiliations with solo private-practice physicians as more doctors seek employment with hospitals.
The University of Minnesota's program, he says, is adding coursework on population health and risk adjustment. The school also recently recruited a physician executive from the Twin Cities health system HealthPartners to teach managing the cost of care as providers face increasing financial risk and pressure to curb spending. HealthPartners developed cost measures endorsed by the National Quality Forum.
William Henry, the University of Minnesota program's associate director, says schools are also striving to get ahead of the industry's rapid push to measure quality, an area where “everybody is trying to get better quicker.” That will require development of new quality measures.
“We're pretty good at telling you how many people got out of the hospital within a week of surgery, but it's a lot more difficult to assess 30-year outcomes in people with diabetes,” he says.
For Taylor, the demands of quality improvement and working closely with physicians might mean a return to school for a clinical degree. His business expertise adds value, he says, “but the leadership, those who are going to be able to lead healthcare and really make change, are going to be clinical and business,” leaders, he says.