Bridging the Separations between Care, Cure, Control, and Community
Managing the Myths of Health Care Bridging the Separations between Care, Cure, Control, and Community Health care is in desperate need of an overhaul: its costs have been rising for decades far faster than its results. In this sure-to-be controversial book, leading management scholar and iconoclast Henry Mintzberg turns his attention to reframing the management and organization of health care. Mintzberg begins by describing various myths of health care, notably that this system is failing. It's hardly a system, but where it puts its effort, it is succeeding remarkably: we are living longer thanks to the many advances in treatments. But the current system is expensive, and we don't want to pay for it. So the administrators, in governments and insurance companies alike, have been intervening to fix it, mostly by cutting costs. And here is where we find a good deal of the failure. The problem is not management per se but a form of remote-control management that has become too prevalent. Detached from the operations yet determined to control them, it reorganizes relentlessly, measures like mad, promotes a heroic form of leadership, favors competition where more cooperation is needed, and pretends that health care should be managed like a business. There are also problems with how health care is organized. Every organization differentiates its work into component parts and then integrates these into unified wholes. But as Mintzberg points out, in health care, the predominance of differentiating over integrating has encouraged all sorts of excessive separations: consulting physicians who barely talk with one another, a preoccupation with evidence at the expense of experience and with researching cures for diseases while failing to investigate their causes, and the reducing of persons to patients and communities to populations. Behind all this lies a professional form of organizing that is the source of health care's great strength as well as its debilitating weakness. Professionals, and often administrators as well, categorize whatever they can so they can apply standardized practices. When the categories fit, this approach works wonderfully well. When they do not-say, a patient falls between the categories-it fails. Even more damaging can be the misfit between managers and professionals, as they pass each other like ships in the night. After the diagnosis, Mintzberg offers the remedy. He shows how the management of health care can be reframed by engaging more than detaching-that is, caring more than curing (heretically, like nursing). And management can be distributed beyond just those people called managers-for example, to facilitate the organic emergence of strategies from the base rather than having them handed down from the top. Health-care organizations can be reframed by encouraging collaboration to transcend competition and communityship to transcend leadership. 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.