Tags: Perspective
Lawton Robert Burns, The Wharton School, University of Pennsylvania
Contact: burnsl@wharton.upenn.edu
“Concise Introduction to Healthcare Management” (Elgar Publishing, 2026)
Two topics
Like many of you, I teach our introductory course on the healthcare ecosystem and how to manage it. I have done so for nearly four decades at various schools. I also have the privilege of serving as an editor of the Shortell & Kaluzny textbook (along with Betsy Bradley and Bryan Weiner).
Healthcare and management are two different fields: a huge industry and a diverse discipline. The Healthcare industry spans 25 different “verticals” along a value chain that contract as buyers and suppliers. Management textbooks focus on a core set of functions needed to run these companies.
Elgar asked me to write A Concise Introduction to Healthcare Management (not easy for a windbag like me). This volume combines these two topics into what is hopefully an accessible and engaging text, discussing healthcare management using seven different approaches. Consider them as alternative frames of reference and skillsets.
- One approach is to have students confront a series of dilemmas and paradoxes. Wrestling with these is a source of cognitive dissonance and a major source of learning, which lend themselves to the Socratic style of teaching. Healthcare is full of conundrums, which is why I start the book with them. They dispel some conventional wisdom that is often incorrect.
- A second approach identifies the major sources of complexity in healthcare. Management sage Peter Drucker famously referred to hospitals as the most complex human organization ever devised. Consider that hospitals are a matrix inside a dual hierarchy inside a conglomerate. It is crucial that students know and embrace this complexity. Healthcare has multiple professions, each with specialized knowledge, and each of which thinks they are the center of the universe. Such knowledge workers make the system productive. Drucker explained, “In a traditional workforce, the worker serves the system; in a knowledge workforce, the system must serve the worker.” In practice, this means the typical organizational pyramid must be stood on its head.
- A third approach identifies the memes that dominate the fields of management and healthcare. These are ideas or phrases that become “sticky” by virtue of sheer mindless repetition (e.g., management buzzwords). They, unfortunately, substitute for rigorous analysis and critical thinking. Critical thinking as a vehicle to confront memes is an exercise which students find humorous; more importantly, they find it memorable and useful for discerning what is really going on around them. Your first task is to recognize a meme when you hear it; your second task is to know why it is (likely) bogus; your third task is to not repeat it to others; your fourth task is to stop wasting your time and hunt for another solution.
- A fourth approach tackles the dominant theme of integration and coordination. If THE big issue in healthcare is fragmentation (as many argue), then integration must be the solution. Integration and coordination are “must haves” in any management approach. The book explores the many management tools that have been deployed to bring them about. These include managing professionals (who need to be integrated), teams, integrated delivery networks, and accountable care organizations. Unfortunately, the evidence base that supports the utility of integration and coordination needs reinforcement.
- A fifth approach is to identify the basic relationships that impact patient outcomes and firm success and, thus, need to be managed. These include relationships between people (e.g., patient-physician, physician-manager, scientist-manager) and between sectors (e.g., payer-provider, employer-payer). The first three of these occur at the micro-level and serve as the foundation for the rest of the healthcare ecosystem; the latter two illustrate the stakeholder relationships that need to be managed. Healthcare is more an enterprise that rests on human capital and relational capital than on technological capital. Relationships are key to hospital quality.
- A sixth approach concentrates on the important management skills that students should develop. These include learning, managing hairy problems, managing cost and quality, managing change, managing process (not structure), and focus. These topics have bedeviled the healthcare ecosystem for decades and pose perhaps the greatest challenge for students and managers.
- A seventh approach is to “disabuse” the student about some likely preconceived notions and persuade them that an idea or belief is mistaken. Here, the mistake is to believe (as many do) that new technology will solve healthcare’s problems. I have seen this approach come and go under many guises. The book deconstructs many of the new technologies that currently fascinate everyone in the healthcare ecosystem. If healthcare is all about people and relationships, your task will be to figure out how to marry and harmonize that with technology – – what is called the “socio-technical” system approach.
This volume seeks to live up to the title of the Elgar series of which it is part: “Concise”. It serves as a “pocket guide” (165 pages !!) to those looking for a quick introduction to the field and an overview of “what do I need to know to manage”. It should thus appeal to executives, healthcare professionals, and students in professional programs. The book also features plenty of humor that makes it an enjoyable and memorable read.