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Health care and the threefold crisis of unsustainable economics, erratic quality, and unequal access

Posted Aug 27 2013 12:33pm
Our healthcare system's need for innovation has become acute. These are the words Harvard's Regina Herzlinger uses in her report on a conference she organized at Harvard Business School in October 2012. Drawing leaders from the academe and industry, she organized a two-day workshop to address specific steps to ensure that management education adapted to  the pressing need for innovation. Vanderbilt's Larry Van Horn was a member of her Steering Committee. I had the good fortune to attend as well. The report is accessible through Harvard Business School's site.

Professor Herzliner's bottom line is that health care globally faces a "threefold crisis" of unsustainable economics, erratic quality, and unequal access." She asks for "unprecedented collaboration" among disciplines and between academia and business. She says we must "revamp curricula that may no longer serve us." She says we must "use the academic tools we know to be effective."

The Executive Summary of her report lists areas of agreement among CEOs and academics attending the conference
  • Innovative processes are more important than innovative products. 
  • A holistic curriculum emphasizing real life situations would be preferable to the current academic focus on isolated training in finance, ethics, medicine, and other disciplines. 
  • Skills in change management, communication, and team building are essential for innovation. 
  • Successful and collaborative programs will be realized when university's break down the school- or department silos separating teaching and research expertise in different aspects of health care management. 
  • A broad-based knowledge of how health care works—including financing, organizational structures, technology, and public policy—and how to apply that knowledge are prerequisites for evaluating and implementing innovations. 
  • There are two camps that must be united through a shared purpose and common language. Uniting these two camps with shared purpose and common language is a critical step for creating significant change in future health care systems. The camps are:
    • Management education helps with business problems
    • Health care policy, medical, and scientific education does not focus on managerial issues. 
  • Fieldwork and structured mentorships offer lessons the classroom cannot. 
Major obstacles identified included
  • Difficulty of finding appropriately trained faculty
  • Hiring and retaining teachers with real-world business expertise
  • Limited curriculum materials, including insufficient real-world data 
  • Too few case studies—especially studies of failure. 

A number of strategies for faculty development were proposed. These included
  • Recruiting faculty members with real-world qualifications and recognizing the importance of their contributions. 
  • Cross-disciplinary training that integrates academic and professional teachers in a shared purpose. 
  • Strategy is not enough. Training must help students understand implementation, execution, and other real-world skills.  
  • Respected journals that do not suffer from "hardening of the categories." All too often the   publishing venues respected by academic promotion committees do not sufficiently emphasize the cross-disciplinary and applied nature of applied research in health care management. 
  • Identifying new ways of fostering cross-disciplinary dialogue and content sharing.
  • Creating affordable and easily accessible centralized information resources from early adopters to show new career paths, make available new tools, and to provide other resources helpful in support of curriculum reform.
  • Recognition that most management education in health care takes place in executive programs, in-house programs, or part-time programs. These vital offerings are usually made by institutions that lack the infrastructure available to the leading institutions offering full-time MBA degrees. 
  • Expanding the role adjunct faculty and nontraditional instructors, with business and health care enterprise expertise or clinical training (such as those with dual degrees: MD/MBA, JD/MHA, MBA/MSN, etc.).
  • Reaching out to health care enterprises in the community to identify sites where students might do fieldwork and consulting.
  • Seeking out colleagues from other departments and schools with whom to teach cross-curricular courses.

One of the most innovative ideas put forth was to support faculty sabbaticals focused on exposure to health care organizations. This idea suggests brining the faculty to the domain whether than simply brining workers within the domain to the faculty. 

We are fairly skilled in attracting students to our institutions. Many universities have created innovative programs that bring promising managers back into part-time graduate management education. The success of these programs is achieved by providing incentives to students and by injecting them into a university setting where they are introduced both to full-time management faculty and to adjunct faculty employed by the private or public sector.  Vanderbilt Owen School's Masters of Management in Health Care Program  is one innovative example.

As both a faculty and a former program director, I've observed directly how important it is to keep tweaking with a program to keep the formula right. I believe that many the Program's the finest full-time faculty who as consultants fearlessly immerse themselves in real-world health care problems. I have recognized how important it is to support adjunct faculty so that they can develop an ability to formulate a syllabus, to teach the case method, to test, and to grade. Teaching health care management is from the teaching requirements in medicine, engineering, and other disciplines. This is a lesson I have learned first-hand.

The development of a stronger " innovation ecosystem " has become a national priority. Cross-disciplinary education is a critical component of this ecosystem. Success is continent on an academic culture and sponsor community committed to developing and sustaining the faculty and students capable a head on approach to the realization of a health care system with sustainable economics, uniform high quality, and equitable access. 

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