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The Role Of The Healthcare Leader, Past, Present, Future
Respected health care futurist Leland Kaiser, PhD, tells the tale of a Sufi Master who rides backward on a donkey. When the Sufi is asked about his unorthodox equestrian style, he replies that by riding backwards, he is unafraid of the future-because by the time he "got there" he had already seen it.
That may be the case for the health care leaders of 2001 and beyond. The role of the executive will have less to do with shaping health care delivery than shaping people to do the job.
It was, perhaps, the image of executives backing into the future that prompted the memory of a dust-covered book in my library: The Functions of the Executive, by Chester Barnard. Barnard, former president of New Jersey Bell Telephone Company, published the original edition in 1938.
Barnard postulates that executives perform three functions in an organization. They:
1. Provide the system of communication
2. Promote essential and cooperative efforts
3. Formulate and define purpose
System of Communication
Barnard suggests the first essential need of an organization is communication, and the key to an organization's success is executives who are excellent communicators.
So what do health care leaders need to communicate? The list is legion, but certainly includes quality standards. Expectations for mutual respect, organizational goals, individual goals, and so on.
But we often see physician organizations disintegrating because executives communicated poorly about:
- The financial impact of a building program
- The potential impact of changing the MIS vendor on accounts receivable during a transition
- Why the current compensation plan is crippling the organization
- Why high-producing procedural specialists change from "revenue centers" to "expense centers" in capitated, managed care environments
In short, the executives communicated poorly.
Promote Essential Efforts
The word choice is critical. The executive "promotes." Too often, executives despair of "promoting" and simply "do." They fail to develop others and severely limit their own ability to manage because they are entangled by the jobs of others.
A seven-physician board of directors, compensated at $200/member/meeting, is not demonstrating effective management when it spends all of a two-hour meeting deciding what coffee vendor the group should use to save the organization $500 annually.
This illustration is from real life. And unfortunately, it's typical of physician-run groups. It's a situation where each board member, elected with a promise to lower overhead, feels empowered to micromanage all aspects of the operation.
"Essential" suggests that there are some efforts that may not be essential. Effective executives know the difference.
Formulate and Define Purpose
One of the cliches attributed to Yogi Berra states, "If you don't know where you're going, any road will get you there."
The executive's job is to remind the staff why their efforts are critical to the purpose of the organization. Years ago, when I was starting my health career at Geisinger Medical Center in Danville, PA., our CEO, Henry Hood, MD, annually addressed our management staff at a dinner. Every year he retold the story of how and why Abigail Geisinger donated the money to start the hospital. Hood would peer over his glasses at the audience as he forcefully intoned Abigail's instructions, "Make it the best." None doubted the clear intent to provide the region, if not the nation, with the highest quality multispecialty health care.
Outcome Stays the Same
Earlier in his book, Barnard suggests that executives serve the organization by facilitating the process by which individuals cooperate to
- Accomplish purposes
- Overcome limitations
- The phenomena of managed care, capitation, and per member/per month charges will come and go.
- Limitations and purposes will remain.
The role of the health care executive is to overcome the one and accomplish the other. That was the case 65 years ago. It's still true today and will be tomorrow.
Something to consider as we ride facing south on our northbound donkeys.
1. (1) Chester I. Barnard. The Functions of the Executive. Thirtieth Anniversary Edition, Harvard University Press, 1938 and 1968.