Theory of Management in Health Care

The essentials of management, by far, are not historically new. One can imagine the management that was needed to build the Egyptian pyramids or the Greek Parthenon. The requirement was to have people work efficiently together toward a successful common end. However, with the rise of industrialization and now with the rapid speed of change and technological advancements, effective management is needed more than ever. Healthcare, which is having such a significant impact on today's society and also undergoing many transitions in a short period of time, is a prime example of an industry that requires the best management possible. Peter Drucker, an economist and journalist, is regarded as the founding father of the study of management by experts in the worlds of business and academia. According to Drucker (2001, pg. 10), management is based on several essential principles: 1) Management concerns first and foremost human beings, who must be made capable of joint performance, their strengths effective and weaknesses irrelevant; 2) Management is thoroughly a part of individual cultures and is variable; 3) Each organization must have a commitment to common goals and unifying objectives that are set my management; 4) Management must find ways of encouraging growth and development of the organization and its members as opportunities change; 5) Within every organization are individuals with different skills and knowledge accomplishing different types of work. This necessitates effective communications as well as each person assuming responsibility for setting individual goals, making those goals known, and working with others to accomplish them; 6) Management is measured on such factors as innovation, market share, quality and people development, not by the bottom line or output quantity; and 7) Most important, results exist only on the outside with a satisfied patient, client or customer. In the early 1960s Drucker read Abraham H. Maslow's theory of management, which is based on the belief that each person has specific needs. He â€Å"became an immediate convert† (Drucker, 1999a, p. 17). Essentially, this means that different groups of employees have to be managed differently, and that the same group of workers has to be managed differently at different times (pg. 21). However, stressed Drucker, â€Å"one does not ‘manage' people. The task is to lead people. And the goal is to make productive the specific strengths and knowledge of each individual (pg. 21-22). In these days of global competition, such a leadership style is essential to point individuals in the most productive directions. One also has to prepare for continual change. In the past, management commitments for the future were based on the question, â€Å"What is most likely happen?† Now, it is necessary to plan for uncertainty by asking â€Å"What has already happened that will create the future?† (Drucker, 1995, pg. 40). All organizations, especially ones in the healthcare field, have to look at such factors as demographic trends; changes in industry, market structure, values, science and technology already in place but yet to have full impact; and trends in the economy and structure of society. They must then convert these â€Å"what is most likely to happen† into opportunities for the organization based on its strengths and competence. Further, it must develop the knowledge and people to be able to respond to these opportunities. Global society is in the midst of a major transformation, where knowledge is the primary resource if, and only if, it is integrated into a task. For managers, this dynamics of knowledge requires building change into the organizational structure. The organization must commit itself to continually creating something new (Drucker, 1995, pg. 79). As a result, management must emphasize continuous improvement or kaizen, exploit its knowledge to develop the next generation of applications from its successes and learn to innovate in a systematic process. This means that organizations must continually make changes. This may even lead to closing down a hospital when changes in medical knowledge, technology and practice make a hospital with less than 200 beds uneconomical and unable to provide excellent care (pg. 81). The organizations of the future must also routinely say, â€Å"People are our greatest asset,† and loyalty is gained through offering employees exceptional opportunities for putting their knowledge to work. Ironically, however, knowledge about the knowledge worker productivity is minimal. For example, a fair-sized U.S. hospital of 400 beds has several hundred physicians and a staff up to 1,500 paramedics divided among 60 specialties, with specialized equipment and labs. â€Å"But we do not yet know how to get productivity out of them† (Drucker, 1992, pg. 336) What is known, Drucker says in Management Challenge for the 21st Century (1999b, pg. 142), are the six major demands that underlie this productivity: 1) need to ask, â€Å"what is the task?†; 2) individuals assume responsibility for themselves; 3) continuing innovation; 4) continuous learning and teaching; 5) quality over quantity; and 6) individuals recognized as an asset. Making knowledge workers productive necessitates changes in basic attitude of the entire organization. Knowledge-worker productivity is the largest of the 21st century management challenges. In the developed countries, it is their first survival requirement (Drucker, 1999b, pg. 157). One of the biggest changes is that workers will have to manage themselves and place themselves in the location where they can make the greatest impact. They will have to learn how to develop themselves and continuously better themselves. They will have to ask themselves: â€Å"What are my strengths?†; â€Å"Where do I belong?†; â€Å"What is my contribution?†; â€Å"Where can I take relationship responsibility?†; and â€Å"How can I plan for the second half of my life?† The lesson, concludes Drucker (1998, pg. 187) is that productivity of knowledge has both a qualitative and quantitative dimension. Managers (actually executives is a better word, he says) must manage both specialists and synthesizes of the different fields of knowledge. The healthcare industry will be significantly involved in all these changes if they are not already. In an online article â€Å"The Next Information Revolution,† Drucker said of healthcare: â€Å"In healthcare a similar conceptual shift is likely to lead from healthcare being defined as the fight against disease to being defined as the maintenance of physical and mental functioning.† The battle against illness remains an essential aspect of healthcare. However, it is rather a subsection of it. The traditional healthcare providers nor the hospitals and general practice physicians may survive this change, and definitely not in their present structure and function. In healthcare, the stress will therefore transition from the â€Å"T† in IT to the â€Å"I,† as it is transitioning in business and in the general economy. Is it possible that the information people in MIS and IT prepared for such changes? He sees no sign of this so far. The 21st century is heralding in a huge transition the healthcare focus (Drucker, 1999b) While the country spent most of the prior century managing disease, it will now spend time emphasizing life extension, or maximizing the length and quality of life. The key is having a work force of nurses and allied health professionals who are educated and skilled as a chronic care coach. It is a step that goes beyond case management since it involves most patients instead of those just with the most complicated cases and situations. Overall, it will involve a major redefinition of healthcare.