Henry Mintzberg, McGill professor and world-renowned guru on organizational management, has divided his new book, Managing the Myths of Health Care into three parts: a description of the nine myths of health systems, an explanation of how health systems are currently organized, and his suggestions on how to reframe the health system and its organizations to function better. One anticipates that this will be a controversial book when reading in the introduction, “From a systems perspective, the narrow knowledge of self-serving professionals is hardly better than the broad ignorance of disconnected managers.”
The nine myths about the Canadian (and other) health care systems that Mintzberg describes are mental models that form barriers to the appropriate functioning of those same systems and organizations for the benefit of citizens and communities. Myth 1: We believe that we have a system of health care when we actually have a set of disconnected parts of disease cures. Myth 2: People are convinced that our health care system is failing. Yet, Mintzberg argues, when we suffer a heart attack today, we are much better off than we were half a century ago when medicine did not have much to offer besides death or bed rest. As for failing from a sustainability point of view, he submits that, as taxpayers, it is our reluctance to pay for more and more increasingly expensive services within a universal health system that is largely to blame.
Myth 3: Some believe that our health care institutions need heroic leaders. Instead we need more communities with human beings leading from the ground and providing collective efforts toward great leadership. Myth 4: Administrative engineering can fix the health care system. Mintzberg makes a good argument that all the restructuring, reorganizations, and regionalizations have not provided the outcomes we had hoped for (assuming that we ever predetermined what those outcomes should have been). Although Mintzberg comes from a business world of categorizing, calculating, and competition, he rejects the notion that health care organizations can be fixed by managing them more like businesses (Myths 5, 6, and 7). Top
The last two myths, 8 and 9, should form a great topic for dialogue across Canada, with two opposing positions: for the sake of efficiency and choice, health care is best left to the private sector; for the sake of equality and economy, health care is best controlled by the public sector. For the sake of quality and engagement, Mintzberg adds the plural sector, arguing that community matters in health care and is largely ignored in economics. Plural sector organizations, i.e., NGOs such as Physicians without Borders and not-for-profit institutions, such as Kaiser Permanente and Intermountain Health, tend to exhibit characteristics of deep engagement, quality, commitment, and loyalty.
Part two deals with how our health care system is organized, what differentiates its elements, and what, as a consequence, separates those elements. Health care is structured around the professional organization model, and Mintzberg explains how such organization categorizes, commodificates, and calculates compared with other models. Top
Part three, “Reframing,” deals with possibilities as reflected in one of the opening sentences, “Reorganize our head instead of our institutions.” Indeed, systems transformation starts with self and with our mental models. In this section, Mintzberg helps us think differently about systems and strategies, sectors and scales, measurement and management, leadership and organization, competition and collaboration. He reframes management as “distributed beyond the top” and “human beyond economic,” culture as “caring before curing,” strategy as “venturing besides planning,” organization as “collaboration and communityship,” and ownership as “plural and common alongside public and private.” The last chapter deals with the obvious: that the health care system needs to be seen as a system beyond its parts and how our mental and cultural models prevent us from doing so.
This book is based mostly on stories, personal opinion, and Mintzberg’s vast experience in the world of human organizations and management, which make it a good read. The first part with its nine myths provides ample of food for reflection and conversations in our communities. Parts two and three sometimes state the obvious and provide little information on how to implement the suggestions. However, no matter how obvious, Canada still hasn’t implemented what Mintzberg suggests. Top
It is good to read from someone in the business world that health care is not straightforward business, but a different beast altogether. At the end, the questions remain. Are we, as a wealthy, developed society, willing to invest in health outside curing acute disease? Are we, as individuals, willing to take some responsibility for our personal health? Are we, collectively, willing to take part in and pay for developing and maintaining healthy communities? As long as we are unwilling to have a dialogue around these questions and answer them in the affirmative, the nine myths of health care will continue to exist.
Johny Van Aerde, MD, MA, PhD, FRCPC, is editor-in-chief of the Canadian Journal of Physician Leadership and past-president of the Canadian Society of Physician Leaders.
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