“Management and Medicine” – by Zahal Levy – The expert opinion on Agerpres.ro – 10.12.2013

“Management and Medicine” – by Zahal Levy – The expert opinion on Agerpres.ro – 10.12.2013

In the course of debates about funding the healthcare system and the talking of ”reforms“ (I wish I knew what these were)… I thought I should turn the spotlight on an issue that is not dealt with very much in our healthcare debates: MANAGEMENT.

As owners of a private company, we are aware of management tasks and we are aware of the importance of management issues in the company we run, we know how important is to find the right person with the right management skills to help us, otherwise nothing really works.

Management is a major issue in my life. I deal with management issues almost on a daily basis. Each idea or project that I promote in my company has a substantial management aspect. If I fail to find the right person, if I fail to manage them properly, if they don’t effectively manage the staff under them, my business plan won’t work.

So who is the ”right person“ for me?

The right person is someone whose combination of natural born skills, education and motivation represents a set of qualities that entitle them to carry the title of: Manager.

Together let’s examine the three issues once again

  1. Natural born skills: Are those assets that are part of that person’s personality from birth. Charisma, intelligence, leadership, a sense of justice, organization-skills and more, we are either born with them or we are not. You can do very little to acquire them if you have not been given them naturally by God.
  2. Education: You want your manager to be educated, but not only to carry a set of qualifications that they have collected along the way, but to make sure that their education is solid, appropriate and well-earned in view of the career lying ahead of them.
  3. Motivation: Perhaps this is the one which counts the most. You want to take the person with the “Can do” attitude, the one which is a born winner and wants to “Make it happen”.

One can argue that there might be more to it than this. Honesty, integrity, consistency, ability to work as part of a team and more are also to be considered as important virtues for a leader. Even if we can agree that there may be many more skills that we wish to see in our manager, the three I have discussed should be seen as the most. At the end of the day, we are looking for a human being and we won’t be able to find a person with an unlimited number of skills at the top level.

Now let’s project this talk towards the Medical environment and see how it fits with what we see in hospitals where we live. In most cases the managers are doctors who became leaders of departments as a consequence of their outstanding medical achievements, and later on they are promoted to higher management positions. Indeed, some of those doctors would pass the exam for skills management in a perfectly, but most of them would not. The management selection  that is made in a hospital revolves around internal politics, and this shouldn’t be the default “selection system” for the management of an establishment where lives are at stake.

A doctor’s knowledge of their medical environment is indeed an advantage, but from here doctors chosen on a political basis will manage on a basis which best suits the hierarchy, and not necessarily the hospital. This is why in most hospitals we can see a real battle going on between the departments managers, fighting over budget, allocation of manpower, clinical trials, medical equipment, space and more. In the EEC I saw some amazing cases of this type of management. Doctors had established, within their own department, private medical care, partnering with outside entrepreneurs, using public facilities and sometimes money and personnel financed by the tax payer. The services are given to the public in lieu of payment, and the private investor would make a payment for rent or commission to the hosting department of the public hospital. I am not against partnerships of private health-care and the public hospitals, but I think we all know that the procedure to establish such partnerships which involve assets that belong to the tax payer should be made on a policy established on a national level with the right transparency tools.

Where there are battles between departments’ doctors and hospital management there are winners and losers. The public, namely you and I, are the main losers. This is why you can see that heavily invested medical institutions are not able to effectively manage their budget, and expensive imaging equipment can be left untouched, just standing unused in a corridor, because the hospital hadn’t bothered to allocate €2.000 for the annual servicing fees for an MRI scanner which cost 2 Million Eur.

As in many issues, the real solution lies almost always in education. There are no overnight solutions. Firing or replacing a manager of some hospitals (as was published in the press last week) has very little impact on the system. I would also bet, though forgive me if I am wrong, that these firings were probably more political in nature or based on petty rivalry, than competence, or a lack of it.

Universities and private colleges should have a medical-management school preparing personnel to be fully qualified to take over management positions in the medical environment. Nurses and doctors could manage, if they had the right personal skills and the right personality, but it should be a must to have a diploma in healthcare-management to occupy a management position. I am aware of the “National School of Public Health, Management and Professional Development” that is located in Bucharest. It would be nicer to be a graduate of this school if you knew that the state was not going to offer medical management positions to anyone who was not officially qualified for the challenge and the genuine holder of a diploma testifying four years of academic education.

We want to know that when the doctor enters the operating theatre that they have the skills and the education to perform their job. It should not be different when the manager joins a hospital management team. Somehow, sooner or later, the two positions and the issues surrounding them will connect. Lack of proper management creates lousy medicine.

The article was published on Agerpres.ro –  the expert opinion column