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29 October, 2012 Posted by John G. Self Posted in Healthcare
4 comments

Healthcare Delivery and Flawed Education System

Posted October 29th, 2012 | Author: John G. Self

Why do we spend so much time and effort on improving quality, patient safety  and working to lower costs when we do not have much to show for our efforts?

Healthcare Education

Because education—medical schools and graduate management education—is not keeping up.  Medical schools, in particular,  perpetuate the problems because they fail to acknowledge that what they are doing may be comfortable for those who control the curriculum, but are simply perpetuating bad practices and values.

In healthcare management, while there is not the same direct connection between flawed training and poor quality of care and patient satisfaction, the education industrial complex has something in common with medical schools—a blind eye to the fact that we need to make radical changes and that when we do finally to get around to change, we are usually five or six years behind. 

In this new era of healthcare management that will be dominated by structural reform and major reductions in spending from deficit reduction, this is a serious problem worthy of discussion.

The future over the next three to eight years will be extremely challenging.  We cannot afford to be running on less than all cylinders.

© 2012 John Gregory Self

© 2018 John Gregory Self

4 comments

  1. Brent Magers says:

    John,
    Hope you are doing well. As executive associate dean for a school of medicine (admittedly, on the business side-not curricula) and as an adjunct professor at a college of businees (in graduate health care administration); I have no doubt, we could do a better job in our teaching. Always, of course. But, can you be specific in what you would like to see taught? Thanks!

    • John G. Self says:

      Brent, there are really two issues:

      1. Attitude
      2. Curriculum.

      Let me address the attitude issue first. Faculty members, particularly in medical schools, tend to pass along the same values and behaviors they were taught. Why? Because that is what they know in a professional environment. We are not breaking the cycle and that is apparent when you listen to some of the newly minted doctors who are making their way into tumultuous medical practice markets.

      Some of the failings with medical record documentation that were problematic in the 1970s are similar to those we see today. There are still faculty surgeons who are not going to the OR to supervise residents, another issue that was prominent in the 1970s. “I am too busy,” or, “I am not paid enough to do all of that,” — actual statements, believe or not — reflect a disconcerting trend. Not only is this bad academic practice but it is fraudulent when it comes to billing. A department chair from a prestigious east coast medical school, in March began serving 7.5 years in a federal prison for just this sort of behavior. There is evidence from Florida to California — including Texas — that suggests this is not an isolated instance. Today, nurses continue to report that challenging a physician over a legitimate patient care concern is a risky practice. The less than professional treatment of nurses by far too many physicians is a learned behavior, probably from medical school, residency, or both. I think we can agree they probably didn’t pick it up from their mothers.

      Curriculum for medical school needs to be broadened. Physicians need more training in business and humanities. The excuse that there is no time for non-scientific coursework lacks any credible defense. Medical school faculty and clinical professors that I have talked to all admit there is an enormous amount of wasted time. We do not change because apparently we lack the will to tackle the tough political and academic battles that nearly always result when this kind of revision is proposed. However, the challenges and transformative changes that we will deal with over the next 10 years will require physicians who are better prepared — not only as doctors but as participants in an industry that will require a broader range of knowledge and experiences if they expect to enjoy a rewarding clinical career.

      Attitudinal adjustments are not just an issue for medical schools. Students who enter a healthcare management with a command-and-control leadership mentality will not be successful over the longer term. Leadership style begins to develop in graduate school. In my conversations with faculty members, I hear concern that not enough attention is being focused on those types of issues, and that some of the better known schools are focusing more on research, retaining their “PR” rankings, and not upsetting their coveted “prized” students. Hopefully this institutional philosophy is not widespread. I recently ran into a practice executive at the Genius Bar of an Apple store in Dallas. Previously he was an associate professor on a tenure track in a graduate management program at one of the highly ranked schools. He left that career, he said, because his Chair warned him that his practice of challenging students in class — the Socratic method — was producing too many complaints and ruffling too many feathers. Tenure, he was told, was fading from his grasp. For this former teacher, the real frustration was that students were not showing up to class prepared for discussion.

      Then there is the age-old concern that what we are taught in class does not reflect what actually occurs in the life of managing a healthcare organization. When I came into healthcare, there were mandatory administrative residency programs that had to be completed before the graduate degree was awarded — that helped equalize that gap — but they no longer exist. Today there are an over abundance of graduate schools that are churning out students who are ill-prepared to easily move into a rapidly changing hospital management environment. I realize there will always be a lag between the curriculum and practice, but when we think about the tectonic shifts that are going to occur over the next 10 years, I am concerned about the ability of graduate management programs to produce the number of quality of future leaders that will be needed. We are going to face unprecedented turnover at the senior level of healthcare delivery over the these next 3 to 7 years — possibly as high as 25 percent — and there is a real concern among executive recruiters that there will be a critical shortage of leaders ready to take on the challenges of running a hospital or other health services business.

      There are already reports of some boards sticking with mediocre CEOs because they do not think they can find anyone who is better. That may be more about poor governance, but in my practice, I interview dozens of candidates — physicians and lay executives each month — and there is a disconnect between what they think is a comfortable style and approach and the realities that healthcare reform and deficit reduction will produce.

      Brent, I realize I am outlining some general issues with fewer specifics, but I believe these are ideas that I think are worthy of discussion. I respect your experience and role in this process and welcome your thoughts.

  2. Brent Magers says:

    John,
    Hope you are doing well. As executive associate dean for a school of medicine (admittedly, on the business side-not curricula) and as an adjunct professor at a college of businees (in graduate health care administration); I have no doubt, we could do a better job in our teaching. Always, of course. But, can you be specific in what you would like to see taught? Thanks!

    • John G. Self says:

      Brent, there are really two issues:

      1. Attitude
      2. Curriculum.

      Let me address the attitude issue first. Faculty members, particularly in medical schools, tend to pass along the same values and behaviors they were taught. Why? Because that is what they know in a professional environment. We are not breaking the cycle and that is apparent when you listen to some of the newly minted doctors who are making their way into tumultuous medical practice markets.

      Some of the failings with medical record documentation that were problematic in the 1970s are similar to those we see today. There are still faculty surgeons who are not going to the OR to supervise residents, another issue that was prominent in the 1970s. “I am too busy,” or, “I am not paid enough to do all of that,” — actual statements, believe or not — reflect a disconcerting trend. Not only is this bad academic practice but it is fraudulent when it comes to billing. A department chair from a prestigious east coast medical school, in March began serving 7.5 years in a federal prison for just this sort of behavior. There is evidence from Florida to California — including Texas — that suggests this is not an isolated instance. Today, nurses continue to report that challenging a physician over a legitimate patient care concern is a risky practice. The less than professional treatment of nurses by far too many physicians is a learned behavior, probably from medical school, residency, or both. I think we can agree they probably didn’t pick it up from their mothers.

      Curriculum for medical school needs to be broadened. Physicians need more training in business and humanities. The excuse that there is no time for non-scientific coursework lacks any credible defense. Medical school faculty and clinical professors that I have talked to all admit there is an enormous amount of wasted time. We do not change because apparently we lack the will to tackle the tough political and academic battles that nearly always result when this kind of revision is proposed. However, the challenges and transformative changes that we will deal with over the next 10 years will require physicians who are better prepared — not only as doctors but as participants in an industry that will require a broader range of knowledge and experiences if they expect to enjoy a rewarding clinical career.

      Attitudinal adjustments are not just an issue for medical schools. Students who enter a healthcare management with a command-and-control leadership mentality will not be successful over the longer term. Leadership style begins to develop in graduate school. In my conversations with faculty members, I hear concern that not enough attention is being focused on those types of issues, and that some of the better known schools are focusing more on research, retaining their “PR” rankings, and not upsetting their coveted “prized” students. Hopefully this institutional philosophy is not widespread. I recently ran into a practice executive at the Genius Bar of an Apple store in Dallas. Previously he was an associate professor on a tenure track in a graduate management program at one of the highly ranked schools. He left that career, he said, because his Chair warned him that his practice of challenging students in class — the Socratic method — was producing too many complaints and ruffling too many feathers. Tenure, he was told, was fading from his grasp. For this former teacher, the real frustration was that students were not showing up to class prepared for discussion.

      Then there is the age-old concern that what we are taught in class does not reflect what actually occurs in the life of managing a healthcare organization. When I came into healthcare, there were mandatory administrative residency programs that had to be completed before the graduate degree was awarded — that helped equalize that gap — but they no longer exist. Today there are an over abundance of graduate schools that are churning out students who are ill-prepared to easily move into a rapidly changing hospital management environment. I realize there will always be a lag between the curriculum and practice, but when we think about the tectonic shifts that are going to occur over the next 10 years, I am concerned about the ability of graduate management programs to produce the number of quality of future leaders that will be needed. We are going to face unprecedented turnover at the senior level of healthcare delivery over the these next 3 to 7 years — possibly as high as 25 percent — and there is a real concern among executive recruiters that there will be a critical shortage of leaders ready to take on the challenges of running a hospital or other health services business.

      There are already reports of some boards sticking with mediocre CEOs because they do not think they can find anyone who is better. That may be more about poor governance, but in my practice, I interview dozens of candidates — physicians and lay executives each month — and there is a disconnect between what they think is a comfortable style and approach and the realities that healthcare reform and deficit reduction will produce.

      Brent, I realize I am outlining some general issues with fewer specifics, but I believe these are ideas that I think are worthy of discussion. I respect your experience and role in this process and welcome your thoughts.

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