Article Analysis

Harvard Business Review on Managing Health Care Boston: Harvard Business School Press, 2007, 184 pages, $19.95.

Perhaps the greatest service and benefit that the Harvard Business Review provides in the publication of Harvard Business Review on Managing Health Care is that it relieves today’s busy healthcare executive, trustee, supervisor, or provider from the need to search for past-published literature that may be relevant and helpful. The book comprises eight articles previ- ously published from 2000 to 2006. The editors of this collection do not explain how these articles were cho- sen. I briefly summarize each article in the book and highlight the most relevant points.

Innovation in Healthcare Regina Herzlinger contributes two

articles (2006 and 2002). In the first, she discusses the trials and tribula- tions associated with trying to make innovation a necessary and essential component of healthcare for the dis- tinct purpose of making healthcare efficient, effective, and user friendly. She presents an interesting frame- work, which helps to identify three distinct types of innovation, as well as six forces that affect them, to insti- tute and encourage change. Herz- linger also argues for a securities and exchange commission for healthcare that would verify outcome data of individual providers of care. How- ever, she stops short of explaining how this would be financed and

would interconnect with a variety of transparent systems that are already in the market.

Consumers in Charge

Regina Herzlinger’s second con- tribution is an article that calls for placing consumers in charge of healthcare, noting that costs have exploded precisely because consumers are not in control. She believes that consumers can and should be edu- cated to help reduce healthcare costs. She calls managed care a “bust” and wants employees to have control over costs and direct their own healthcare. Perhaps with a highly educated, strongly motivated workforce, this concept holds some promise. But in a world where science and medicine are imperfect at best and where market forces encourage more prescriptions, more technology, and the continued power and influence of the physician as referral and provider agent not to be questioned, this approach may be more dream than reality. The problem is that even educated, enlightened healthcare consumers face numerous obstacles to obtaining sound com- parative pricing and care.

Presenteeism

Paul Hemp’s (2004) article identi- fies a somewhat invisible but signifi- cant drain in productivity (some $150 billion) by discussing presenteeism (i.e., people who are sick or who are in poor health but who are working) and its negative effect on productiv- ity. Hemp rightly notes that produc- tivity can be an elusive, ghostlike con-

cept but there really is not anything new for combating the disease of presenteeism, which I believe is more existential and unavoidable.

Clues and Customers

Leonard Berry and Neeli Benda- pudi’s (2003) article is an intriguing 5-month observational marketing- type study of over 1,000 patients and employees with countless hours spent at the Mayo Clinic. It is more of a phenomenological piece in that the place (i.e., Mayo Clinic) speaks to the authors about Mayo’s successes in a triangle comprising of people, collaboration, and tangibles, while the authors emphasize that all is good and rewarding about the Mayo expe- rience. It would be fascinating to see how this is experienced today and why, if it is so positive and uplifting, more healthcare facilities have not copied it by now. Nevertheless, the article may help readers to understand how Mayo developed some of these best practices and what processes ensure continuation and maturation of these practices and processes.

Saving Money and Lives

Jon Meliones (2000), an insider as chief medical director of Duke Children’s Hospital, discusses how his debt-ridden-should-have-collapsed hospital transformed itself into a vibrant, profitable entity. The pri- mary principle that he extols seems to be that with collaboration and com- munication, anything can be turned around. This article offers plenty of simple solutions that just may help

Harvard Business Review on Managing Health Care BOOK REVIEW

38

or at least create a more humanistic, interactive healthcare environment for all. For example, Meliones wants everyone to “share the pulpit. People with other expertise can help build consensus” (146), and “cultivate your sense of humor—people will respond if you can laugh at yourself” (146). These are just two of his numerous tips for success.

Disruptive Innovations In the article titled “Will Disrup-

tive Innovations Cure Healthcare?” (2000), Clayton M. Christensen, Richard Bohmer, and John Kenagy seriously question expensive healthcare by recommending, advocating, and illustrating sometimes simpler alterna- tive care. The authors discuss how the medical establishment (i.e., the sta- tus quo) is fighting and resisting this notion of disruptive innovations rather than embracing it. Although they offer a number of intriguing insights, the authors appear at times naive to the complexities and entrenched inter- ests in healthcare by making recom- mendations that often would fall on deaf ears. For example, the authors state, “Overcome the inertia of regu- lation” (168), and they suggest that “regulators need to frame their jobs differently” (169). In reality, perhaps

some of the regulations and regulators should be removed, deregulated, or eliminated.

Change and Knowledge Management

Two of the articles are case studies in which researchers attempt to illus- trate dramatic changes. In “Change Through Persuasion” (2005), David A. Garvin and Michael A. Roberto illus- trate change by advocating a persua- sion campaign of the kind that was used to dramatically turn around Beth Israel Deaconess Medical Cen- ter in Boston, Massachusetts. This article contains a helpful list of six dysfunctional routines that can stop change in its tracks, which are good to know about to enable avoiding them. According to the authors, Beth Israel went from a $58 million loss in 2001 to a $37.4 million net gain at the end of fiscal year 2004 by using a persuasion campaign with four phas- es. Again, I wonder how much of this advice could be translated into other hospital turnarounds.

In “Just-in-Time Delivery Comes to Knowledge Management” (2002), Thomas H. Davenport and John Glaser discuss how Partners Health- Care used a just-in-time knowledge- management system to reduce medi-

cal errors and help providers stay cur- rent by embedding knowledge into the technology that doctors use in their jobs. This initiative used com- munication and collaboration among physicians as a means to implement and institute positive change.

Conclusion

In sum, Harvard Business Review on Managing Health Care is one in a series of more than 60 “Ideas With Impact” paperbacks that Harvard Business Review has published. Although it does hold some merit, it seems more likely that the Harvard Business Review is attempting to recycle ideas for profit rather than publishing real-time, new knowledge. Adding more references and relevant Web sites would have strengthened this effort by the Harvard Business Review. Last, using 2006 and 2007 articles, instead of those from 2000, seems more current. But at $19.95, the book might be a bargain for some people.

Dennis S. Palkon, PhD Executive Editor, Hospital Topics Professor, Health Administration Florida Atlantic University Boca Raton, Florida Copyright © 2008 Heldref Publications

HOSPITAL TOPICS: Research and Perspectives on Healthcare 39

Ashish Chandra, PhD, MBA, MMS, is professor and department chair of health administration at the University of Houston– Clear Lake in Texas. Dr. Chandra has served as a healthcare marketing consultant. He has published extensively in healthcare adminis- tration, marketing, and management journals such as Health Care Manager, Journal of Medical Marketing, Journal of Hospital Marketing and Public Relations, Clinical Research and Regulatory Affairs, and Journal of Nonprofit and Public Sector Marketing. Dr. Chandra has pre- sented at several conferences throughout the United States, Mexico, Turkey, and Hong Kong. He has served as the president of MBAA International, Business and Health Administration Association, and Association of Collegiate Marketing Educators. He regularly writes the column “In Context” on healthcare and public policy issues for Hospital Topics.

Kurt Darr, JD, ScD, is professor of hospital administration in the Department of Health Services Management and Leadership at The George Washington University in Washington, DC. Professor Darr’s research focuses on ethics and healthcare, hospital and medi- cal staff management and organization, quality improvement, and applying the Deming method to healthcare. He is the author of Ethics in Health Services Management, coauthor of Managing Health Services Organizations and Systems, and coeditor of Cases in Health Services Management, all from Health Professions Press, and the Hospital Topics column “Nexus: Ethics, Law, and Management,” which was awarded a gold in the category of Best Regular Column-Staff Written by the American Society of Healthcare Publication Editors. After more than 20 years as Executive Editor and columnist for Hospital Topics, Professor Darr now serves as Executive Editor Emeritus to the journal.

Ahmet “Ozzie” H. Ozturk, MD, MS, FIPP, is medical director of the Cabell Huntington Hospital Regional Pain Management Center and Pain Rehabilitation Education Program in Huntington, West Virginia. Dr. Ozturk earned his medical degree from Egean University in Izmir, Turkey, and a master’s in healthcare administration from Marshall University in West Virginia. He is a fellow of interventional pain practice and holds active medical licenses from three states. Dr. Ozturk has served as an editor for Hospital Topics since 2005.

Executive EditorsHOSPITAL TOPICS Research and Perspectives on Healthcare

Dennis S. Palkon, PhD, MPH, MSW, is a professor and former chairman of the Health Administration Department at Florida Atlantic University in Boca Raton, Florida, where he has taught for more than 25 years. He has received the distinguished Teacher of the Year award from the schools of business and social science. Dr. Palkon has published in a variety of journals and most recently co- authored the book Cutting Costs in the Medical Practice, now in its second edition from Greenbranch Publishing. In 2007, Dr. Palkon placed fourth in the Barron’s Challenge, an annual hypothetical stock-picking contest for college students and professors. He has been an executive editor of Hospital Topics since 1991.