Website Article Assignment

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Chapter 1 gave you a good sense of wh at healthcare management is and what it is that healthcare managers do. Before examining education for the profession and recommending strategies to find a job in the field, it is worth taking a bit of time to look back at the history of healthcare management as a career.

The early days of healthcare management coincided with the growth of hos- pitals, and transformation of medical practice into a science-based activity. Up until the later 19th century, hospitals were typically institutions where cure was infrequent and death was commonplace. For example, the first voluntary hospi- tal in the United States was established in 1751 at the Pennsylvania Hospital to care for the sick and poor. A condition of admission to the Pennsylvania Hospital was the requirement of patients to scrub floors and serve food to others. Patients who had adequate personal resources were cared for at home by private physi- cians and rarely, if ever, set foot in a hospital. Hospitals were typically “man- aged” by physicians (often whose clinical skills had diminished), nurses, or the clergy.

By the late 19th century, several important scientific discoveries and advances in medical practice began to transform hospitals into the organizations we see today. Antiseptic technique and developments in anesthesia simultaneously reduced the incidence of infection and allowed surgery to be performed without inducing needless pain and suffering. Coupled with this was the professionaliza- tion of nursing that began in 1873, with the opening of three schools of nurs- ing in New York, New Haven, and Boston (Starr, 1984). Along with these and other developments was the release in 1910 of the Flexner Report. This report was important in that it called for the uniform training of physicians and reduced the number of proprietary medical schools (Starr, 1984). The net effect of implement- ing the Flexner Report was to reduce the number of physicians in practice, but assure patients and state licensing boards that all physicians had a similar depth and scope of educational preparation.

As clinical care improved, hospitals began to shift away from providing almost exclusively charity care toward a model where patients were asked to pay for their care, resulting in hospitals starting to be run as a business. This change required a group of workers not previously seen—administrators and managers arranged in a bureaucratic structure. Day-to-day control of the hospital shifted from physi- cians and members of boards of trustees to professional managers. Concurrent with the growth of professional management was the significant increase in the number and size of hospitals. In the period between 1875 and 1925, the number of

C H A P T E R 2 A BRIEF HISTORY OF HEALTHCARE MANAGEMENT

C o p y r i g h t 2 0 1 8 . S p r i n g e r P u b l i s h i n g C o m p a n y .

A l l r i g h t s r e s e r v e d . M a y n o t b e r e p r o d u c e d i n a n y f o r m w i t h o u t p e r m i s s i o n f r o m t h e p u b l i s h e r , e x c e p t f a i r u s e s p e r m i t t e d u n d e r U . S . o r a p p l i c a b l e c o p y r i g h t l a w .

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I Over view of Healthcare Management

hospitals in the United States grew from just over 170 to about 7,000, and the num- ber of hospital beds increased from 35,000 to 860,000 (Rosner, 1989). In 1933, the American College of Hospital Administrators (ACHA) was founded to represent the professional interests of this growing number of hospital administrators. In 1985, ACHA was rebranded as the American College of Healthcare Executives (ACHE), in part to reflect the fact that there were many persons practicing health- care management outside of the hospital setting.

Over the past two decades, we have witnessed an important shift in the pro- fession and practice of healthcare management. While the profession has its roots in hospital administration and hospitals continue to employ large numbers of clini- cal and nonclinical staff in administrative and managerial roles, hospitals are not the only venue at which healthcare managers practice. As noted in Chapter 1, we use the term “health sector management” to draw attention to the variety of organizations that are either directly or indirectly involved with providing care to patients—the focal point of our healthcare system. For our purposes, let us catego- rize the health sector into units as shown in Table 2.1.

Excluded from this categorization are practitioners who work in solo practice or small groups. This includes most dentists and therapists (physical and occupa- tional). Also excluded are individual consultants or any other health sector profes- sional who works outside of a “traditional” organizational setting.

It should be noted that within each of the organizations mentioned, there are multiple types and variations. For example, long-term care includes, but is not limited to, organizations such as nursing homes, assisted living, adult day care, home health care, and hospice. Public health includes organizational forms such as county health departments, the U.S. Public Health Service, Centers for Disease Control and Prevention, Indian Health Service, and many others.

The point to this discussion is that healthcare management has undergone a profound transformation since Benjamin Franklin founded the Pennsylvania

TABLE 2.1 HEALTH SECTOR ORGANIZATIONS

Delivery Organizations Direct Support Organizations

Indirect Support Organizations

Hospitals Health insurance Regulatory agencies

Physician group practices Health information technology

Universities and other educational programs

Long-term care Consulting firms Executive search firms

Federally qualified health centers

Pharmaceutical manufacturing and sales

Research and development

Public health Durable medical equipment Healthcare associations

Mental (behavioral) health Biotechnology firms

Military health and the Veterans Administration (VA)

Correctional health

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2 A Brief History of Healthcare Management

Hospital in 1751. The diversity and complexity of organizations connected at some level to the delivery of care to the patient require highly professional and competent management. The subsequent chapters detail what is required in terms of educational preparation and the personal attributes crucial for success in this field.

REFERENCES Rosner, D. (1989). Doing well or doing good: The ambivalent focus of hospital administra-

tion. In D. Long & J. Golden (Eds.), The American general hospital: Communities and social contexts (pp. 157–169). Ithaca, NY: Cornell University Press.

Starr, P. (1984). Social transformation of American medicine. New York, NY: Basic Books.

EBSCOhost - printed on 2/15/2022 11:26 AM via UNIVERSITY OF MARYLAND GLOBAL CAMPUS. All use subject to https://www.ebsco.com/terms-of-use

EBSCOhost - printed on 2/15/2022 11:26 AM via UNIVERSITY OF MARYLAND GLOBAL CAMPUS. All use subject to https://www.ebsco.com/terms-of-use