Management and medicine: Odd couple no more. Bonding through medical management research

Abstract

According to conventional wisdom, management and medicine do not mix well. Organizational studies tend to confirm this view [1]. Health care is a professional service, and the professional experts who offer their services are licensed practitioners with a knowledge monopoly and professional autonomy. They are driven by a moral code to always do what is best for the patient, implicitly, without limitation or exception. To bring professional experts together in a concerted action, to motivate them to contribute their expertise in collaboration and to accept that limited resources need to be allocated in a way that grants the best return, is a very real challenge. That is the task of management. This begs the question if medically informed management would fare better? Enter medical management. Medical management is mentioned in two forms in cyberspace. It can refer to organized care programmes – ideally evidence-based – i.e., care management, which includes, in addition to identifying diagnostic and recommended therapeutic interventions and programmes designed accordingly, activities like patient advocacy and support, health information, and the education of the involved professionals. We can also find commercial companies offering medical management as a professional support service to a medical group or hospital. In short, medical management needs to cover both the ‘‘micromanagement’’ of the clinical processes, and the ‘‘macromanagement’’ of the organizational structures in which they are embedded. In the UK, medical managers are medically qualified managers – ‘‘doctor managers’’. Their distinct advantages are said to be greater credibility among colleagues, deeper knowledge of how health care works and ‘‘less trammelled ability to speak out’’ [2]. The British National Health Service has since the introduction of ‘‘general management’’ in the 1990s and ‘‘clinical governance’’ in the 2000’s actively tried to increase the interest among physicians to engage in management [3]. When the Medical Management Centre (MMC) was established at Karolinska Institutet, Stockholm, Sweden, in 2001, its ambition was to focus on research and research training in healthcare management and thus establish the area as an academic discipline in its own right. A stronger standing was expected to raise interest among physicians (and other health professionals) in management and make a management career a credible alternative to a clinical one. In addition to the MMC, two programmes in medical management were identified through an internet search. The master of medical management at the Carnegie Mellon University, Pittsburgh, USA, is offered to physician executives and focuses on three core competencies: effective leadership, strategy and management of information. The University of Washington in Seattle, USA, grants a certificate in medical management to mid-career physicians and healthcare administrators. It is a 12-month part-time programme covering strategy, marketing, quality measurement, techniques for efficient medical and management practices, leadership, and financial tools.