SOME YEARS AGO Peter Drucker observed that healthcare organizations are among the most difficult organizations to manage. The increasing complexity of the healthcare industry poses even greater challenges to those who assume management roles today. Managers need to anticipate the effects of new technologies, selecting those that provide greater benefits than costs. They must assess and negotiate complex financial deals, providing needed resources without risking longterm fiscal viability. Managers must mediate internal conflicts between professionals, and balance the competing demands of community groups, regulators, payers, staff, and patients. These are difficult tasks. It is not surprising, therefore, that faced with a growing range of choices, many students in schools of business and public health are not opting for managerial positions in health delivery organizations. While good statistics on the gap between supply and demand are lacking, apprehension is growing that insufficient numbers of health managers are graduating from health administration programs. This shortage has been aggravated by limited succession planning in many organizations. Search consultants lament the lack of experienced managers with the skills and motivation necessary to assume leadership posts, particularly in larger health delivery organizations (Gustafson 2001). Few healthcare organizations of any size have emulated General Electric, which developed a number of potential successors to assume Jack Welch's post when he retired (Tichy 1997). Healthcare management, which so recently emerged as a profession, seems to have reached a potential crisis-a shortage of managers whose training and experience qualifies them to assume these challenging and necessary positions. Warden and Griffith argue that what is needed is a long-term plan to recruit, educate, and develop healthcare managers to meet this need (Warden and Griffith 2001). Efforts to address these current leadership problems are essential. But the root cause of the difficulties facing healthcare management stem from broader problems in healthcare. The current system works poorly not just for managers, but also for professionals and other workers, employers, insurers, and, especially, patients. Moreover, the challenges of an aging and increasingly demanding population, the growing shortages of clinicians, and the unending cost pressures will only exacerbate current dilemmas and frustrations. Short-term solutions to increase the supply of managers in healthcare will be inadequate unless we restructure the healthcare delivery system to reduce the incessant and conflicting strains that bedevil those working in it. The Institute of Medicine (2001) in its report, Crossing the Quality Chasm, provides a set of recommendations and a list of to reorient and restructure U.S. healthcare. It offers an appealing vision of a healthcare system focused on the patient, offering timely, safe, efficient, and effective services to all who need them. The new rules, outlined by Mary Stefl earlier in this issue, would transform the healthcare experience, greatly alter relationships between caregivers and patients, and create a much healthier work environment. These simple rules and attractive vision of the future create a compelling sense of what might be possible. However, as the rom committee acknowledges, the journey required to create an environment where such rules govern the experience of patients and caregivers will be difficult. The changes needed include a refocusing on developing integrated care for patients with chronic conditions, developing a database of effective healthcare interventions that is more easily available to clinicians, and making considerable investments in information technology to create an accessible record of each individual's current health status and previous experiences with caregivers (IOM 2001). More fundamentally, the current system culture-one that often relegates the needs of patients behind the needs of those who provide care or pay for it-must be transformed. …