Good Managers Make Good Hospitals

In the last year, two research reports were published which focus on the importance of management in improving health care performance. The joint study by McKinsey and LSE, "Management in healthcare: why good practice really matters", analyzes 1,200 hospitals in seven countries and finds a correlation between good management practices and the clinical and economic performance of hospitals. A second empirical study published in Social Science and Medicine, conducted on the top 100 US hospitals for 16 different clinical areas, goes on to show that when good management practices are implemented by doctors, performances decidedly improve.
These two research studies also provide a clear lesson for Italy, where reliable measures of performance are not available: good management practices are fundamental ingredients to ensure a bright future of Italian hospitals and health care firms.
On one side the economic crisis, on the other the growing complexity of decision-making about new medical technologies where dilemmas of fairness-economy-ethics are increasingly relevant, all this makes the formation of a competent managerial class of health care professionals crucial and urgent, especially if one considers that the political class shrinks from hard decisions either for lack of competence or fear of voters' retribution.
Here are some example of currently hot issues in health care management. Consider the use of an innovative pharmaceutical treatment, medical device, or hypertechnological prosthesis. When should a treatment be interrupted if the patient is not responding? What kind of prosthesis should be implanted in an elderly patient that has limited life expectancy? If and when should a treatment be started that allows only a few months of additional life? These are complex questions, which have a strong ethical component but must nevertheless be addressed in the systematic way of management science. Otherwise professional subjectivity risks producing extreme variability in access to and fairness of medical treatment and care.
Furthermore, the trend toward clinical specialization combined with the broadening of therapeutic options and the emergence of an older and more fragile average patient all require multidisciplinary work, in order to stave off the turf wars typical of overlapping medical competencies. A leadership function in charge of the operational management of hospitals, able to regulate its increasingly complex flows of people and treatments, is thus indispensable. It won't be enough to solve the problems of universal access, fairness and sustainability of the Italian Health Service, but it is necessary to start a process of thinking and decision-making that is unaffected by political and professional biases alike. The scant investments made over the last two decades for managerial training in the Italian Health Service have been lacking a vision and have mostly gone to feed local political networks. The time has come to develop a true class of managers in the Italian health care system.