Managing professionals: The otherness of hospitals

21 DOI: 10.1179/175330310X12665775636427 Peter Berchtold is Co-Director of the College for Management in Healthcare (College M), an institution of management development as well as of research and consulting in healthcare management. After an academic career in internal medicine, Peter was general manager of the Department of Medicine at the University Hospital in Bern, Switzerland until 1998. At College M, he designs and directs multidisciplinary management programmes for senior health professionals as well as significant research projects such as evaluation of various aspects of integrated healthcare. He is also President of the Swiss Forum Managed Care. Christof Schmitz is Co-Director of College M, which has its main strength in the interdisciplinary and systemic approach to the management of institutions in healthcare. Christof studied business administration and sociology by academic training. His special concern is the otherness of professional organisations and the development of appropriate structures, processes and cultures. He trains, consults and researches in the field of managing professionals. Introduction Systematic management development — a standard process in many large companies nowadays — is still rarely practised in hospitals. It is still unusual to find hospitals that invest in management. While management programmes are provided by various institutions, they are mostly of a singular nature and have little connection with the objectives and strategic intentions of the organisation in question. The reasons for this are many and varied. Two of the most important reasons are the fact that management competence has been a low priority for such institutions to date, and the even lower availability of management programmes specifically designed for hospitals. The first reason is attributable to the fact that, until only a few years ago, management and positioning issues to be tackled were few and far between. There was therefore little need to specify management and management competence for the hospital organisation. Secondly, and as a result of this, management as a discipline neglected the unique nature and special characteristics of this type of organisation. Hospital management has been understood as practising health economics. The specific organisation of hospitals and its challenges for management has only recently been highlighted by related studies.1–5 We hypothesise that hospitals are truly different and that their otherness is not well understood by the management experts or by the public. This otherness is defined by an exceptionally strong internal differentiation. Glouberman and Mintzberg have demonstrated this using a model: the so-called ‘hospital cross’ (Figure 1).6 The differentiation of the four quadrants, cure, care, control and community, each with its own languages, forms and cultures, points to the challenges entailed in the overall management of such an organisation. The task is to focus consistently on the new, prevent the immediate activation of subsystemspecific immune systems, and remain in constructive cooperation. In particular, the (unavoidable and progressive) economisation of hospitals (eg by diagnosis-related groups) makes it even more challenging to surmount the horizontal barrier — the so-called ‘clinical divide’ — between the ‘core business’ and ‘management’. This barrier constitutes a major obstacle, and every doctor, nurse and hospital manager has his or Opinion paper Managing professionals: The otherness of hospitals