Medical Tribune, 10.12. 2009 (Year 5, #28, pg. B5)
HEALTHCARE IS A BUSINESS, WHETHER WE LIKE IT OR NOT
Interview with Professor Sharon Oswald from Auburn University, academic partner representative
For a number of years now, the CMC Graduate School of Business, which is based in Čelákovice not far from Prague, has provided management study courses leading to a Master of Business Administration (MBA) degree. Since last year it also has a special offer for healthcare personnel. A third group of students will soon start the MBA healthcare program. The individual course modules are supplemented by visiting professionals. Last September one of these was Professor Sharon L. Oswald from Auburn University in Alabama. She has specialized for years in the problems of effective management of healthcare facilities. She is familiar with the Czech environment mainly because her university is the academic partner of CMC.
Your school is one of the top fifty in the USA. What educational programs do you offer healthcare managers?
We have offered programs specialized in healthcare for ten years now. Our offer is flexible – from intensive presentation courses to long-distance studies. We do not, however, have courses based solely on communication over the internet – there is always some time dedicated to direct contact between the students and their teachers and mentors. We also allow some time for field work – for example, we travel with students beyond the borders of the USA so that they can learn about other healthcare systems. We have a very wide range of students – from CEOs of large clinics to physicians from small, rural hospitals. I think that similar interesting, diverse groups are also created here in the Czech Republic. That is a good thing, because the more diverse the students are, the more they can enrich each other. They will definitely profit from making informal contacts with people whom they would not otherwise have met.
Why do you work together with CMC?
Without an international dimension in today’s globalized world it is impossible to teach management, so we have long-term ties with, for example, a Japanese partner. In fact the creation of Czech programs for healthcare management is something we have been involved in from the very beginning, we have helped create course curriculums, and we have met many times with Czech colleagues to discuss, for example, syllabi for individual modules. I think the quality of the lectures given here is quite remarkable. And I am looking forward to being here when the first group graduates.
There are basically two paths to successful healthcare management– either healthcare personnel adopt at least the basic economics and management principles, or people with economics or legal training get an overview of specific areas of medicine. Which do you think is the more successful?
Both are of course possible, but in my opinion it is easier to teach healthcare professionals. I think they are more eager to accept new knowledge. We can also see this in courses aimed at management in general – physicians are usually among those who work the hardest.
What are your feelings about your work with Czech students?
My experience so far has been very brief. However, my impression is that they are highly motivated and very well informed. And they had very interesting questions.
Why is it necessary to create programs aimed solely at healthcare? Are management principles not universal?
Healthcare has many distinct features. One of them is the need to face up to constant change. This, of course, can also apply in any other branch, however in healthcare it is especially prominent – here the pressure on innovation is brought to bear by the incredibly rapid development of medicine. There is also no one typical client. Apart from patients, you need to communicate with politicians, with representatives of regulatory bodies, with care payers. Somehow you have to satisfy all of them. The situation is made even more complicated by the fact that the person paying for the care is usually not the person receiving it. The crisis situations that the management must solve are unique. Also in no other branch do emotions play such an important role. And the list could go on and on …
Every healthcare system is totally individual – what works in one can cause a negative domino effect in another. To what extent is experience gained in one state transferrable to another?
They are definitely not completely transferrable, but we can inspire each other. If we take our two countries as examples, the main difference is that in the Czech Republic people consider access to medical care a right, but Americans view it as a privilege. The Czech system has many shortcomings, as does the American, maybe a better system could exist somewhere between these two. I have to say that I consider some of the ideas on healthcare reform you have prepared here to be very challenging. Even here we can see that we face many of the same problems. The same thing happened here as in the USA – even purely professional, factual topics have started to get buried under disorganized political debate. What ties these individual systems together is medicine. Medicine is very similar throughout the developed world, even though it is also very culturally biased. What healthcare professionals believe in and what they want for themselves and their patients is not very different.
President Obama is now attempting to push through a number of fundamental changes to the American healthcare system. He is trying to enroll tens of millions of uninsured Americans into the insurance system and simultaneously to reduce the astronomical healthcare costs paid by the USA. What do you think of his chances?
I now believe, for the first time in thirty years, that we have a real hope for positive change – however there is no way the president will be able to get everything he wants. But the amount of energy he is dedicating to this task is impressive. As far as I know from discussion with Czech colleagues, the problem with the reform here was that the public did not know what the reform would bring them. President Obama actually goes from city to city and talks to people. He is really trying to tell them what he wants to do. In many places he also encounters very confrontational situations. Thanks to the media, intense discussions about healthcare are taking place throughout the society.
Does successful healthcare reform even exist?
Unconditional success is extremely rare indeed. The best example would probably be the Netherlands. However, the situation there was easier, since it is a relatively small country. Interestingly, they have succeeded in unifying the electronic documentation for patients throughout the system – in the USA this often does not work even between a few hospitals with the same operator.
You have been observing developments in Czech healthcare for a number of years. What observations have you made?
I must have been in the Czech Republic 20 times now, the first time in 1992. You might not notice them much, but for an outsider the positive changes are very obvious. What is happening here is very impressive. This does not only concern improvements in technical equipment – the quality of care is also getting better in almost all its aspects. I can also see that the issue of healthcare is becoming a more and more important topic in general discussions, people think about it a lot more. I do not consider that a functional healthcare system can be taken for granted. It is remarkable how little money Czech healthcare needs to achieve comparable results with far richer countries. We would like to show the students from Auburn University this – we plan to bring them here on a “school trip”.
Let us return to the program which you are working on here. Particularly in the Czech Republic, where we are not used to paying for education, the school fees must be a very limiting factor, since they are definitely not symbolic…
Yes, a good education is expensive. However healthcare involves enormous amounts of money. Organizations that are already being run by our students have multimillion turnovers – and sometimes tens and hundreds of millions are at stake. They can very easily make a mistake that would result in the healthcare facility having to pay many times the school fee. Our program was devised to ensure that the investment made by the students, or rather by their employers, is returned to them, otherwise this could not become a long-term project.
Where do you see room for the development of this type of program in the Czech Republic?
There is definitely the potential for an international course in English, where people from the former Eastern Europe could study and where even the lecturers would be truly international. CMC is working on this and Auburn University will be happy to contribute to this project.
In conclusion, why should management healthcare personnel be interested in an integrated management training program?
Simply because healthcare is a business, whether we like it or not. People who have decision-making power have to understand the principles underlying the management of an organization and its economical and legal aspects. If it is not the case, then sooner or later it will have a negative impact on the medical care they offer.