Many of the issues faced by those who would offer leadership in healthcare services stem from incomplete understanding of the health field, hospitals, and professions and how they all come together. It is a unique, complex business with lines of accountability, or lack thereof, unlike any other! That, together with the fascination that the public has with doctors, nurses and hospitals, explains why Jeffrey Simpson refers to healthcare as the third rail in Canadian politics.
In times like these we need to bring back the images of Florence Nightingale and Dr. Malcolm MacEachern. Florence, of course, set the bar for nursing practice and professionalism. Dr. MacEachern was, a couple of generations ago, the father of Hospital Administration in North America and, indeed, around the world.
He, like Florence Nightingale long before him, was pretty concerned about the standards of care in hospitals. He was a surgeon, certified by the American College of Physicians and Surgeons. In the early 19th century hospitals were pretty rudimentary with limited attention to standards of care and practice. Dr. MacEachern, as a great surgeon and visionary, called attention to the needs for standards of practice to avoid the lack of discipline that was prevalent in hospitals.
He became active in the American College of Surgeons and through that involvement, was one of the key founders of the Hospital Accreditation Council. Within a few years, the Accreditation Council became the standards-setting and monitoring body for hospitals and hospital medical practice. In short, the impact of MacEachern and the Council was to inject a level of standardization of practice and management that soon caught on around the world.
The Canadian Council on Health Services Accreditation was formed by those who had been trained as surveyors with the American body. Thus, we began to see the weeding out of practices that placed patients at risk in hospitals across the continent.
What MacEachern soon learned was that there is an entire body of knowledge required for those who choose to serve in positions of leadership in hospitals; consequently, he authored what has been referred to as “the Hospital Bible”, a 1000 page book entitled “Hospital Organization and Management”. Until a few years ago, that book was to those in health management what Grey’s Anatomy was to medical students. In the more prominent graduate programs in North America, that book was given to each first year student as the key reference text.
MacEachern then became prominent in university post graduate education programs that prepared physicians, nurses, pharmacists, and business people for careers in directing health care programs and insititutions. He became a Professor at Northwestern University and within a few decades there were 20 programs in existing in prestige universities across the US and Canada.
Early students of these programs were physicians, nurses, pharmacists, all of whom found themselves in positions of leadership in hospitals but without the training required to provide a broader understanding of human resource management, finance, public health, social work, public policy, organizational concepts and more. MacEachern himself mentored many physicians and nurses who went on to be leaders, professors, and consultants in the field of health administration. In Canada, three of his major disciples were Dr.G.Harvey Agnew, Dr. F. Burns Roth, and Eugenie Price, RN.
Agnew became one of Canada’s foremost hospital consultants, forming the prestigious Agnew, Peckham and Associates. Teaming up with prominent architect Arthur Peckham, they designed dozens of major hospitals across the country. Dr. Agnew would teach local boards, medical and nursing staffs and other professional staffs what is involved in the modern design and operation of a hospital. Arthur Peckham would take the programming from those discussions and create a design for efficient hospital function.
Agnew then also went to University of Toronto to direct the program in Hospital Administration which was the first such program in Canada and graduated many people who were prominent in the health and governmental fields from the 1950’s to current days. Other programs have emerged in Montreal, Ottawa, Halifax, BC, and Saskatchewan, all stemming from the influence of one American surgeon!
Dr. Burns Roth succeeded Agnew as Director of the University of Toronto Program and was known for years in Canada as a strong leader in Health Administration. He was networked to leaders in the health and civil service fields for the duration of his career and oversaw the training of many who assumed major roles in most provinces in the civil service and hospitals.
Eugenie Stuart was a nurse that saw clearly that nurses in leadership roles needed broad training in human resources management, finance, legal concepts and more. She herself completed a Masters Degree in Hospital Administration and committed her life to mentoring hundreds of people who chose careers in hospital administration.
From all of this, the Canadian College of Health Leaders was birthed in 1970. What was recognized in Canada was that people were routinely placed in managerial and leadership positions in hospitals and departments of health who had wonderful professional training (as a nurse, doctor, pharmacist, technician) but struggled when faced with labor issues, budget processes, governance issues, team-building, accountability, and decision-making.
This body was established to serve as a basis for establishing basic educational standards for those whose career is in health administration. The College has basic entry requirements then a process of further education and testing to progress to Certification, then a further, highly challenging process of much study and research leading to recognition as Fellow of the College. The purpose of all this is to provide a place where new practitioners can meet others whose careers are developing, to network, to share success stories, to be recognized for achievement, and to improve the standards of practice in the field of health administration.
In most provinces, recognition at some level by the CCHL is a priority quality for persons being selected for managerial positions in hospitals, planning agencies, regional structures and certainly in long term care. The challenge is that unlike Medicine and Nursing, there is no legal requirement for those practicing in this field to be part of a professional regulator process. In some provinces, membership is a high priority and the costs are reimbursed by the employer. Not so much in New Brunswick. There has been a small chapter of the College in New Brunswick in which 8-10 people tried to keep a momentum.
The importance of this simply is that those who manage in health and long term care need basic training. There is nothing in the training curriculum for any of the health professions that prepares them for the challenges of managing people in a health care environment. Taking the most competent, professional nurse and giving her responsibility for managing a budget and a group of 100-1000 staff is a formula for failure. Similarly with physicians who have had stellar education and training to the specialty level, then suddenly they are Chief of a Department or Chief of Staff, chairing meetings, trying to develop consensus, managing or influencing a budget, serving on committees.
Earlier in my career I registered our Chief of Medical Staff in a very intense Physician Management Program and on return, after about the 4th session, he confessed that he was a different person, seeing things quite differently from the exposure in class with new information.
If Health Reform is to be effective in New Brunswick, a good and central part of reform must be a commitment to leadership development within the broader health system. The most frustrating thing in the world is to give a person, however smart, a new assignment requiring new knowledge and skills, and not providing the training. Disaster awaits!
Ken McGeorge,BS,DHA,CHE is a retired career health service executive, part time consultant, and columnist with Brunswick News.
Ken McGeorge, BS,DHA,CHE is a career health care executive based in Fredericton, NB, Canada.