There has recently been debate on these pages regarding optimal expertise for biomedical leadership, precipitated by Roy Poses' posts NY Times Proclaims Anyone Can Run a Health Care Organization with a Little Studying Up.
I am resurfacing a post I wrote in Jan. 2009 entitled that I believe succinctly states the problems with 'management by amateur.'
Read the entire post, but here are the highlights:
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Those in charge cannot see that which the domain specialist sees.
They cannot see because they lack the training, experience, and what is described as 'meta-competence' essential to seeing that which is obvious. Obvious, that is, to those who lack these characteristics. In addition, I've also observed that some lack the fundamental analytical abilities essential to understanding and managing the complexities of biomedical R&D.
Why those without domain expertise are in charge of organizations whose long term viability depends entirely on the most advanced and creative pursuit of biomedical 'miracles' is another matter. I won't address this here, other than saying it reflects the adverse consequences of a bias that has evolved in management "science."
That bias is the belief that all the world consists of faceless labor resources performing easily definable processes upon interchangeable widgets, and that management can therefore be done by generic managers. Some of the world is like that , but some isn't, such as biomedical R&D. There is nothing here to spin, there is nothing to debate. There is nothing to discuss. This is a Failure to accept this reality results in Those who believe otherwise are engaging in magical thinking.
Further, those without biomedical domain knowledge who disagree should be prepared to discuss how their lack of domain knowledge might affect their insights and opinions on such complex matters, compared to those with both domain knowledge and leadership experience. A question is this: based on the same Western traditions of inquiry and critical thinking that led to modern biomedical science and its accomplishments, whose opinion is likely to be more valid?
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They cannot see because they lack the training, experience, and what is described as 'meta-competence' essential to seeing that which is obvious. Obvious, that is, to those who lack these characteristics. In addition, I've also observed that some lack the fundamental analytical abilities essential to understanding and managing the complexities of biomedical R&D.
Why those without domain expertise are in charge of organizations whose long term viability depends entirely on the most advanced and creative pursuit of biomedical 'miracles' is another matter. I won't address this here, other than saying it reflects the adverse consequences of a bias that has evolved in management "science."
That bias is the belief that all the world consists of faceless labor resources performing easily definable processes upon interchangeable widgets, and that management can therefore be done by generic managers. Some of the world is like that , but some isn't, such as biomedical R&D. There is nothing here to spin, there is nothing to debate. There is nothing to discuss. This is a Failure to accept this reality results in Those who believe otherwise are engaging in magical thinking.
Further, those without biomedical domain knowledge who disagree should be prepared to discuss how their lack of domain knowledge might affect their insights and opinions on such complex matters, compared to those with both domain knowledge and leadership experience. A question is this: based on the same Western traditions of inquiry and critical thinking that led to modern biomedical science and its accomplishments, whose opinion is likely to be more valid?
Our recent about health care organizations recruiting executives with no experience in or knowledge about giving health care or biomedical science has attracted some attention. Some people suggested that letting some people from the "outside" into health care leadership might lead to fresh thinking and new ideas. My concern was not about that. However, I do believe that to be succesful, the leadership of health care organizations ought to collectively be knowledgeable about health care, and understand its context, culture, science base, and values. My concern was not about a few "fresh thinkers," but that the preponderance of health care leaders today know little about what it's like to actually take care of patients, have little understanding of biomedical science and health care research, and do not understand, much less share the values of clinicians.
To illustrate with some admittedly anecdotal data, I looked up the official biographies of the CEOs of some health care organizations that have recently been mentioned in Health Care Renewal. I selected the most recently mentioned examples of the following types of health care organizations: hospitals and health care systems, managed care organizations/ health care insurers, pharmaceutical companies, device companies, biotechnology companies, and health care information technology companies.
Here are the results.
Hospitals/ Health Care Systems
Example: Sutter Health
CEO: Patrick Fry
Mr. Fry joined the Sutter organization in 1982 as an administrative resident at Sutter General Hospital in Sacramento. Over the ensuing years he held increasingly responsible administrative positions both at the local affiliate level and region level, with responsibilities covering the breadth of Sutter Health's services.
After serving as regional president for Sutter Health’s affiliates in the greater Sacramento region, Mr. Fry became president of the organization’s eastern operations. He later assumed leadership of Sutter Health’s Western Division and in 2000 became Sutter Health’s second-in-command, serving as chief operating officer and executive vice president. In 2005 Mr. Fry became President and CEO.
Mr. Fry earned a bachelor’s degree in public health administration from the University of California, Davis in 1979 and earned a master’s degree in health services administration from George Washington University in Washington, D.C.
Managed Care Organizations/ Health Care Insurers
Example: WellCare
CEO: Heath Schiesser
Heath Schiesser assumed the role of president and chief executive officer in January 2008. He originally joined WellCare in 2002 as senior vice president of Marketing and Sales and focused most of his effort on the growth of the Company’s Medicaid and Medicare businesses. As president of WellCare Prescription Insurance, he led the Company's successful national entry into Medicare prescription drug plans. Between mid-2006 and the assumption of his current position in January, he served in a part-time role as a senior advisor, focusing on WellCare’s rapidly growing Medicare products.
Mr. Schiesser brings extensive experience in improving operations, developing strategies and growing businesses in several sectors. Prior to joining the Company, he worked at the management consulting firm of McKinsey & Company, co-founded an online pharmacy for pharmacy benefit manager Express Scripts and worked in the development of new ventures.
A cum laude graduate of Trinity University, Mr. Schiesser received his Master of Business Administration from Harvard University.
CEO: William C. Weldon
William C. Weldon is Chairman of the Board and Chief Executive Officer of Johnson & Johnson, the world's most comprehensive and broadly based health care products company.
Mr. Weldon assumed his current responsibilities in April, 2002. Previously Mr. Weldon served as Worldwide Chairman, Pharmaceuticals Group, and a Vice Chairman of the Board of Directors. He was elected to the Board in February, 2001.
Mr. Weldon joined Johnson & Johnson in 1971 in the sales and marketing department of its McNeil Pharmaceutical subsidiary. In 1982 he was named manager, ICOM Regional Development Center in Southeast Asia. Mr. Weldon was appointed executive vice president and managing director of Korea McNeil, Ltd., in 1984 and managing director of Ortho-Cilag Pharmaceutical, Ltd., in the U.K. in 1986. In 1989, he was named vice president of sales and marketing at Janssen Pharmaceutica in the U.S., and in 1992 he was appointed president of Ethicon Endo-Surgery.
In 1995 Mr. Weldon was named a company group chairman of Johnson & Johnson and Worldwide Franchise Chairman of Ethicon Endo-Surgery, the Johnson & Johnson affiliate that develops new procedures for minimally-invasive surgery and designs related products. In 1998 Mr. Weldon was promoted to the Executive Committee and named Worldwide Chairman, Pharmaceuticals Group.
Among his outside activities, Mr. Weldon is a member of the Board of Directors of JPMorgan Chase & Co. He is also Chairman of the CEO Roundtable on Cancer, Vice Chair of The Business Council and a member of The Sullivan Commission on Diversity in the Health Professions Workforce. Mr. Weldon also serves on the Liberty Science Center Chairman's Advisory Council and as a member of the Board of Trustees for Quinnipiac University. He previously served as Chairman of the Pharmaceutical Research and Manufacturers of America (PhRMA).
Mr. Weldon was born in Brooklyn, NY, and is a graduate of Quinnipiac University in Hamden, Connecticut. He and his wife have two children and one grandson.Senior Vice President and President of Medtronic's Vascular business in January 2002.
Bill joined Medtronic from Novoste Corp., where he had been President and Chief Executive Officer since 1998. Previous positions included Corporate Vice President and President of the Sherwood Davis and Geck organization of American Home Products; President of the Ethicon Endo-Surgery organization of Johnson & Johnson; President, Devices for Vascular Intervention and U.S. Operations, for Guidant Corp.; and several increasingly responsible executive positions culminating in the presidency of the Ivac organization for Eli Lilly & Co. He began his medical technology career with Carolina Medical Electronics in 1977.
He received his bachelor’s of science degree in electrical and biomedical engineering from Duke University in 1976 where he also conducted medical research in pathology. Bill also earned a master’s degree in business administration from the Darden School of Business, University of Virginia, in 1982.
Bill is a member of the Board of Visitors of the Engineering School of Duke University and the Guthrie Theatre Board.CEO: Mitchell H Gold, MD
Gold joined Dendreon in 2001 as the vice president of business development. He subsequently was appointed a director in 2002 and was named the chief executive officer of the Company in 2003. Dr. Gold has led the Company’s corporate development, acquisition and financing efforts in recent years, completing transactions valued at approximately $225 million, including the acquisition of Corvas International, and raising approximately $350 million in capital. Prior to joining Dendreon, he served as the vice president of business development for Data Critical Corporation, a company engaged in wireless transmission of critical healthcare data, now a division of GE Medical. He also served as the co-founder, president and chief executive officer of Elixis Corporation, a medical information systems company. Dr. Gold is a former urologist at the University of Washington and currently serves on the boards of the University of Washington/Fred Hutchinson Cancer Research Center Prostate Cancer Institute and the Washington Biotechnology and Biomedical Association. Dr. Gold received his B.S. from the University of Wisconsin-Madison and his M.D. from Rush Medical College in Chicago.Glen E. Tullman joined Allscripts as Chief Executive Officer in August 1997 to lead the Company's transition into the Healthcare Information Sector. He led the Company's Initial Public Offering and Secondary Offerings of the Company, which is now traded on NASDAQ (MDRX) and has driven the Company to becoming the leading provider of clinical software, connectivity and information services to physicians.
Prior to joining Allscripts, Mr. Tullman was Chief Executive Officer of Enterprise Systems, Inc., a leading healthcare information services company providing resource management solutions to large integrated healthcare networks, from October 1994 to July 1997. Mr. Tullman led the company's Initial Public Offering and secondary offerings. HBO and Company of Atlanta acquired Enterprise in 1997 in a stock transaction valued in excess of $250 million. From 1983 to 1994, Mr. Tullman served in a number of management roles including President and Chief Operating Officer of CCC Information Services, Inc., a provider of information systems to the country's largest property and casualty insurers. Under his leadership, the company grew from $17 million to more than $100 million and is publicly traded.
Mr. Tullman graduated from Bucknell University Magna Cum Laude, with a double major in Economics and Psychology. Upon graduation, he joined the Executive Office of the President of the United States in Washington, D.C. and later accepted a fellowship to study social anthropology at St. Antony's College, Oxford University, England. Mr. Tullman serves on the International Board of the Juvenile Diabetes Research Foundation and on the Board of Trustees of the Certification Commission for Healthcare Information Technology (CCHIT). He also is Co-Chair of the National ePrescribing Patient Safety Initiative (NEPSI), a $100 million campaign, led by Allscripts and Dell Computers, to deliver free electronic prescribing to every physician in America. In 2006, he was named CEO of the Year by the Illinois Information Technology Association.So there we have the leaders of seven important health care oganizations. Only one is health care professional (although he is described as a "former urologist.") Only one of them claims any biomedical science experience, and that was in college. One has bachelors and masters level degrees in health administration, and another has a bachelors degree in electrical and biomedical engineering. That seems to be the sum total of the group's experience, expertise, and formal training in health care and biomedical science. Only one claims any experience directly taking care of patients. Only one has training in any health care profession. Only one is a (?"former"?)doctor, nurse, therapist, or biomedical scientist.
Of course, there are at least thousands of health care organizations in the US alone, each with its own often large (and some might say top-heavy) management teams. But I would wager that if there was a systematic survey of these leaders, the majority would turn out not to be health care professionals, not to be biomedical scientists, and not to have much direct health care experience. I would further wager the larger the organization, the less health care experience, knowledge and training would be found among the leadership.
I repeat, to really reform health care, we need health care leaders who actually understand health care, and support its values. But the bubble may have to burst before many people learn that lesson. For now, there is too much money to be made.
I have written numerous times on this blog about the blind-man ignorance displayed by many healthcare IT and biomedical companies regarding Medical Informatics expertise.
As a graduate and postdoctoral-level Medical Informatics educator with considerable applied expertise, as well as talent management experience, I teach students of a variety of healthcare backgrounds that the only way to overcome the sociotechnical complexities (i.e., issues at the intersection of people and their interaction with technology) of HIT is via education and considerable experience.
Once students become aware of the nuances and complexities of HIT in real-world clinical settings (if not already enmeshed in such environments), they find the lessons learned from substantial and rigorous immersion into a wide corpus of literature, overseen by someone with expertise, profoundly important towards advising their own organizations in avoiding pitfalls and achieving success.
I note that I used to admire German engineering rigor, but after seeing ill conceived, misguided position ads like the following from Siemens Healthcare, I am having sincere doubts about that country's current prowess in that domain.
I refer to a recent ad (here at the moment) for a Physician Consultant:
Job Description
Siemens Medical Solutions is the industry leader in Healthcare IT technology and Clinical workflow solutions. We are seeking to hire an experienced Physician for our Professional Consulting Services Organization. In this highly visibly position, you will support the implementation of Siemens products (such as Soarian ) in hospitals nationwide. To be considered for this position, qualified candidates must have the following credentials and experience:
• U.S. based Medical degree with at least five years of post-residency experience in large multi-specialty practice or hospital-based facility in the United States.
• Currently practicing medicine, or must have practiced at least 1 week per month within the last 3 years
• Leadership experience with at least one CPOE implementation in a large, multi-facility health system, Integrated Delivery Network (IDN) setting
• Extensive public-speaking and executive presentation experience
• Medical informatics credentials or advanced degree preferred, but not required [Medical Informatics not required? - ed.]
• Prefer some experience in public-health related projects
Here are the obvious major problems:
One CPOE implementation or even several does not by any means qualify a person to counsel other medical organizations and clinicians as a representative of a company citing itself as "the industry leader in Healthcare IT technology."
Further, the criteria "Medical informatics credentials or advanced degree preferred, but not required" suggests the crafters knows little about Medical Informatics, or hold it at a low level of esteem, considering it an optional "gift" that might add slight extra value to the incumbent's ability to travel the country and give good advice and support in clinical IT implementation. What might substitute for such knowledge and expertise?
This J.D. might better be described as "glorified salesperson." It might be a good exit route for a "techie doc" (usually, someone who knows just enough about HIT to be destructive) who hates the current practice environment. It might also be good for managers who don't want knowledgeable experts pointing out their bad decisions and mismanagement, but I think a global company like Siemens should be setting its sights higher in such a crucial area as electronic medical records and clinical IT consultants.
I would not want such a physician advising or supporting complex HIT projects at my organization.
I spent time at Siemens Healthcare headquarters in Erlangen in 2000, and was offered gracious hospitality and a position overseeing the Soarian cardiology suite. The people I met in Erlangen then seemed extremely competent and informatics-savvy, but I turned the offer down through no fault of Siemens. I'd received a near-simultaneous offer (FAXed to my hotel in Erlangen, in fact) from pharma that involved a much stronger management role.
I understand through conversations over the past few years with current and ex-Siemens personnel that most of the Siemens personnel I'd met in Germany in 2000 are no longer with the company. I was told they'd performed suboptimally after the acquisition/merger with Shared Medical Systems (SMS) in Malvern, PA. (I do not find that credible, and would find it far easier to accept that the problems were on the American side, but that is a personal opinion.)
Questions raised by these observations:
- What manner of ideology about education and expertise does this job description represent?
- Is there nobody left in Germany with a realistic sense of the education and expertise required to advise on and support HIT implementations in a competent manner, I ask?
Allow me to answer question #1. It represents the IT designer-centric, data processing and tabulator punch card culture-based (and antithetical to medicine and science) view that with enough generalists and sufficient "process", any problem can be solved. By this logic, Bach and Beethoven would have had symphonies written for them by low level musicians in the name of "efficiency" and cost savings.
Wanted: consultants to write my Ninth Symphony, according to the Acme Symphony-Writing Process Manual. Musical experience not essential. Must be team players.Shareholders, take note. I emailed this post to the Siemens Healthcare CEO Hermann Requardt, who I note (almost predictably) lacks a biomedical background other than having been a research assistant for aviation medicine once, and having worked on MRI:
Education
- Secondary school (baccalaureate)
- Studied physics at the Technical University of Darmstadt and University of Frankfurt (Dr. phil. nat., Dipl.-Phys.)
A lack of response is therefore not surprising. Read More..
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