REQUEST TO HEALTH CARE MANAGEMENT PROFESSIONS TO READ THE ARTICLE AT LEAST ONCE TO KNOW THE HISTORY, PERCEPTION AND REALITY ABOUT OUR PROFESSION...REALLY INFORMATIONAL...

1. Healthcare Management: Perception, Reality & History
Gopal Kumar Gupta
BHCM-II
In many ways, healthcare management is a “hidden” the twentieth century, very little could actually be done
career. When we think of a hospital or a clinic, we tend in hospitals to improve the health of patients. People
to think of physicians, nurses, and other caregivers. The who had enough money received nursing care in their
myriad of people who work in the organizations that homes when they were ill or dying or having a child.
support health services delivery organizations, like Those who became hospital patients were generally
insurance and managed care companies and poor and without family or friends to care for them.
government policy-making and regulatory agencies, are However, with the advent of antisepsis and anesthesia,
even more invisible and are not who we think of when the development of modern surgery, and the discovery
we hear the phrase “health services.” However, they of antibiotics in the late 1800s and early 1900s,
play very important roles in making health services hospitals became places that could offer cures and
available and accessible. Think of medical dramas on relieve suffering. Between 1875 and 1925, the number
television or in the movies. Rarely do you see a health of hospitals in the United States grew from just over
services executive among the characters, and when you 170 to about 7,000, and the number of hospital beds
do, it is many times in a rather unflattering light, such increased from 35,000 to 860,000. Early hospital
as the greedy executive who is more concerned about administrators were called “superintendents” and
money than patients. The news media also tend to focus typically had little specific training for their jobs—
on hands-on caregivers in health services organizations many were nurses who had taken on administrative
or to present executives in these organizations responsibilities. Over half of the superintendents who
negatively. This article will help you see the range of belonged to the American Hospital Association 2
work options that are available to health services careers in healthcare management in 1916 were
executives. It will also help you see that careers in this graduate nurses, and the first formal hospital
field take many different directions and many different administration and nursing school administration
paths. Most of all, we hope that this article will help educational program, in health economics, was
you see the incredibly important role that healthcare established for nurses at Columbia Teachers College in
executives play in health services delivery in the United New York in 1900. Other hospital superintendents were
States. While these executives may often be hidden and physicians, laypersons, and Catholic sisters. The first
work behind the scenes, they have a tremendous effect degree-granting program in hospital administration was
on the availability, accessibility, and quality of health established at Marquette University in Wisconsin. The
services in our communities. They help to provide an original idea for this program came from Father
environment in which physicians, nurses, and other Moulinier, a force behind the Catholic Hospital
caregivers can practice effectively and efficiently, and Association and a member of the 1922 Rockefeller
they help provide safe, comfortable, and compassionate Commission on the Training of Hospital Executives. In
places for people to receive health services when 1927, two students, both women religious, received
needed. Although they are concerned about the their degrees, but by 1928, the program, with no other
business side of healthcare, ultimately they are graduates, had failed. In 1929, Michael Davis published
concerned about the health of people in the his book Hospital Administration, A Career: The Need
communities they serve. There is not one term for the for Trained Executives for a Billion Dollar Business,
field we are talking about or the people who practice and How They May Be Trained, proposing a two-year
it—healthcare management, health services graduate degree curriculum in hospital administration.
administration, and other variants can be used The first year of this curriculum was centered on
interchangeably. People who practice in this field may coursework in accounting, statistics, management,
be called health services executives, healthcare economics and the social sciences, and the history of
administrators, health services managers, or other hospitals and the health professions, with limited
similar names. This can be confusing if you are new to practical observation. The second year was mostly
healthcare, but it will become second nature. Another spent in practical work with some coursework in
source of confusion is the fact that administrators may business policy, public health, and labor relations.
be identified by the specific type of organization in Following on Davis’ proposal for graduate training in
which they work, for example, as a hospital executive hospital administration, the Committee on the Costs of
or nursing home administrator. However, the meaning Medical Care in October 1932 stated: Hospitals and
of such terms is usually clear. The development of clinics are not only medical institutions; they are also
healthcare management as a career field has largely social and business enterprises, sometimes very large
followed the development of medical science and the ones. It is important, therefore, that they be directed by
growth of hospitals in the world. Until the early part of administrators who are trained for their responsibilities

2. and can understand and integrate the various Association, the Canadian College of Health Services
professional, economic, and social factors involved. Executives, the Healthcare Financial Management
Definite opportunities should be provided in Association, the Health Information Management and
universities or in institutes of hospital administration Systems Society, and the Health Insurance Association
connected with universities, for the theoretical and of America) devoted to accountability and quality
practical training of such administrators. The improvement in the education of health administration
administration of hospitals and medical centers should professionals and serves as the recognized accrediting
be developed as a career which will attract high-grade body for master’s programs in health administration in
students. However, before the founding of the first the United States and Canada. Over the course of the
graduate program in hospital administration, a group of last century, the field of healthcare administration and
practicing administrators came together in 1933 to form the organizations in which executives work have
the American College of Hospital Administrators (now changed dramatically. Hospitals have become large,
the American College of Healthcare Executives), the complex organizations; technology has advanced at an
first professional association for hospital almost unbelievable rate; the financing of healthcare
administrators. And, while both clinically trained and has moved from self-pay to a complicated third-party
lay administrators could affiliate with the new College, reimbursement system; and government has taken an
the emphasis was clearly on the lay administrator. increasingly larger role in healthcare delivery. Despite
Among the 106 charter fellows of the College, 16 were these increased complications, the field continues to
women and 32 were physicians. The professional status sustain three primary objectives. First, healthcare
of the field was furthered in 1934 when the University administrators are responsible for the business and
of Chicago established the first graduate program in financial aspects of hospitals, clinics, and other health
hospital administration, naming Michael Davis as its services organizations, and are focused on increasing
head. Many of these programs followed the Davis efficiency and financial stability. Their roles include
model of one year of coursework and one year of human resources management, financial management,
practical experience. In 1958, the Sloan graduate cost accounting, data collection and analysis, strategic
program in hospital administration at Cornell planning, marketing, and the various maintenance
University in New York started a new trend toward a functions of the organization. Second, healthcare
two-year graduate program, a model that is followed by administrators are responsible for providing the most
most programs today. The early programs used the term basic social service: the care of dependent people at the
“hospital administration” in their titles; however, this, most vulnerable points in their lives. Third, healthcare
too, has changed to “healthcare administration” or administrators are responsible for maintaining the
some similar phrase, as the field has changed to include moral and social order of their organizations, serving as
a broader range of organizations in which healthcare advocates for patients, arbitrators in situations where
executives work. there are competing values, and intermediaries for the
The number of academic programs for healthcare various professional groups who practice within the
executives has grown over the years, and the programs organization. As healthcare services have become
have organized to continue to improve the quality of increasingly expensive and as the environment for the
health administration education. In 1948, several early organizations that deliver these services has become
graduate programs in the field joined together to form more turbulent and hostile, these three objectives seem
the Association of University Programs in Health more and more contradictory. However, the three
Administration. This association now includes both objectives remain. The greatest challenge for health
graduate and undergraduate health administration services executives and for the educational programs
programs and focuses its efforts on the development that train them is to find the skills and competencies
and continuous improvement of health management needed to balance these objectives and to achieve them
education. In 1968, the Accrediting Commission on in a continuously changing environment. Today, the
Graduate Education for Hospital Administration was opportunities for healthcare administrators are
incorporated as the accrediting agency for graduate increasing and the challenges they face in ensuring
programs in health administration. The name of this effective, efficient healthcare services for communities
accrediting body was changed in 1976 to the are many. Shortages of nurses and other healthcare
Accrediting Commission on Education for Health workers, concern for the safety and quality of
Services Administration (acehsa). Today, acehsa is healthcare services, rising costs, a growing number of
sponsored by a group of educational and professional uninsured Americans, an aging population, and rapidly
associations (including the American College of changing medical technology and practice all make the
Healthcare Executives, the American College of field of health administration a very big job for those
Medical Practice Executives, the American Hospital who are willing to accept the challenge. For those who
Association, the American Public Health Association, do, the rewards come in knowing that you are making a
the Association of University Programs in Health positive difference in the lives of people and
Administration, the Blue Cross Blue Shield communities.