Mintzberg et l'hopital

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Barbara Bigelow and Margarete Arndt Coeditors

Health Care Manage Rev, 2001, 26(1), 56–92 © 2001 Aspen Publishers, Inc.

This FORUM features two articles by Henry Mintzberg and Sholom Glouberman, commentaries by Tom D’Aunno and Peter Weil, and the authors’ response to the commentaries. It makes for a stimulating sequence, indeed! In their first article, Glouberman andMintzberg take a broad view of the health care system and identify four aspects—care, cure, control, and community—that function to a large part independently and under different mindsets. They see that as one reason why it is so “enormously difficult” to control the overall system. In their second article, the authors focus on how closer coordination of the four quadrants could be achieved.Mintzberg and Glouberman refer to “curtains” that inhibit communication and collaboration between members of licensed professions and alternative providers. But, as became evident to us from articles presented at this year’s Academy of Management meeting, there are curtains between the formal professions as well (for example, between physicians and nurses), making the transfer of knowledge difficulteven among people who collaborate closely in the care of each patient. Both Tom D’Aunno and Peter Weil agree with the authors that much separation remains among the participants in the health care system. Both also provide further insight. For example, D’Aunno points to a considerable body of research that empirically confirms arguments made by Mintzberg and Glouberman while adding nuances that gobeyond the suggestions made in the articles. Weil’s comments focus on the role of management and attempts by hospitals to achieve higher integration between management and clinicians, as well as between the organization and its community. He also makes a case that management should be seen as a profession. The issues raised in these fine articles and commentaries are not only extremely important,their very presence in this FORUM bespeaks their intractability when we remember that they have occupied policymakers, managers, clinicians, and the general public

Thomas D’Aunno, Ph.D., is Associate Professor, School of Social Service Administration, University of Chicago, Chicago, Illinois. Peter A. Weil, Ph.D., F.A.C.H.E., is Vice President, Research and DevelopmentDivision, American College of Healthcare Executives, Chicago, Illinois.


Managing the Care of Health and the Cure of Diseases––Part I


since the beginning of the hospital movement. A look at the early issues of the practitioner literature shows how much emphasis has been placed during the last hundred years on clarifying the roles of different clinicians and the relationship betweenclinicians and management, while recognizing the need for collaboration. The proper role of the hospital in the community has received continuous attention as well. Over the years, it has been argued that hospitals should not only be a place for acute care but also should play a role in public health and even in educating and socializing patients to societal values. Efforts to elevate managementto the status of a profession are similarly long standing, as Duncan Neuhauser showed in his history of the American College of Healthcare Executives. We thank Henry Mintzberg and Sholom Glouberman for giving the readers of this journal so much food for thought, and we thank Tom D’Aunno and Peter Weil for their very thoughtful commentaries.

Managing the Care of Health and the Cure ofDisease—Part I: Differentiation
Sholom Glouberman and Henry Mintzberg

The clinical methods used in health care and disease cure are easily understood. Yet when combined into institutions and broadened into social systems, the management of them becomes surprisingly convoluted. Part I of this article presents a framework to help understand how this happens.

Why are the so-called systems of health...