Just as members of the professional culture live with the hope of thwarting the physical death of their patients, members of the managerial culture live with the hope of thwarting the death (chaos and unpredictability) of their organization. They look for organizational strategies that will reduce their anxiety regarding organizational chaos and delay the inevitability of organizational decline and death.
There is another important artifact of the managerial culture. People from this culture are not allowed to touch patients, but they are allowed and hold the rights and responsibilities to touch the organization and its resources, especially money. By touching and controlling the resources, health care managers believe that they can directly benefit their patients as well as society in general. Over the years, health care managers have primarily focused on the provision of resources for the amelioration rather than prevention of illness and injury. These managers have traditionally believed that they could reduce both their own anxiety and the anxiety of their customers (patients) by demonstrating that they could provide healing services at reasonable costs to their customers.
Today, we find a greater emphasis on prevention among some health care managers and in some health care systems. In some instances, this shifting priority is quite real and tangible. Typically, this new emphasis on prevention is occurring because prevention has been found to be more financially viable, under certain conditions, than effective but often costly treatment programs. In other cases, the increasing attention to prevention is more a matter of rhetoric and appearance than a sign of real shifts in attention. Prevention is often added to the vocabulary of health care managers and the plans of health care systems they administer primarily in order to make their services appear more attractive.
The same is often true of alternative health care options that are covered to attract members. These alternative health care options are usually inexpensive, even though they have often not been proven to be effective. By contrast, health care managers often refuse coverage of bone marrow transplants for cancer treatment because this treatment modality hasn’t been sufficiently proven. One suspects that expense, rather than patient welfare, is the real reason for refusal of coverage for many bone-marrow transplants.
We would suggest that prevention still has being given secondary attention in most sectors of the managerial culture, despite the rhetoric and verbal commitments. Furthermore, we propose that when an emphasis on prevention does occur, this shift in priorities might tend to reduce the anxiety of the managers, but it is not likely to reduce the anxiety of those who are receiving health care services. They are accustomed to treatment plans and dependency on health care professionals. Prevention requires a shift in responsibility back to the patient. This is not very reassuring for most patients. Thus, the rhetoric of prevention might not even be an effective marketing strategy.
Members of the managerial culture have also traditionally valued access. In the past, this emphasis on access helped reduce the anxiety experienced by both manager and clients. Managers could count the number of patients being served and take pride in the provision of maximum service at minimum cost. Citizens could feel assured that treatment was at hand if they needed it.
