Those who reside in the Managerial Culture sometimes lose touch with the real reason for engaging in the business of health care—especially if they work in an administrative setting. Many people from the management Culture, including accountants, information services technicians, insurance agents, and members of the human resource staff, have little direct contact with patients. A dominant concern for profit and lack of personal interaction with patients eventually leads to indifference about the primary customer (the patient) and the primary reason for the existence of the healthcare system (provision of medical services to treat illness and injury).
Activist Leader/Advocacy Culture
In recent years, some physician leaders have served not only as clinical directors or administrators in their healthcare system but also as reforming, activist leaders inside and outside their healthcare system. McKenna and Pugno (2006, p. 110) believe this role is not only quite appropriate but also all-too-infrequently engaged:
“Doctors have consistently been among the most trusted members of our society. In the Hippocratic Oath we as physicians swear to do our best to benefit the sick, do no intentional harm, and ensure our actions are never dictated by external motives. Even now in modern twenty-first-century medicine, this ancient code governs the approach to our most important and sacred vocation.
. . . [I]t is vitally important [that] we explore the possibility that the values outlined in Hippocrates’ writing describe our obligations not just as doctors, but [as] civic leaders. As caretakers for people of all backgrounds and social classes, we have been imbued with implicit rust from our patients. Suitable to this most intimate responsibility, we are regarded as trustworthy, independent, and fundamentally moral and ethical professionals. These traits are not only crucial to effective medical practice, they provide the foundation for effective leadership in virtually all arenas of human interaction.
In light of the similarities between successful medical practice and public leadership, it is unfortunate that there are so few doctors currently servicing [in governance positions.]”
It is instructive to note that while McKenna and Pugno challenge the assumption that clinical skills readily translate into administrative skills, they tend to support an assumption that values inherent in the Hippocratic Oath readily apply to a physician leader’s commitment to social activism. They suggest that is not only acceptable but even commendable that some physicians envision their role to be one of healing not only individual patients but also a sick and wounded society.
Physician leaders and others who reside in the Advocacy Culture serve as activists in response to problems they witness regarding the way healthcare is being delivered in contemporary healthcare systems. Achievement for these activists is to be found in successful healthcare reform. Those physicians who serve in the role must become knowledgeable about health care policies and regulations—so that they can successfully help advocate for reform of these policies and regulations. As advocates, these physician leaders must possess strong interpersonal and communication skills that enable them to be persuasive in promoting needed reform.
The attention of most physician leaders who serve in an activist role is directed toward individual rights. Physician activists and other representatives of the Advocacy Culture provide an invaluable role to the social systems they serve by seeking to ensure the equitable distribution of resources critical to the pursuit of health—or (more broadly) life, liberty, and the pursuit of happiness. Physician activists and other members of the Advocacy Culture find meaning primarily in establishing equitable and egalitarian policies and procedures regarding the distribution and use of healthcare resources within all societies.
