Members of the Managerial Culture have traditionally valued access. In the past, this emphasis on access helped reduce the anxiety experienced by both managers and clients. Managers could count the number of patients being served and take pride in the provision of maximum service at minimum cost. Some physicians aligned themselves with this commitment to lowering costs. They joined with some healthcare administrators (and many members of the Advocacy and Alternative cultures) in expressing concern about healthcare inaccessibility for some community members because of healthcare costs. They wanted citizens to feel assured that treatment was available if they needed it. Support was given to governmental subsidies, work-based health insurance plans, and the role played by nonprofit (philanthropic) low-cost health care services.
Today, this assurance is no longer warranted. Americans can no longer trust that they will receive adequate treatment—unless they are wealthy. Healthcare managers (including physician leaders) can no longer feel comfortable counting the number of patients served. They now must take costs more fully into account. This often leads to a dramatic reduction in the amount of time spent by physicians with each patient. Those physician leaders who are serving in an executive role are caught in the crossfire between the management of costs and the provision of high-quality and caring patient services.
Accountability is also valued by the Managerial Culture. This emphasis is intended to reduce anxiety for both managers and clients. It is also intended to reduce the anxiety of physician leaders who are trying to serve as managers and stewards of their organization’s resources. Taken to the extreme, this emphasis on accountability can produce a bean-counter mentality—something that most physicians detest. Furthermore, for many members of the Managerial Culture, accountability primarily relates to another managerial value, namely profit. This is a value that most physicians even more virulently detest.
One of McKenna and Pugno’s (2006, p. 243) physician leaders stated this about doing the “right thing”:
“Is leadership about doing things? It’s about doing the right thing. . . .My advice to those who aspire to be leaders is this: Do what you can with the gifts that you have and do things for the right reasons.” (Gary Morsch, MD, Family and Emergency Medicine Physician, U.S. Army Reserves, Found, Heart to Heart International).
For those trained to care for patients, the “right thing” has much more to do with the quality of medical treatment than making a profit. On the other hand, profits are required to keep most contemporary healthcare systems in business. Once again, the executive role and executive perspective lead us back to career survival.
In sum, this emphasis on profit and efficiency is intended to reduce only the anxiety of those aligned with the perspective, practices and values of the Managerial Culture. Patients typically care very little about profit. They often even take great offense when they discover that their illness, injury or health is a source of profit for another person or institution. Most physicians have traditionally lined up with their patients rather than those in the Managerial Culture (who traditionally have resided outside the clinical setting). Unfortunately, the Managerial Culture’s emphasis on profit creates a climate of indifference when taken to an extreme.
