Professional Education For Tomorrow's Hospital Administrators
As Viewed By A Hospital Planner
Robert
M. Sigmond
One of the major problems of the areawide hospital planner
today is the misunderstanding of his function by almost everyone,
including professionally educated hospital administrators.
Most think that we are concerned with evolving an over-all
scheme of arrangement for hospitals in a metropolitan area
or region,
with each unit carefully interrelated with all the other units
in an aesthetic whole, which precludes duplication, overlapping
and gaps in service. The secure administrator favors this
type of planning, because he likes to know where the other
hospitals fit in the scheme. He is confident that he can convince
the planner to adapt the scheme of arrangement to meet his
own hospital's aspirations, if the planner lacked the wit
to reflect these aspirations in the first place. Less secure
administrators oppose this type of planning, because they
fear loss of self-determination.
Both reactions are wrong because they are based on a faulty
conception of areawide planning.
The hospital planner today is not concerned with a scheme
of arrangement, but with a scheme of action. Planning involves
visualizing the future, establishing goals and programs for
achieving goals, and continuous re-evaluation of goals and
of implementation programs. Planning avoids fitting individual
units into the strait jacket of an over-all scheme of arrangement.
Planning involves interrelating independently established
goals and implementation programs, so that they don't conflict
and cancel out.
Planning is an integral part of any activity that will be
changing over time. It is a process, not a technique. Since
hospitals are rapidly changing institutions, every hospital
administrator must be a planner.
The areawide planner helps the hospital administrator to plan;
he does not plan for him.
In a "scheme of arrangement" approach to planning,
all the key variables are converted to constants.
A "scheme of action" approach to planning avoids
the tendency to freeze the pattern and hold back
progress. A "scheme of action" approach helps the
hospital administrator to identify the key variables
and to deal with them in a realistic way.
For the hospital planner, the only constant is change. Tomorrow's
hospitals will be different from today's hospitals, with or
without a systematic planning process. With a successful planning
process the changes will be less surprising, less painful
and more closely related to valid professional objectives.
The planner is especially interested in any decisions which
must be made today but which will have lasting impact in the
years ahead, such as investment in buildings and in education
of personnel. If these decisions for the future are made in
relation to today's needs without consideration of the shape
of the future, the new buildings and personnel will probably
constitute a serious handicap to progress as the future unfolds.
Tomorrow's hospital administrator should be educated for leadership
in administration of tomorrow's hospital. But he must also
be prepared to help in administering today's hospital, and
in easing the transition from today's hospital to tomorrow.s
hospital.
Education for tomorrow's hospital administrator must be based
on visualization of tomorrow's hospital
and of the nature of the transition period ahead.
TOMORROW'S HOSPITALS: A PREDICTION BASED ON ANALYSIS
OF HISTORY
The hospital planner has a fairly effective tool
to predict the characteristics of tomorrow's hospitals, within
limits. This tool is historical analysis, which demonstrates
that the hospital is a dynamic institution that reflects changes
in the community and changes in medical technology, but with
a significant time lag. Because of this lag, the forces that
will shape tomorrow's hospitals are already at work today.
To visualize the future, all that is necessary is to identify
these forces and assess their impact.
This approach is much more accurate in predicting what will
happen than when specific changes will occur. Also, prediction
must be limited to general directions; the exact path cannot
be plotted, especially at individual institutions. But the
somewhat clouded crystal ball of historical analysis reveals
enough for purposes of a discussion of education for tomorrow's
hospital administrator.
HISTORICAL BREAKTHROUGHS
Historical analysis suggests that there have been
two major upheavals or breakthroughs in the characteristics
of the hospital as a community institution, and that a third
upheaval is about to take place. Professional hospital administrators
were not involved at all in the first two breakthroughs. In
fact, the birth
of the professional hospital administrator was one of the
predictable results of the second. The professional hospital
administrator has a key role to play in the impending third
breakthrough.
The first breakthrough occurred at the end of the nineteenth
century as the result of technological advances which made
it possible to control cross-infection, and which made the
hospital a safe place for care of the sick. Prior to this
time, the hospital was used only by the poor and the homeless,
and then only as a place of last resort. Sick people were
cared for at home, unless they had no home or had to be removed
from the community as public nuisances. Care in hospitals
was primarily custodial, and results were poor.
Those who supported the hospitals did not use them. Those
who used them did not pay for the service.
Physicians contributed their services out of humanity, and
for educational and research values.
With the development of aseptic technique, doctors began to
admit their private patients to the hospital. Treatment of
large numbers of sick people in single locations led to improved
powers of observation, new discoveries and new techniques,
specialization of labor and rapid advances in medical science
and technology. These advances, in turn, led to improved health
care and to a rapid rise in public expectation.
By the end of World War I, the hospital was recognized as
the doctors' workshop, in general use for rich
and poor alike. Patients paid the hospital for certain services
and their physician for other services, but
each physician was responsible for "his" patients.
The physician "ordered" services a la carte, and
his
orders were carried out. The hospitals were small, the services
relatively uncomplicated and problems of coordination were
relatively minimal. The need for a professional administrator
was not felt; the physicians administered their own cases.
MEDICAL KNOWLEDGE EXPLOSION
The second major breakthrough resulted from the growth of
specialized medical knowledge, which led to uncertainty about
the quality of care provided by the individual physician.
This uncertainty, in turn, led to the development of better
training of physicians, recognized medical specialists, and
recognition of the need to establish standards and controls
of medical practice within the hospital framework. Under the
auspices of the American College of Surgeons and the American
Medical Association, approval programs were established for
general hospitals, with highest standards for those training
interns and residents. The initiative for these developments
came from medical organizations, and the major emphasis was
properly placed on the hospital's medical staff as the primary
instrument to assure quality. But the approval programs applied
to the hospital as an institution, not to the medical staff.
The medical staff began to evolve from a loose professional
association to become an integral part of the administrative
structure of the hospital. The hospital began to emerge as
a professional health center, with institutional responsibility
for an identifiable, coordinated program of patient care services,
including control of quality, education and research.
The hospital continued to serve as the doctors' workshop as
in the past, but the basic focus was shifting to institutional
responsibility for the quality and scope of services. Coordination
became much more difficult, and professional administration
was needed and eventually was born. The beginning of the transformation
of the hospital from a doctors workshop to a professional
service center can be dated from approximately 1918, the first
year of the approval program of the American College of Surgeons.
Professional administration did not begin to emerge as a dominant
force until two or three decades later.
CRITICAL TRANSITION
The primary task of the professional administrator
to date can be viewed as helping to bring about this transition
from primary focus as a doctors' workshop to a professional
service center. In most hospitals today, this transition is
by no means completed or thoroughly understood and accepted
by all physicians
or the general public. This breakthrough has involved primary
emphasis on quality of care, on coordination to produce and
control quality, and on involvement with education and research
programs. At the most developed hospitals, this transition
established the dominance of hospital-practice-oriented physicians,
primarily specialists, over community-office-practice-oriented
physicians, primarily general practitioners.
This development was accompanied by increasing complexity
and effectiveness of hospital services, ever greater emphasis
on diagnosis and treatment as contrasted with custody and
personal care, increased specialization, ever more complicated
mechanisms of internal coordination and control and rapid
withdrawal from community involvement. The focus of the professional
hospital administrator, especially in the metropolitan area,
where he was likely to be found was internal, not external.
His hospital world was extremely complex, a world of its own.
Costs rose rapidly, and became a major concern of the hospital
administrator. High utilization of income-producing resources
became the key focus of financial planning.
The goals of the professional hospital administrator are usually
expressed in terms of high quality patient care, broad scope
of service, a well-functioning team of chiefs of service and
department heads identified
with the institution and financial stability.
The third major breakthrough in the role of the hospital in
relation to the community is just ahead. It will result from
the increasing concentration of an ever higher proportion
of the community's ever more complex health resources in the
hospital. The hospital as the professional service center
has become the key factor in community health and cannot much
longer escape the consequences. Since its activities largely
determine the level of community health, it must broaden its
goals to embrace not only better care for patients, but optimum
health services for people. The hospital is about to be transformed
from a professional health service center to a community health
service center. As this added goal gradually moves into top
priority position in the years ahead, hospital organization,
service and administration will undergo dramatic changes.
THE PRIMARY HOSPITAL GOAL
Although hospital planning is primarily an individual
hospital process, the initial identification of optimum health
services as the primary hospital goal originated with groups
outside the hospital interested in planning for a multi-hospital
area. Areawide planning was applied in only a very few places,
notably New York City, before it was adopted as national policy
in 1946 with the passage of the federal Hill-Burton legislation.
In order to obtain Hill-Burton funds for hospital construction,
each state was required to prepare a state-wide plan on an
area basis, setting forth a coordinated network of base, intermediate,
and district hospitals and public health centers. The goal
was optimum health care for the people, and the underlying
assumption was that the hospital should serve as the focus
of all community health services.
Almost from the beginning, however, Hill-Burton state plans
were used primarily as a set of formulae for distributing
limited federal funds to individual hospitals on an objective
basis. The underlying goal of optimum health services was
side-tracked.
A resurgence of interest in areawide planning within the past
ten years has centered around its potential as a cost control
mechanism. Within the past few years, however, there is evidence
that the rapidly growing areawide planning agencies, now being
systematically subsidized by federal funds, are beginning
to re-define their goals in terms of optimum health services
for people.
FRAGMENTED PATIENT CARE
The individual hospital has tended to view optimum
health services for people as an inevitable consequence of
fulfillment of other hospital goals, rather than as a primary
goal in itself. There is little evidence, however, that pursuit
of individual hospital goals automatically results in optimum
health services for the people. Increasing evidence suggests
the opposite. As patient care has become better and better
because of its increased specialization and mechanization,
it also has become more and more fragmented and, in effect,
less and less available to the individual. The people in need
of care have greater and greater difficulty in making contact
with this complex system so as to find their way to the right
place at the right time.
This may be the reason why basic health indices in this country,
such as the infant mortality rate, which were improving rapidly
for many years, are now leveling off and at worse levels than
in some other countries with more orderly (though possibly
less innovative) distributive systems of medical care.
In most hospitals today, there is no knowledge of community-based
health indices. No one is assigned responsibility for knowing;
no one seems to care. It almost appears that hospital officials
expect the people to serve the hospitals (by generating a
flow of patients) rather than the hospitals to serve the people.
HOSPITAL ADMINISTRATION
Hospitals have tended to concentrate more and more
on the productive processes and have increasingly neglected
or overlooked the distributive processes of health care. Needs
are thought of in terms of patients, rather than of people.
The common view seems to be, "If our hospital provides
the best patient care, the people will come here when they
are in need ... other hospitals will be striving for this
same objective, but
our hospital will be best ... this competitive quest for excellence
will provide the community with optimum health care."
As a consequence of this approach, most hospitals couldn't
care less about community needs, as distinct from needs of
their patients, and their service programs. The very best
hospitals are most divorced from community needs, despite
(or because of) their concentration on the newest features
of high quality patient care. To these hospitals, community
service is a euphemism for service to the poor, although the
poor, hopefully, are becoming smaller and smaller segments
of most communities. Increasingly, in hospital
circles "community hospital" is a belittling term,
a term of derision, describing a hospital that is not in
tune with the times.
PEOPLE AND THEIR TOTAL NEEDS
As the hospitals have simultaneously become the chief
community health resource, while avoiding direct identification
with community needs, conditions have been created that require
another major shift in the goals of individual hospitals.
The new emphasis will be on optimum health services for people.
The new focus on people and their total needs will be much
broader than the current focus on patients and their care.
Patients will be recognized as special cases (albeit very
special cases) of people. The focus will be on people, and
on delivering comprehensive health care services of high quality,
convenient availability, and lowest possible cost. The pressure
for a shift in goals will come from hospital planning associations,
government, prepayment agencies, knowledgeable spokesmen for
consumer groups, hospital associations, individual hospital
leaders, and individual physicians.
Already, the Board of Directors of the American Hospital Association
has issued a Statement on Optimum Health Services, which concludes
that:
The hospital, with its medical staff, is now the major health
resource in most communities. To meet the expanded responsibilities
of this position, it is essential that it widen its concerns
to include the totality of health services and, with others,
to provide leadership in their attainment. The hospital should
be prepared to assume a primary position in the implementation
of community health plans. Each hospital, then, through its
governing body, medical staff, and administrator, has a clear
mandate continuously to examine its organization and facilities
in the light of this central role in coordinating the principles
of optimum
health services.
DEFINITION OF OPTIMUM HEALTH SERVICES
The American Hospital Association has provided the most authoritative
definition of optimum health services to date, identifying
six characteristics: (1) a team approach to care of the individual
under the leadership of the physician; (2) a spectrum of services,
including diagnosis, treatment, rehabilitation, education
and prevention; (3) a coordinated community and regional system;
(4) continuity between hospital and non-hospital aspects of
patient care; (5) continuity between hospital in-patient and
out-patient services; and (6) continuing programs of evaluation
and research in quality and adequacy in meeting the needs
of the patient and the community.
Of these six characteristics of optimum health services, the
third merits quotation in full in a paper by an areawide planner:
(3) A coordinated community and/or regional system that incorporates
the full spectrum of health services, and provides for coordination
of care from the time of the patient's primary contact with
the system through the community hospital to the university
hospital and/or medical center and other health agencies.
Each should provide the portion of the total spectrum of health
services that is feasible in terms of the type of community
it serves and the over-all pattern of health facilities of
the region in which it exists.
Evaluation of almost any hospital's program in terms of the
AHA Statement on Optimum Health Services is a most shattering
experience. Only a handful of hospitals can measure up. The
situation is comparable to that which faced hospitals comparable
to that which faced hospitals when the Standardization Program
of the American College of Surgeons was first tested in 1918.
In both situations, a new set of standards, logical beyond
dispute and required by a new set of conditions, defines a
crisis situation for hospitals.
Since most hospital officials and public representatives are
not aware of the wide gap between optimum health services
and the existing programs of the hospitals, no crisis exists
as yet. But the crisis is
fast approaching.
Most hospital officials and physicians can be expected to
have great difficulty in applying the AHA Statement on Optimum
Health Services to a specific institution. The broad concepts
of optimum health: services are not easily understood, and
are therefore not yet taken seriously. The American Hospital
Association and other groups now face the task of translating
the broad concepts of optimum health services into a series
of specifics which will be understandable and useful to hospital
officials, including leaders of the medical staffs, in redefinition
of hospital goals.
MULTI-HOSPITAL GROUP
One point is clear. Except in very unusual circumstances,
a single hospital by itself cannot be expected to provide
optimum health services. Coordination with other institutions
is required. Each hospital if it wishes to provide optimum
health services must become a part of a multi-hospital group
or system. This conclusion is equally applicable to the medical
school teaching hospital, to the large non-affiliated teaching
hospital with approved intern and residency training programs,
and to the small community hospital. If the goals of each
of these different kinds of hospitals is to be related to
optimum health services, each of these, but especially the
teaching hospitals, must join forces with other institutions.
Common management may be desirable in this situation, but
is not as important as a common point of view.
Tomorrow's hospital will be a unit in a multi-hospital network
that assumes responsibility for delivering a full range of
coordinated health services to a defined population. The term
"hospital care" will be in the process
of disappearing from the language as lacking in meaning. Health
care services will be provided under the hospital's roof and
elsewhere; all health care services will be related in one
way or another, to the hospital and its medical staff. The
double standard, with respect to quality of patient care in
and out of the hospital, will be disappearing. The hospital
will be equally concerned with the quality of the care received
by patients before entering the hospital, during their stay
in the institution, and after leaving it. The hospital will
be at least as concerned with distributive processes as with
productive processes.
The hospital "room and board" services will be identified
as the true ancillary services, ancillary to the diagnostic,
treatment and rehabilitative in-patient and out-patient services
that will make up the basic services of the hospital.
The hospital will be concerned not only with getting the patients
out of hospital beds, but with keeping them out. Relationships
with health departments and with other health and welfare
agencies will be much more intimate and time-consuming. Many
hospitals will assume landlord relationships with these other
agencies.
THREE TYPES OF HOSPITALS
In the coordinated network of facilities that will
be evolving, three distinct types of hospitals will emerge
and establish identity (although there will be many healthy
mongrel specimens):
(a) A large number of hospitals will be identified with a
specific community, and will concentrate on distributive processes.
These community hospitals will place major emphasis on prevention,
early diagnosis and treatment, and on affiliation arrangements
with other institutions for more complicated procedures and
educational programs.
(b) A smaller number of large regional hospitals will have
more comprehensive service programs and a secondary affiliation
with a medical school complex. These regional hospitals will
provide service to a
group of community hospitals in the region with which they
will maintain close working relationships.
(c ) A still smaller number of hospitals will have primary
medical school affiliations, a major commitment to education
and research, and will provide the most complex services.
These medical school hospitals will develop working relationships
with the regional hospitals to assure optimum health services
in their areas of influence. At the medical school hospitals,
major emphasis will be on productive processes.
Some of these multiple hospital systems or complexes may evolve
through merger under single management. In most cases, however,
autonomy of the individual institution will be preserved.
The system will function by a series of more or less formal
affiliation agreements, involving joint
medical staff appointments, cost sharing, joint trustee committees,
etc.
Although the over-all goals at all three levels will be identical
optimum health services, each will tend to place greater or
lesser emphasis on productive and distributive processes.
Each will be dependent on the others, however, and autonomy
for each institution will necessitate invention of formal
mechanisms for resolving constructive conflict among the different
units.
Greatest challenge will face the large regional hospital.
Lacking both a specific community identification and a dependent
medical school, its very identity will be vitally related
to the coordinated system itself.
TOMORROW'S HOSPITAL ADMINISTRATOR
Tomorrow's hospital administrator will find himself
increasingly projected outward into the community and community
affairs. Those who are not prepared for this shift in emphasis
will probably just be ejected out.
The administrator's primary interest will be in (a) ascertaining
community needs, identifying and becoming acquainted with
spokesmen of community and consumer interests as well as other
health interests, and
(b) adapting the hospital's program to community needs and
resources in order to achieve optimum health services for
the people.
Consumer representatives who still visualize solutions to
health problems in terms of improved financing programs will
be increasingly aware that the basic solutions involve improvement
in organizational arrangements. Consumer representatives will
be more knowledgeable. There will be more of them, including
new types. Direct spokesmen for low income groups, other than
labor union, welfare agency and government spokesmen, are
beginning to emerge. Failure to recognize this development
may project hospital administrators into the headlines, receiving
the same treatment as Kerr, Gross, and Willis have received
in the field of educational administration.
In the transition to tomorrow's hospitals, the professional
hospital administrator will strive to pursue professional
objectives without getting caught in the crossfire of conflicting
interests of consumers and producers of health care services.
This role will be easier to handle if the composition and
attitudes of hospital boards of trustees shift to reflect
valid consumer interests more adequately; also, if key medical
staff members are encouraged to view their valid specialized
interests in a broad framework of
optimum health services.
CHANGING THE FOCUS
Tomorrow's hospital administrator will need to be especially
sensitive to the many opportunities for fatal errors of judgment
in any period of rapid transition. It will be most difficult
to turn the focus of a hospital out toward the community until
the hospital has established identity as a professional service
center, dedicated to quality and to institutional medical
care objectives. Development of professional institutional
identity has involved a turning-away from the community, a
loosening of the influence of community physicians who have
expected the goals of the institution to be identified with
their private practice, rather than vice versa. If an effort
is made to turn the institution outward to the community before
there is a strong nucleus of institutional commitment, the
result may be retrogressive, should those interested in nothing
more than a doctor's workshop regain ascendancy and control.
In most institutions, hopefully, potential conflicts among
institutionally-oriented physicians and private practice-oriented
physicians can be resolved in terms of a common interest in
optimum health services for people. Professional administrators
will need to encourage more formal and informal involvement
of medical staff in broad policy-making and administration,
ever sensitive to the delicate balance among various points
of view on the medical staff.
An important function of the professional hospital administrator
will be to arrange for exposure of consumer and medical spokesmen
to each others points of view. In general, consumer representatives
will be more than happy to leave the initiative with health
professionals if they feel that the health professionals are
sensitive to consumer interests and objectives.
PROFESSIONAL EDUCATION FOR TOMORROW'S HOSPITAL ADMINISTRATION
The issue that has been traditionally posed for the
Graduate Programs in Hospital Administration is "institutional
management emphasis or medical care, patient care emphasis."
The issue for the future is emphasis on management of a patient
care institution or management of an institution for optimum
health services for people, including patient care services.
Like university administration, hospital administration involves
certain basic institutional responsibilities: housekeeping
and plant maintenance, feeding, record keeping, budgeting.
The complexities of internal management are reasonably well
known. The additional knowledge required by tomorrow's hospital
administrator grows out of the added responsibility to the
community and to the health professions to
assist in the provision of optimum health services for people.
AREAS OF CONCERN
This added knowledge involves three general areas. First,
tomorrow's hospital administrator needs systematic knowledge
about the community: community organization and process, community
patterns of health services, community based health care indices.
Second, he needs to be well grounded in the characteristics
of personal health care: the elements of comprehensive health
care, the changing doctor patient relationship, methods of
organizing and financing health services, characteristics
of health manpower with special emphasis on physicians. In
particular, he should be knowledgeable about the history of
personal and public health services throughout the United
States as well as in foreign countries. Third, tomorrow's
hospital administrator should be knowledgeable about the new
field of change process as it is evolving in the study of
community organization, administrative science, behavioral
sciences, and other
interdisciplinary groups.
Professional education must be concerned with attitudes and
behavior as well as skills and knowledge. I must admit that
my confidence in the ability of educators to transfer knowledge
is greater than any confidence in their ability to improve
or change attitudes, behavior and even skills.
Presumably, men and women best qualified to administer tomorrow's
hospitals will be produced by some combination of (a) a sound
selection process, (b) a well balanced curriculum, and (c)
a well supervised field training experience or residency.
THE SELECTION PROCESS
Of these three aspects of a professional education
program, the selection process is probably the most crucial.
Hopefully, educators have devised reasonably reliable techniques
for identifying a superior group by weeding out those who
lack necessary basic attitudes and qualities: intelligence,
honesty, idealism, and commitment to lifetime learning. If
the selection process can be initiated two or more years prior
to selection, it should be possible to attract superior candidates
for entering classes with tested skills and a demonstrated
ability to absorb desirable knowledge. It seems desirable
that every student have some sort of hospital placement (if
only summer employment as an orderly) prior to starting the
graduate program. The admissions committee should be in a
position not only to suggest hospital placement, but to arrange
such placement in a supervised setting. In addition, if the
admissions procedure starts early enough, it should be possible
in many cases to guide the undergraduate program. Sound grounding
in administration, economics, statistics, accounting, behavioral
and biological sciences prior to graduate school will free
class hours for thorough coverage and deeper probing in more
specialized subject matter.
The selection process should also involve active and continuous
seeking for candidates from among mature, experienced and
talented workers in the fields of health and community organization.
With these individuals, too, the selection process should
be unhurried and viewed as a productive period in itself.
The curriculum in a one-year graduate program should concentrate
as much as possible on change process, community organization,
government, and organization and financing of optimum health
services, with special emphasis on manpower and international
developments in health service.
The residency period seems to me to be a most important phase
of the education program. As I see it, the residency should
be lengthened, and more closely supervised by the university
program. A significant proportion of the residency should
be spent at a first-class hospital, but the majority of the
time should probably be spent outside of the hospital at such
locations as a hospital planning agency, a hospital association,
a labor health program, a governmental agency, a prepayment
program, etc. In all likelihood, much more adequately compensated
second, third and fourth year residencies should be developed,
permitting identifiable specialization in administration of
medical school hospitals, regional hospitals, community hospitals,
entire hospital systems, prepayment plans, planning agencies,
etc. Finally, top hospitals should be encouraged to provide
administrative staff sabbaticals, and the equivalent of Nieman
Fellowships should be provided by some foundation to enable
a few promising graduates of programs to return to school
after eight to ten years of experience for preparation for
national leadership. Presence of a few such individuals at
each school would also be most stimulating to the students
as a supplement to interaction with the faculty.
ASSOCIATION TIES
In
the absence of some experienced students, the graduate program
is well advised to develop a close geographical affiliation
with a hospital association, following the example of the
Pitt program and the Hospital Council of Western Pennsylvania.
Such close affiliations can become the basis for a program
of community service by the graduate program, with the important
by-product of helping to keep the faculty in touch
with reality.
Almost
all of the graduate programs are now associated with universities
with medical schools and medical school hospitals. Eventually,
as the university's medical school hospital complex develops
a network of services dedicated to optimum health services
for an area, the university's graduate program in hospital
administration should develop an affiliation with it and concentrate
its residencies in the many hospitals
in the complex.
Continuing
education and tests for residency preceptors appears to be
an essential element of a sound program of professional education.
Preceptors should be discouraged from using the rotating residency
approach and should substitute the "alter ego" approach.
Those who are not comfortable with an alter
ego should be weeded out.
Professional
education along these lines would help each graduate to be
an effective planner in whatever setting he finds himself.
Those with special interest in planning could take their residencies
in planning agencies and find many opportunities for careers
in the planning field.
The
doer and the planner are closely related. One works from the
present to the future; the other from the future back to the
present.
The
doer concentrates on the decisions that must be made to solve
day-to-day operating problems, but
with a keen sense of the future implications of alternative
decisions.
The
planner concentrates on the shape of the future and what must
be done currently to bring about a desirable future.
The
ideal administrator is neither one nor the other, but rather
a proper mixture of the two.
This
paper is adapted from a talk which the author presented at
the Tenth Anniversary Institute of the Program and Bureau
of Hospital Administration, University of Michigan, Ann Arbor,
on June 3, 1965. His talk was one of a series in which professional
education for tomorrow's hospital administrators was analyzed
from a number of different viewpoints: a hospital administrator,
an educator, a physician, and a hospital planner. As in the
other papers, Mr. Sigmond's analysis of professional education
is preceded by a statement of the viewpoint of the planner.
For
a more detailed discussion of the hospital planning process
see Sigmond, R. M., "The Hospital Planning Process and
the Community," in Areawide Planning, Report of the First
National Conference on Areawide Health Facilities Planning,
Chicago: American Medical Association, 1965, pp. 100-12.