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Nondegree business education program may be answer.

Nondegree Business Education Program May Be Answer

Not long ago, in a time of charge-based reimbursement and before the beginning of serious competition, the health care industry was truly different from other business sectors. This no longer applies and should not be permitted to act as a reason for not operating a health organization using sound business principles. Besides the growing competition among providers, based on service, price, quality of care, and ability to market, techniques from industry can be adapted to health care to increase production efficiency. Berwick has written about a different approach to quality improvement using techniques developed in industry. [2] The fact that the most common third degree reported in the Grebenschikoff survey was the MBA may reflect the new perception that learning business principles and techniques is important to management success in health care.

I received my "third degree," a master's degree in public health, in 1968, at a time when relatively few physicians were involved in management. My degree program provided no business management insight. Like many physicians who finished training at that time, I gained management education primarily through experience, except for an occasional management course. Thus, when I discussed my own career development in early 1988 with my superior, I asked about how one might gain some concentrated knowledge about business administration without taking one or two years off for a degree program.

To my great pleasure, despite the intense competitive and financial pressure on my organization of the time, I was invited to consider business administration programs offered at Stanford and Harvard for senior-level managers. The courses lasted from several weeks to months. Subsequently, my company supported my application to the Harvard Business School, and I was accepted to the 12-week 104th Advanced Management Program beginning in the spring of 1988.

The program, which was begun during WWII, is directed at developing skills of the general manager in companies grossing one half billion dollars of revenue per year. It is a full-time educational activity, with students living in a dormitory on the campus of the business school. The class, 161 strong, was chosen so that one half came from the United States and the rest from 16 countries around the world. All students held positions of major responsibility in their companies, and all were considered by their companies to be candidates for further major responsibility. The course was not directed in any way toward health care, and there were only four physicians in the class.

Teaching was provided by several full professors from the business school, whose only academic responsibility for the period was the program. The case method was used, with little lecturing. During the course, we studied approximately 160 individual business situations (cases), all taken from real life and all with one or more "take away" messages to be mined. Brought up on the didactic method of teaching, with lectures to be memorized and regurgitated, I found it very difficult early on to get the main point of the case, and often discovered myself adrift in detailed and irrelevant study of an incredible array of companies that, among other things, manufactured and repaired elevators, sold irrigation pipe, or manufactured automobiles.

The professors were the best group of teachers to which I have been exposed. Each was appropriately eccentric, and all had mastered the case method thoroughly, dragging discussion and then controversy out of a class that, for all its outward good manners and courtesy, loved to argue and disagree. When the professors did lecture, they were usually brilliant, combining encyclopedic knowledge of their subjects with a love of good theater.

The students represented a most diverse group of achievers. The average age age was the late 40s and all had significant positions of responsibility and wide business experience. They had been sent to Harvard to gain skills as general business managers and to network with other business people from around the world. Some of the largest banks in the world were represented, as well as companies manufacturing snowmobiles and individuals working for the governments of Australia, New Zealand, Boston, Hong Kong, and Peking. Fourteen came from England, 10 from Japan, and 5 from Communist China.

We were divided into groups of eight, with each student having a tiny bedroom and bath and the group sharing a large living and conference room. Significant amounts of extra class time were intended for group interaction, with each group made up of 4 Americans and 4 foreign nationals. My group consisted of a Scot, a Frenchman, a South African, a Japanese, and 4 Americans. One student had a PhD in nuclear physics, another only one year of college. We were advised that we had been grouped by occupation so that we could bring different perspectives to problem solving. My group was made up of a lawyer, a physicist and ex-submariner, a factory manager, an accountant, a regional manager for a major English beer retailer, a manager for a fabric manufacturer, a scrap metal importer, and myself.

Three case studies given daily, as well as additional reading and guest lecturers, were more work than anyone could cover alone. Our group began meeting every night after dinner for study sessions that would last until 12 or 1 a.m. We would assign ourselves cases on the basis of interest or prior knowledge. Weekends and the little off time we had were usually spent together, dining and moving about Boston.

The group became, for me, an away from home family and a small consulting firm. We helped each other understand cases and tried to develop solutions to the problems in the cases. Our widely differing educational and business backgrounds and temperaments and varying ability to use English required us to work hard to fit together. Teamwork was essential. While my group grew together to an extraordinary degree, that was not the case with all other groups, where personalities led to clashes and intragroup hostility.

The educational experience was derived from interaction with the 8-person group, the three regular classes per day, guest lecturers, and one's own study. In many cases, the students provided much of the teaching, using their own knowledge and experience. The experience was very different from my college or medical school education, where there was much more direct teaching from the professors and quiet acceptance from the students.

Learning from fellow students was also facilitated by a one-hour informal conference starting each day. Groups composed of eight students met, with the composition of groups rotating every 4 days. This provided exposure to the majority of the class, enabling discussions about jobs, salaries, and cultures.

Students were generally on their best behavior, with great courtesy shown at all time. However, problems inevitably arose, adding to the richness of the educational experience. Because of the emphasis on Japanese business success, the constant comparison between Japanese success and American and other Western country failure in international competition caused some friction to develop. Also, there were only four women in the class, and issues around what was perceived to be latent sexism arose.

The easiest way to understand the educational process is to consider that we were a group of family practice generalists, trained in different countries, being provided a period of mini courses by subspecialists. However, this analogy cannot be carried too far, given the diversity of backgrounds and the fact that many students were actually specialists themselves. The curriculum included discrete business areas such as finance, marketing, and information systems, as well as the procedures necessary to develop effective corporate strategies using these disciplines. During the latter part of the course, the program went beyond internal corporate matters to the global environment and finally ended by concentrating on the responsibilities of the chief executive officer.

This was my first formal exposure to subjects such as marketing, financial management, and accounting. While the exposure was too short for development of competence, it did provide some familiarity. The integration of the disciplines into an understanding of corporate strategy development was especially valuable.

Because health care is not an international business (yet), much of what was taught about the global economy was not directly relevant to my day-to-day tasks. However, the study of how Japanese industry developed and sustains techniques for quality improvement has led me to look at using some of these techniques in my own health care company.

We spent much of the time discussing individual leadership, and I thought a great deal about my own management techniques and how I might improve them. Perhaps the most important issue coming out of this part of the course for me was how to develop from an organizational administrator to a business leader.

Given the fact that the course cost more than $30,000 and 3 months of my time, the question of what the ultimate value is for such an educational experience for both my organization and myself needs continued consideration. Some have described the course as providing, at the very least, the confidence to the student and the Harvard Business School on his or her resume. There is much more, however.

This is a consciousness-expanding experience. It can provide the physician manager with an extraordinary opportunity, in a very short but concentrated period, to see the basics corporate business and the development of corporate strategy, on a company and industry level. It also provides the opportunity to meet a very unusual group of business people with whom one can continue to interact after the program is finished.

Translating the experience into benefit for one's self and one's company is something that is, of course, left to the individual. Classmates have given me widely differing opinions as to what effect the course has had on their day-to-day behavior in the workplace. In my own case, besides greater sensitivity to shortcomings in my management style, I gained insight into technical kinds of activities, such as learning to better read and understand a balance sheet, and also into understanding how companies should be reviewing their competition in the marketplace. The cooperation of my colleagues in solving problems every might showed me how interdisciplinary teamwork can provide much better understanding and solutions to problems. This regard for the knowledge and experience of others who are not health care professionals is crucial for the success of physician executives in the business of providing health care through organizations rather than through the care of individual patients. I find it much easier now to play the role of the physician professional with others trained in business disciplines.

I would urge those physician managers who would like some concentrated business education to consider courses such as the Harvard program. Besides gaining the benefits noted above, they will also find themselves "alumni," assuring themselves of receiving all the mail of a graduate and all the opportunities for alumni contributions.


[1.] Grebenschikoff, J., and Kirschman, D.

"Getting the Third Degree." Physician

Executive 15(2):27-28, March-April 1989.

[2.] Berwick, D. "Continuous Improvement as

an Ideal in Health Care." New England

Journal of Medicine 320(1):53-6, Jan. 12,

COPYRIGHT 1991 American College of Physician Executives
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Title Annotation:short-term business management programs offered by universities provide education to executives without obtaining any degree
Author:Berman, Joseph I.
Publication:Physician Executive
Date:Jan 1, 1991
Previous Article:Controlling group medical costs.
Next Article:Excellence in Ambulatory Care: A Practical Guide to Developing Effective Quality Assurance Programs.

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