Health management … what do I need to be a health manager?

I was asked by a reader of one of my recent posts, what I regarded as the ideal preparation to become a manager of health services? The question was posed by a medical student about to graduate as a doctor and it set me thinking what is the best preparation for entering the field of health management? Given my background and experience I will focus primarily on a management career in the public health service. So here are my thoughts …

I do not think that management of health services is the province of medical practitioners alone although for many years it was the case as evidenced by those who in the past managed either state or private healthcare in this country and elsewhere. An understanding of healthcare and the priorities that govern effective healthcare delivery are not the sole province of those trained and qualified as healthcare professionals and I am not of the view that this is an absolute requirement for those entering healthcare management.

In some ways being a health professional complicates the decisions required to effectively manage healthcare. As a doctor in clinical practice, I was ethically bound to put the interests of my patient above all others. As a health manager, I made decisions that affected the future of patients knowing that the decision could negatively affect the life of a particular individual but taken in a wider context benefit others. Adopting a utilitarian approach to decision-making assisted me in taking those difficult decisions. However, as with a consideration of the ethics of all decisions, the key is whether, if the unbeknown to you, the individual affected by that decision was a family member would the decision have been different?

There is a belief that management skills are generic and while there is truth in the statement, I firmly believe that experience in the health sector, be it financial or people management, logistics or as a health professional, is an essential prerequisite to enter the echelons of senior health management. An understanding of public health would assist a health manager to understand the complexities of healthcare but while a qualification in public health be it as a public health specialist, which is a qualification that requires a degree in medicine, or a post graduate qualification in public health would benefit a health manager, I would not see it as a prerequisite for success in healthcare management.

What then of a qualification in management of which the MBA has been for many years seen as the pinnacle of management training and has benefited business schools across the globe? The standard MBA, largely focused on the commercial world of the private sector, is in my opinion of limited value for an individual considering a career in healthcare management with many of the modules concentrating on aspects of the commercial world foreign to the health sector. Nevertheless, there are MBA offerings that focus on the healthcare sector and as a grounding for the aspirant health manager, this qualification has considerable merit. My concern with many of the courses within this spectrum is that they are often lead by people who have had little practical experience in managing a health care facility, let alone a larger healthcare organisation. Would we feel comfortable in an aircraft with the knowledge that the pilot had been trained by people who had never actually flown an aircraft? This may seem a harsh analysis but it is nevertheless an aspect of the MBA culture that requires attention.

In many other countries, managers of government healthcare services and indeed any management post in government service require a formal accredited training in management before they can be considered for a management position. It appears that in South Africa, the National School of Government (NSG) is intended to fulfil a similar role. While the NSG Vision statement of “An Ethical and Capable Public Sector in Service of the People” and the Mission statement “To Empower Public Servants to be Responsive to Citizen Needs and Government Priorities, through Education, Training and Development interventions” are noble in intent, a review of the contents website is less encouraging. The section allocated to “Leadership” provides information on various courses some in cooperation with various universities but none in my opinion focus on key practicalities of management and decision-making which are key to the effective management of health services. Certain NSG courses, such as “Project Khaedu” (Khaedu means Challenge in Tshi-Venda) which has been implemented for over a decade, are obligatory for those occupying management positions in the South African public service but in my opinion while having certain merit they do not sufficiently capacitate managers to face the multiple challenges they will confront in managing health services.

Noteworthy is a document released for public comment at the end of 2020, “A National Implementation Framework towards the Professionalisation of the Public Service”, which in somewhat turgid academic language wrestles with the concept of “professionalism” and reiterates statements many of which, from my recollection, were made over two decades ago in other government policy documents regarding the South African public service. The country examples quoted in the document reflect a distinct political and ideological bias, which in turn possibly mirrors the ideology of the government of the day. Sadly in my view both the curriculum of the NSG and the document to which I refer will not address many of the shortcomings evident in the management of healthcare in South Africa today.

So where does this leave the aspirant health manager of today wishing to pursue a career in health management particularly in view of the many challenges to be posed by the implementation of National Health Insurance (NHI) in South Africa at some time in the future? And what would be my advice?

Firstly, I would recommend that time spent in the health services either as a health professional or employed in another capacity within the health services is essential. Particularly, if one is not a health professional a postgraduate qualification in public health to provide an understanding of the field would be an advantage.

Secondly, consider the possibility of employment in a health facility in an administrative position to understand the workings and systems of administration in health whether in the public or private sector, given that there is a difference between the two.

Thirdly, once in a lower or middle management position, consider enrolling for an MBA or equivalent qualification focused on the health sector.

Finally, understand that you are entering an area of management that is in many ways one of the most challenging positions possible that will continue to test your resolve and commitment.

There are a number of retired senior managers, myself included, who would be prepared to add value to senior management courses and mentor newly appointed managers to avoid the pitfalls that we have experienced in our careers. Pilots who have indeed flown the aircraft! As someone at the end of my professional career, both clinical and managerial, I am available to advise and mentor those who embark on this challenging journey. It is a journey worth taking and with rewards in so many ways, not necessarily financial, but rather the knowledge that the work that you do improves the quality of life of so many others.