Managing the myths of health care : bridging the separations between care, cure, control and community

Mintzberg begins in part 1 by confronting myths about health care, including the following:* We have a system of health care.* Health-care institutions can be fixed with more heroic leadership.* The health-care system can be fixed by more administrative engineering.* The health-care system can be fixed by more categorizing and commodifying to facilitate more calculating.* The health-care system can be fixed with increased competition.* Health-care organizations can be fixed by running them more like businesses. Part 2 examines how health care is organized, in relation to what we know about differentiation, separation, and integration in organizations and systems in general. Mintzberg shows that in health care, the inclination has been to do an awful lot more differentiating than integrating. This has resulted in all sorts of excessive separations: curtains across the specialties, sheets over the patients, and walls and floors between the administrators. The favored form of organizing health care-the professional organization-is the source of its great strength as well as its debilitating weakness. Part 3 then offers guidelines to reframe the core components of health care: strategy, organization, scale, ownership, management, and the "system" itself. For example, managing has to be about care more than cure, and organizing has to favor communityship over leadership, collaboration over competition.