Managing the Myths
of Health Care
Henry Mintzberg
June 9, 2011
International Economic Forum of the Americas
-1© H. Mintzberg.
Some Myths of Management
 Myths abound in management—managers on
“top,” “leadership” apart, “Shareholder Value”
maximizing shareholder value, strategy
formulated on the top to be implemented by
everyone else, “if you can’t measure it, you
can’t manage it”, etc.
 Myths abound in health care too.
 Combined, they can be especially destructive.
-2© H. Mintzberg.
Some Myths
of Health Care
-3© H. Mintzberg.
Myth # 1:
We have a system of health care.
Mostly we have a collection of disease
cures, or at least interventions, and the
more acute the better.
-4© H. Mintzberg.
Myth # 2:
This system of health care is dreadfully
complicated.
The technical and professional aspects
are surprisingly simple; the
complications arise when they are
embedded in the social, managerial, and
political systems.
-5© H. Mintzberg.
Myth # 3:
This system is failing.
Perhaps it is succeeding, expensively.
-6© H. Mintzberg.
Canada has the worst health care
system in the world.
… except for all the alternatives.
-7© H. Mintzberg.
Myth # 4a:
The health care system can be fixed by
clever, central social engineering.
Much of the effective change flows out
of the operations, not down into them.
-8© H. Mintzberg.
Myth # 4b:
Health care institutions can be fixed
by bringing in the great leader.
Maybe they need more
“communityship” and a different
kind of leadership.
-9© H. Mintzberg.
Myth # 4c:
The health care system can be fixed by
more competition.
Maybe there is too much competition,
and the need is for more cooperation.
- 10 © H. Mintzberg.
Myths # 5 & 6:
Health care is rightly left to the private
sector, for the sake of efficiency.
Health care is rightly controlled by the
public sector, for the sake of equality.
Where is the social sector—for the sake
of quality?
- 11 © H. Mintzberg.
Myth # 7:
No matters which sector delivers the
services, business provides the model
for managing health care.
The field of health care is a calling, not
a business.
- 12 © H. Mintzberg.
Myth # 8:
Measurement, “evidence-based”, must
underlie all progress.
Measurement is fine so long as it
doesn’t mesmerize; the trouble is that
it so often does, as does scale.
- 13 © H. Mintzberg.
Reframing Health Care as a System
Reframing Organization:
beyond hierarchy
Reframing Management:
as distributed
Reframing Strategy:
as venturing
Reframing managerial style: as care, not cure
Reframing the system:
as cooperative
- 14 © H. Mintzberg.
The Gap
Administration
Gap
Operations
Applies at the
system
regional
institutional levels
- 15 © H. Mintzberg.
My Big Issues of Health Care
 The Gap Issue: How to bring the administration closer to the
operations, connecting it for support beyond control?
 The Collaboration Issue: How to get the different parts of health
care working in greater cooperative harmony?
 The Engagement Issue: How to enhance engagement through the
promotion of human scale and not just economic scale?
 The Sector Issue: What is the role of the social sector (not-forprofits”, “NGOs”, etc.) that sit between the now dominant public
and private sectors?
 The Performance Issue: How to balance the needs for efficiency,
equality, and quality?
- 16 © H. Mintzberg.
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