Mental health care is delivered by professionals. To be able to manage them, it is important for management to speak the professionals’ language and to have an understanding of the primary process. Of course, ‘general’ business skills are also crucial. Unfortunately, people who combine both sets of skills are rare. That’s why many organizations decide to appoint both a business manager (BM) and a medical manager (MM). Which of these two should be in charge?
Someone has to take ultimate responsibility…
Many organizations work with dual management. That can work well, if the two sides have a good relationship. But this can go wrong in some situations, such as when business optimizations are at odds with medical care provision. In this kind of situation, it’s important to evaluate the situation as a whole and this evaluation can only be carried out by one person. So it seems sensible not to set up a dual management system but to explicitly allocate ultimate responsibility to one person.
… and that one person with ultimate responsibility is the medical manager
In principle, it doesn’t matter who takes ultimate responsibility. As long as responsibilities can be delegated explicitly, it’s possible to cooperate effectively. So the question is: which is easier to delegate, responsibility for the primary process or business responsibility?
The results of many business responsibilities can be measured. Costs and income, for example, are hard outcomes, as are growth, absenteeism and staff satisfaction. There is also a great deal of consensus about these measures; acceptable levels of absenteeism and healthy margins are well-established. So business responsibility lends itself well to being delegated.
However, consensus about outcomes for medical care provision is much more difficult to delegate because as yet there is little consensus about the desired outcome. In many institutions the process of establishing outcomes has barely started, let alone that the targets have been clearly formulated. So success is not yet easy to measure. Which means that, at present, it is harder to delegate responsibility for the substance of medical care provision because it’s more difficult to hold the medical manager accountable for the results.
Of course another factor is that the primary process in mental health care is delivered by professionals. Which makes it very useful if the person with ultimate responsibility speaks their language and is also a professional.
At present it is most convenient to give ultimate responsibility to the medical manager who can then delegate a significant proportion of the business responsibility to a business manager.
Want to know more?Then read the extended version of this vision statement in Chapter 4.3 of our book for the mental health care sector 'Scherp aan de Wind' (currently available in Dutch only). Or Erik-Jan Vlieger:
T +31 (0) 6 55392678
E vlieger.erikjan@kpmgplexus.nl