( 1992 Quentin Bristow)

[A light-hearted look at the future in health care, as outlined in an inaugural address by a new CEO to the staff of a Canadian hospital in the new millennium]

"I have asked you to come here this morning to share with you my thoughts and perceptions on the way this hospital is now being run, and the concept that I have as the new chief executive officer for the future management style. As you are aware, before coming here I was Dean of the management studies faculty at the prestigious Harris-Klein College of Business Administration and the first thing that I noticed when I arrived here was the dangerously high ratio of specialist staff to management and administration staff. One of the very first things that one learns in the management-one-hundred course at HKCBA, is that this ratio should on no account exceed a value of one. At this hospital there are some seventy five medical staff with only one hospital administrator, an assistant, and a staff of ten to take care of everything. I found to my horror that there is no advertising and marketing function, no management consulting function, no human resources function, no communications function, and no corporate policy function. In fact the entire organisation is for all practical purposes - non-functional. I can only assume that the reason that there has not been a major catastrophe to date is that you have just been incredibly lucky. Clearly the decision by your board of directors to appoint someone with the requisite management skills was made just in time.

"The first issue which must be addressed is the reduction of the lopsided specialist/management ratio. It is clear to me that this stems mainly from the nature of our current client-base. One of the most profound concepts discovered by the late Professor Schtockbrocher at HKCBA (for which he received the first Schtockbrocher medal), was that the structure of a company is related to the product it produces, and that the product is dictated by the client-base. Change the client-base, and you must then change the organisational structure required to meet the different needs. Now I realise that these are difficult and abstract concepts to grasp. They are drawn from the post-graduate advanced management-studies six-hundred course material at HKCBA, so if you have trouble understanding some of it there is no need to feel ashamed.

"My strategic goal over the next five years is a re-definition of the client-base to reduce the need for the high number of specialists. This will be done by admitting only those patients who do not require medical treatment. Now to those of you who have not had the advantages of comprehensive management training, this change will seem to be no more than a trifling modification of the form filled out by patients in the admissions office. In reality it is text-book example of the power of the Schtockbrocher principle and will have the most far- reaching implications for the future modus-operandi of this hospital.

"First and foremost it will make it possible to implement the Generalist Concept, a basic tenet which will receive my unswerving support and commitment and one to which this hospital must now be dedicated. The first step in this process will be the gradual conversion of the medical staff from specialists to generalists. They will undergo a form of electro-therapy called brain-erasure-reformat. It was developed under a contract managed by HKCBA and funded by large organisations (about seventy percent of them were Public Sector ones) with a similar commitment to the Generalist Concept. The equipment consists of a computer-human interface unit to which electrodes are connected. These are attached to the head of the subject in the usual manner. Special software then erases the specialist information and down-loads files of basic management material into the brain of the patient. The conversion is not complete, but sufficiently good to prepare the former specialist to become a management trainee. The software packages are tailored to the specialisation of the subjects, in this case the MD/MBA conversion package would be used. There is often some apprehension in this process, however since you medical people are familiar with electro-therapy you will be entirely at ease I am sure.

"The benefits of the new hospital structure will be dramatic, for example the patient mortality rate will drop to zero, greatly enhancing our reputation as the foremost provider of quality health care in the community which we serve. The medical staff will be freed once and for all from the hum-drum tedium of surgery and research and will be able to participate in the exciting and productive challenges which abound in the management environment. The cost savings will allow us to have professionally produced promotional material in order that we can aggressively target our new client-base. We will be able to offer them a comprehensive range of services that no other hospital in the region can match.

"In keeping with our corporate image as a health care organisation we will for example be offering first-aid and home-surgery courses. These health care solutions are becoming increasingly popular with governments and large corporations as the costs of the more traditional centralised institutional treatments become prohibitive. In addition we will be able to offer family-finance and career counselling to help them rebuild their shattered lives following the disruption which a serious health problem requiring home-surgery can produce.

"There are numerous other spin-off benefits which will allow proven management tools to be utilised in maintaining effective control. For example the planning and budgeting process will now be more predictable without the uncertainties due to ad-hoc expenditures for emergency treatments, blood plasma and so on. I have had a pilot study done by some management consultants on cost-control. Their preliminary report recommends that their contract be extended to cover a three-year study to analyse this vital issue. Thanks to the re- definition of our client-base using the Schtockbrocher principle, we will now be able to spend a significant portion of our resources on more cost-control studies.

"Having an essentially homogeneous organisation will also allow us to rationalise procedures for performance evaluation reviews. At the moment it is difficult for a generalist to understand what a specialist does, well enough to be able to evaluate performance. Under the new structure this will no longer be a problem because there won't be any specialists.

"Now we come to the re-allocation of resources, clearly we must make the best possible use of the existing physical facilities with the minimum of expensive renovation. Accordingly the Intensive Care Unit will now become the Integrated Communications Unit. Note that this will be accomplished without even changing the 'ICU' signs on the doors. One of the first lessons in People-Skills one-hundred at HKCBA is that change should always be camouflaged as much as possible. The main operating theatre will be converted to a boardroom in order to accommodate the greatly increased number of meetings which will be necessary in the new integrated management environment. We will have to get rid of all those unsightly gas cylinders and other paraphernalia, bring in a few executive armchairs, soften up the lighting, and lower the table a bit, but other than that it should be entirely suitable.

"Security is something which will need to be tightened up substantially when people who were once part of our client-base find out that they no longer are. To this end the X-Ray lab will now be set up to screen all incoming mail for the protection of the staff who have to open it.

"Finally we come to the matter of what is called in management circles "visible hierarchical identification symbolism". I won't attempt to present the underlying theory which is a whole course in itself, (at HKCBA it is taught as Management-Psychology two-hundred). Suffice it to say that it is important that there be a visual impact which immediately communicates to outsiders what the organisation does, and what the hierarchical structure is. In the health care field of course the white coat has been the universal symbol for many decades. In spite of the classless society and so forth, the idea of status symbols dies hard, the size of the office, the thickness of the rug and so on are deeply entrenched in our tribal psyche as visible symbols of the pecking order.

"In deference to this need, all staff will not only wear white coats, but will also carry stethoscopes which will reflect their importance in the organisation. Junior employees, such as the new breed of management trainees resulting from the electro-therapy conversion, will carry plastic replicas, while more senior ones will have the authentic instruments previously used by the medical staff. Senior management will have de-luxe versions with hand-carved ivory ear-pieces and crocodile-skin tubes. Let me hasten to assure any militant animal-rights activists among you that each of these will come with a certificate from the manufacturer certifying that the elephants and crocodiles from which the tusks and skins were taken, died of natural causes.

"Well I think that is all I have to say for now, and in the spirit of open communication which I want to prevail from now on, I am prepared to answer any questions which you may have.

"What the hell do I think a hospital is for? Well first let me say that shouting, frothing at the mouth and pounding the table with your fist is the absolute antithesis of the sort of management style we need here, I can see that your conversion from chief surgeon to management trainee will be a lot more difficult than I had anticipated. To answer your question, a hospital is there to serve its client-base, obviously you have not understood a single thing I have said in the last hour and a half.

"Who will heal the sick? I regard that as one of the most important and exciting challenges which society faces as we go into the twenty-first century. Bernard Shaw once said that politics are far too important to be left to politicians. Possibly we have reached the stage where health care is far too important to be left to the medical community. I hope that answers your question.

"Now please.. one at a time.. order.. order.. stick it where?.. I beg your pardon.. I may not be a medic, but I don't need lessons in anatomical geography from you thank you very much.. Really this is disgraceful.. I would have expected a little more decorum from such a well-educated audience. Fortunately my training and experience have made me well equipped to deal with negativism of this sort from people who are not prepared to adapt to change and become team players. Such people should be assessed very carefully to see if their contributions warrant their continued association with the organisation. Threatening?.. who said anything about threats.. I am just stating my position.

"Do I have a problem with the ethics of the brain-erasure-reformat procedure? Certainly not, there are times when the rights of the individual have to be weighed against the greater good of the organisation.

"We have a computer-human interface unit here you say?.. no I didn't know that.. what are you doing.. GET your hands off me.. what's that diskette you've got there.. conversion package?.. from what to what.. MBA-to-medical orderly?.. How DARE you!..I absolutely refuse.. this is totally unethical..oh dear me.. I feel so sleepy.