Book Review

Management Mantras

Publishers: Blackwell Pub/Jossey-Bass Authors: Linda E Swayne, University of North Carolina at Charlotte Jack Duncan, University of Alabama, Birmingham Peter M Ginter, University of Alabama, Birmingham Pages: 880 Wiley List Price: US $80.00

Strategic Management of Health Care Organizations is a comprehensive text on strategic management as it applies to a variety of healthcare organisations, across the healthcare spectrum. The central theme of the text is that business-oriented strategic management can improve the success of healthcare organisations in a turbulent environment. Strategic planning has been defined as the set of organisational processes for identifying the desired future of the organisation and developing decision guidelines (Ginter, Swayne and Duncan, 1995).

The book discusses the challenges being faced by one of the wealthiest nations, the US, and how it is grappling to provide access to quality and affordable healthcare to all its citizens. At healthcare spending of 16.0 per cent of GDP or $2.6 trillion, and per capita health expenditure of $5,000, it is easily the most expensive healthcare service in the world today. Today, the American healthcare organisations are passing through dynamic environment that is characterised by competition, reimbursement issues and the challenges described as white-water changes. The healthcare organisations can meet these challenges successfully only by adopting the processes of strategic thinking, planning and management on long-term basis, argue the authors of this book.

Previous Editions

More than 15 years ago, the three authors agreed that healthcare was entering 'Whitewater Change' and that healthcare strategic management might benefit from a strategic perspective drawing upon the experience and strategic thinking and planning processes first developed in other industries. At that time, they wrote in the preface of the first edition, 'Clearly healthcare has had difficulty in dealing with a dynamic environment, holding down costs, diversifying wisely and balancing capacity and demand'.

In addition, in first edition the authors had stated, "Today healthcare organisations that do not have a clear strategy are doomed to mediocrity at best - and failure at worst - resulting in poor quality of life for the community." Health care organisations that did not develop that clear strategy are gone - more than 1,400 hospitals have closed their doors. The financing of healthcare has significantly evolved and the industry has undergone two decades of re-structuring with a multitude of new types of organisations and services.

Changes in this Edition

The sixth edition of this established text is streamlined to a more manageable format, with the appendices moved to the web-site and a significant shortening of the main text. There is a greater focus on the global analysis of industry and competition and analysis of the internal environment. In consultation with feedback from their adopters, the authors have focused on the fundamentals of strategy analysis and the underlying sources of profit.

Current healthcare examples are integrated throughout the 10 chapters of text material, organised around a model of strategic management. Step-by-step, readers are presented with the theory of strategic management and a process to carry out strategic management. Additionally, six to 10 actual current situations are presented in each chapter as perspectives. Following the chapters, there are 20 cases for students to analyse by applying the theory as presented in the text to current healthcare situations. Along with the healthcare industry, this text has evolved as well. Its evolution in many ways mirrors the changes that have taken place in the healthcare industry and its management. As a result, this edition brings strategic thinking to the forefront and clearly differentiates strategic thinking, strategic planning, and managing the strategy (managing the strategy momentum). These concepts represent the central elements of new conceptual model of strategic management that reflects the realities of developing and managing strategies.

Broadly, the new model depicts strategic management as the processes of strategic thinking, consensus building and documentation of that thinking into a strategic plan and managing the strategic momentum.

Features Retained

Strategic management is highly subjective, often requiring significant intuitive powers. A major task of the future strategic thinker is to develop objective or analytical means - a logical sequence - to strategic planning. The authors have used the analogy of the map and the compass to express approach. Students of strategic management need to study a wide variety of organisations and situations to gain greater insight - their own compass - into strategic management.

All the three authors of this classic textbook are accomplished academicians and recognised authority on the subject. Peter Ginter, along with W Jack Duncan is Professor of Management in the Graduate School of Management and Professor of Healthcare Organisation and Policy in the Lister Hill Centre for Health Policy at the School of Public Health at the University of Alabama, Birmingham. Linda E Swayne is Professor and Chair, Department of Marketing in the Belk College of Business Administration and Co-Director of the Physicians' Management Institute at the University of North Carolina, Charlotte.

The book has an outstanding readability of the text, contains incredible amount of information, and the great balance of theory with practical approaches. Many books about management are a bit short in the area of practical tools. This one gives the reader tools to work with. I used the outline of this book to do a strategic analysis of an organisation with which I work.

The only significant weakness of the book is the uneven quality of the case studies. Because of its grounding in theory and research evidence, the book is well designed for use in graduate courses in health and hospital administration, medical informatics, medicine and nursing and in general all those interested in adoption of strategic thinking and planning in healthcare organisations. Public health managers, hospital CEOs, financers of healthcare projects can use the book effectively as well, either as general reference or by focusing on the conceptual and applied material as a framework for strategic management.

Though primarily written in western healthcare context, the book is equally pertinent for the rapidly transforming healthcare industry in our country. Many corporates are on an expansion spree adding additional beds and using innovative models of healthcare delivery. We must learn lessons from the mistakes committed by the developed nations. With the increasing competition among Indian organisations for efficient, patient-centric and cost effective delivery of healthcare, the book shall provide a useful and comprehensive study material on strategic management. Further, healthcare organisations running a chain of hospitals and interested in giving a strategic direction to their enterprise shall find this book a valuable accompaniment.

Reviewed by Dr Sanjeev Sood, Senior Medical Officer and Healthcare Administrator, IAF