Interview with James W. Begun, PhD, James A. Hamilton Professor of Healthcare Management, School of Public Health, University of Minnesota.
Universities and colleges
(Officials and employees)
Universities and colleges (Minnesota)
|Author:||O'Connor, Stephen J.|
|Publication:||Name: Journal of Healthcare Management Publisher: American College of Healthcare Executives Audience: Trade Format: Magazine/Journal Subject: Business; Health care industry Copyright: COPYRIGHT 2012 American College of Healthcare Executives ISSN: 1096-9012|
|Issue:||Date: March-April, 2012 Source Volume: 57 Source Issue: 2|
|Topic:||Event Code: 540 Executive changes & profiles|
|Product:||Product Code: 8220000 Colleges & Universities NAICS Code: 61131 Colleges, Universities, and Professional Schools SIC Code: 8221 Colleges and universities|
|Organization:||Organization: University of Minnesota. School of Public Health|
|Persons:||Named Person: Begun, James W.|
|Geographic:||Geographic Scope: Minnesota Geographic Code: 1U4MN Minnesota|
James W. Begun, PhD, is the James A. Hamilton Professor of
Healthcare Management at the University of Minnesota. He earned his PhD
in sociology from the University of North Carolina (UNC). He previously
served on the faculty of UNC, Cornell University, and Virginia
Dr. Begun teaches graduate-level courses in management and leadership in the University of Minnesota School of Public Health, where he was the recipient of the 2009 Leonard M. Schuman Award for Excellence in Teaching. In addition, he has received teaching awards from the MHA program and the Carlson School of Management executive MBA program at the University of Minnesota and the master of health services administration program at Virginia Commonwealth University.
Dr. Begun's research focuses on the strategy and performance of healthcare organizations and occupations. Among his more than 100 publications is the book Strategic Adaptation in the Health Professions: Meeting the Challenges of Change (Jossey-Bass, 1993). In 2001, he received ACHE's Edgar C. Hayhow Award for his article "Strategic Cycling: Shaking Complacency in Healthcare Strategic Planning," coauthored with Kathleen B. Heatwole.
Dr. Begun has served as director of the master of healthcare administration program and chair of the Department of Healthcare Management at the University of Minnesota. He has also chaired the Accrediting Commission on Education in Health Services Administration (now known as the Commission on Accreditation of Healthcare Management Education [CAHME]) and has been an active promoter of competency-based education. In 2008, the Association of University Programs in Health Administration (AUPHA) awarded him the Gary L. Filerman Prize for Innovation in Healthcare Management Education.
Dr. Begun is a member of the Plexus Institute Science Advisory Board; Board of Commissioners, Commission on Nurse Certification; Board of Directors, CAHME; ACHE's Higher Education Committee; and the editorial advisory board of Health Care Management Review.
Dr. O'Connor: You earned a PhD in sociology from the University of North Carolina (UNC). What prompted you to get into the healthcare field
Dr. Begun: I was interested in using knowledge and research to affect policy and practice, and healthcare was an obvious place to do that in the 1970s when I completed my doctoral degree. Medicare and Medicaid had begun about a decade earlier, and HMOs were coming into vogue. I was lucky enough to get involved with some HMO research at UNC while pursuing the sociology degree there. At that time, the field of health administration was professionalizing and growing. Members of the field were upgrading the knowledge base and doing more research, and institutions were hiring academics and expanding teaching programs. After completing the doctoral degree, I was fortunate to continue to work at UNC and, subsequently, three other excellent programs: Cornell University, Virginia Commonwealth University, and now, the University of Minnesota.
I enjoy this field because it is so purpose driven. Working in health administration offers people great opportunities to make a big difference as teachers, researchers, or practitioners. I find healthcare practitioners and academicians to be incredibly motivated and caring. My work has been a lot of fun. It has also been fulfilling, because it allows a life of purpose.
Dr. O'Connor: The Commission on Accreditation of Healthcare Management Education (CAHME) is the accrediting body for graduate healthcare management education programs in the United States and Canada. You have chaired this commission in the past and presently serve as a CAHME Board member. What do you see as the value of accreditation for developing our field ?
Dr. Begun: Our undergraduate and graduate health administration educational programs are critical to raising the quality of practice and have direct effects on improving health and healthcare. So how do we get good educational programs? One way is to model excellence, and CAHME accreditation at the graduate level and AUPHA certification at the undergraduate level is a means to do that. All of our educational programs, whether accredited or not, have benefited from accreditation because it has raised the bar in health administration education. Accreditation has helped professionalize our field by encouraging the development of a knowledge base and by providing a way to assess that knowledge base, which most recently has been accomplished through the development of competency frameworks. The key to CAHME's success and importance is that it is a partnership between academia, employer organizations, and professional associations, and I believe that this partnership greatly enriches and strengthens all three sectors. CAHME would not exist without the support of employers and the professional associations such as the American College of Healthcare Executives. In fact, the competency frameworks would not exist without that partnership.
In pursuit of this partnership, it is important to continue expanding opportunities for students to learn within organizations through course projects, internships, and fellowships. I hope all administrators get the opportunity to host an intern, employ a fellow, or let potential students shadow them or other people in their organizations.
Dr. O'Connor: You have been actively involved in studying and working with the profession of nursing. Why is that?
Dr. Begun: I am interested in professionalizing occupations that are leverage points for change in healthcare delivery. I see nursing as very similar to health administration in that regard. Health administration and nursing are critical to the improvement of health and healthcare because they have not historically had the respect or the power that I think they deserve. One response to that lack of respect is to professionalize. Nursing has gone through that professionalization process by upgrading professional education, systematizing its knowledge base, pushing for more leadership roles, and advocating for patients. The same may be said about health administration.
I have spent the last several years serving on the Commission on Nursing Certification. This commission certifies a new master's degree role called a clinical nurse leader (CNL). That role exemplifies the kind of practitioner who uses evidence-based systems thinking to improve patient care outcomes by facilitating, coordinating, and overseeing the care a healthcare team provides. In 2006 I published an article in the Journal of Healthcare Management with Jolene Tomabeni, RN, FACHE (R), and Kenneth White, PhD, FACHE, that described and promoted the CNL. That article contributed to the development of the CNL role, and today there are more than 1,900 certified CNLs. That is a small number given the large number of nurses, but it is important in professionalizing and improving the role of nursing and delivery systems.
Dr. O'Connor: Complexity science has been an intellectual anchor for you. What is complexity science, and why do you find it so interesting?
Dr. Begun: Complexity science is the scientific study of the interaction of multiple, heterogeneous, dynamic agents. Complex systems are massively entangled, and they often evolve over time in unpredictable ways. Now, all of that sounds abstract, but think about building an accountable care organization, integrating services for chronic care, stimulating innovation, and developing and implementing clinical guidelines. Or think about an organization creating a culture of safety or quality or fostering employee engagement. All of these efforts involve creating complex systems that work well. In fact, the most challenging and intractable problems we face in healthcare are complex problems.
Dr. O'Connor: Few healthcare executives or students are fervent disciples of complexity science. In fact, most seem to resist its principles in favor of less complexity and greater control. In what ways can complexity science inform and improve healthcare management practice and education ?
Dr. Begun: Complexity science builds on our knowledge of how to control simple systems. It does not reject that knowledge. However, the path to simplicity and control often passes through complexity. To treat a complex system as though the system is simple gives us the illusion of control, but not real control. The control we get is short-term and halfhearted. We think for awhile that we have solved a problem, then the problem resurfaces. Take the case of developing a culture of safety. The simple approach is to devise and impose rules. That approach is useless unless leaders take the time to talk with and listen to all of the participants and stakeholders and balance their needs with the organization's preferences--to work through the complexity. At the end of the process, the organization might end up with some simple rules, but it worked through the complexity to discover those rules. An organization controls the system to produce patient safety by discovering the simplicity on the other side of complexity.
Here is another example: Assume that organizations can control employees through goal setting. A simple approach is to impose the organization's goals and tell employees what to do. A more complicated method is to jointly develop them with the employees. A complexity approach, however, would lead the organization to try to create conditions in which employees discover the goals themselves. When that occurs, organizations get engagement and high quality of work life. The complexity approach takes longer, but it pays off. The simple approach gives the illusion of control, but not real control. Employees would disengage and would not give their best work efforts.
The simple and control solutions are attractive in part because time and resource constraints are so real in healthcare. We have to make quick and thrifty decisions. We don't take the time to consult or to grow consensus. It is difficult to take the time to work through complexity. However, I am impressed by the many practitioners who embrace complexity--they see it, respect it, and work with it. These practitioners are actually practicing complexity science; they just may not know it and certainly may not call it that.
For example, any manager who respects and uses the power of culture is a complexity practitioner. Nobody talked about culture 30 years ago, but today most managers and all leaders understand its critical role in transforming organizations. For evidence of that, look at the framework that John Griffith, LFACHE, and Kenneth White, PhD, FACHE, present in The Well-Managed Healthcare Organization (2010). That framework is based on cultural transformation. Challenges such as building accountable care organizations, improving patient safety, or fostering employee engagement cannot be fixed with top-down solutions. Rather, their solutions come from cultural transformation.
Another example is any leader who when asked a complex question has stood back and said, "I don't know; let's try to find the answer together." Those leaders are practicing complexity science but not necessarily calling it that.
A good source for those interested in more formal learning about complexity science is the Plexus Institute, a nonprofit organization that is dedicated to improving healthcare through complexity science. I have enjoyed being on their board of advisors for many years.
Dr. O'Connor: What topics and issues would you like to see addressed by authors in the Journal of Healthcare Management?
Dr. Begun: Consistent with the importance of continuing to professionalize our field, I would like to see attention to building the healthcare management knowledge base and, in particular, the evidence base around management practices such as strategic planning and pay for performance. As a field we must continue to develop knowledge about what contributes to excellent performance and to do that in a scientific, evidence-based way.
Second, JHM can publish research papers about leading organizations' new, innovative, and bold efforts in tackling complex challenges. This includes organizations that are taking risks to improve safety, building cultures of interprofessional teamwork, moving into community health, and working to change health policies. We have lots of work to do to face these challenges every day and achieve excellence. I think that JHM can help us keep up with and even get ahead of some of those challenges.
Begun, J. W., J. Tornabeni, and K. R. White. 2006. "Opportunities for Improving Patient Care Through Lateral Integration: The Clinical Nurse Leader." Journal of Healthcare Management 51 (1): 19-25.
White, K. R., and J. R. Griffith. 2010. The Well-Managed Healthcare Organization, seventh edition. Chicago: Health Administration Press.
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