On Generic Management in Health Care: Hospital Chief Information Officers (CIOs) Say Patient Engagement is All About… Themselves?

Lambert here: I would be very surprised if an indictment of generic managers very similar to that made by Poses below, for health care, could not be made for higher education.

By Roy Poses, MD, Clinical Associate Professor of Medicine at Brown University, and the President of FIRM – the Foundation for Integrity and Responsibility in Medicine. Cross posted from the Health Care Renewal website

To laugh or to cry? – now it seems that hospital CIOs think they “own” patient engagement.

An article in Medscape summarized a presentation at the Healthcare Information and Management Systems Society (HIMSS) Annual meeting that provided a surprising insight into how some hospital managers think. The survey focused on the concept of patient engagement:

In separate surveys, researchers polled a national sample of 125 chief information officers, 359 primary care physicians, and 2567 patients who visited their doctor in the previous 90 days. Questions centered on beliefs about engagement, the perceived roles of the stakeholders, and barriers.

The patients seemed to have a sensible idea about their own engagement,

From the patient perspective, getting help from a provider they trust is most important, said Mazi Rasulnia, PhD, from M Consulting LLC, who is cofounder of Pack Health, a patient-activation company in Birmingham, Alabama.

What they expect most, according to the survey, is a provider who listens to them and helps them understand treatment options before they make a decision.

‘Patients want questions answered around the specificity of their own health, not just what generally happens with ‘patients like you’ or from a population standpoint,’ Dr Rasulnia said.

‘What they don’t really care for or expect is for providers to ‘give me a website so I can access my medical information’.’ That, and asking patients about their personal life, ranked lowest on patients’ lists of expectations.

They want providers to help them navigate not only their disease, but also the health system. Providing access is important, but that alone won’t help patients engage, he explained.

The article did not provide much information about the physicians’ responses, but did suggest

When physicians talk about patient engagement, they tend to think in terms of the doctor–patient relationship,…

So in general, the doctors and patients were on the same page, but

doctors believe patients need to take more responsibility for their outcomes, and patients say they can’t because their doctors, who are responsible for engaging them, don’t spend enough time with them.

Setting aside the causes and approaches to the problem of insufficient time during patient encounters, the chief information officers (CIOs), had a radically different idea,

when healthcare executives talk about the patient engagement envisioned under the Affordable Care Act, they think in terms of transactions,…


Chief information officers believe they are responsible because patient engagement involves technology,…


The chief information officers surveyed ‘clearly saw themselves as the owners of patient engagement,’ said Lorren Pettit, MBA, vice president of market research for HIMSS Analytics, who reported on the systems perspective.

When chief information officers were asked who is most accountable for patient engagement in their organizations, 46.4% said they were, but 14.4% thought nurses were accountable for patient engagement, not physicians or patients.

Comment – on the Hubris of Generic Managers

I have to assume that the article, presentation, or the survey were hopelessly garbled. If not, what on earth were the chief information officers thinking?

Chief information officers think they are the “owners of patient engagement?” While “patient engagement” does not seem to be a well-defined term (look here), and seems like an example of bureaucrat speak or politically correctness, it surely seems to be related to communication between patients and health care professionals. It surely does not seem to be directly about information technology. At best, the health care information technology CIOs manage could support patient engagement. Furthermore, the explanation apparently offered by the CIOs, that patient engagement involves technology, is not helpful because at this time, all of medicine and health care to some extent “involves technology.”

So why would CIOs claim to “own” patient engagement? Maybe they are simply clueless about what patient engagement really involves. CIOs rarely interact with patients. Most CIOs have no direct health care experience, and are not trained as doctors or nurses. For example, a recent list of “100 Hospital and Health System CIOs to Know” included only 10 with health professional degrees (seven MDs, three RNs).

Why then, not simply admit that the issue is out of their area of expertise, rather than claiming “ownership.” My best guess is this is the bravado, or arrogance of generic managers.

In 1988, Alain Enthoven advocated in Theory and Practice of Managed Competition in Health Care Finance, a book published in the Netherlands, that to decrease health care costs it would be necessary to break up the “physicians’ guild” and replace leadership by clinicians with leadership by managers (see 2006 post here). Thus from 1983 to 2000, the number of managers working in the US health care system grew 726%, while the number of physicians grew 39%, so the manager/physician ratio went from roughly one to six to one to one (see 2005 post here). As we noted here, the growth continued, so there are now 10 managers for every US physician.

The managers who first took over health care may have had some health care background. Now it seems that health care managers are decreasingly likely to have any health care background, and increasingly likely to be from the world of finance. Meanwhile, for a long time, business schools and the like seem to have teaching managers that they have a God given right to manage every organization and every aspect of society, regardless how little they know about what the particular context, business, calling, etc involves. Presumably this is based on a faith or ideology that modern management tools are universally applicable and nigh onto supernatural in their powers. Of course, there is not much evidence to support this, especially in health care.

We have discussed other examples of bizarre proclamations by generic managers and their supporters that seem to corroborate their belief in such divine powers. Most recently, there was the multimillionaire hospital system CEO who proclaimed new artificial intelligence technology could replace doctors in short order (look here). Top hospital managers are regularly lauded as “brilliant,” or “extraordinary,” often in terms of their managerial skills (look here), but at times because of their supposed ownership of all aspects of patient care, e.g., (look here)

They literally are on call 24/7, 365 days a year and they are running an institution where lives are at stake….

If hospital CEOs, who spend lots of time in offices, at meetings, and raising money, really see themselves as perpetually on call, and directly responsible for patients’ lives, then maybe it’s not surprising that their CIOs think they own patient engagment.

So in summary this latest survey shows the continued hubris of the generic manager, and hence their continued unsuitability to run health care organizations. It is time for health care professionals to take back health care from generic managers. True health care reform would restore leadership by people who understand the health care context, uphold health professionals’ values, are willing to be held accountable, and put patients’ and the public’s health ahead of self-interest.

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About Lambert Strether

Readers, I have had a correspondent characterize my views as realistic cynical. Let me briefly explain them. I believe in universal programs that provide concrete material benefits, especially to the working class. Medicare for All is the prime example, but tuition-free college and a Post Office Bank also fall under this heading. So do a Jobs Guarantee and a Debt Jubilee. Clearly, neither liberal Democrats nor conservative Republicans can deliver on such programs, because the two are different flavors of neoliberalism (“Because markets”). I don’t much care about the “ism” that delivers the benefits, although whichever one does have to put common humanity first, as opposed to markets. Could be a second FDR saving capitalism, democratic socialism leashing and collaring it, or communism razing it. I don’t much care, as long as the benefits are delivered. To me, the key issue — and this is why Medicare for All is always first with me — is the tens of thousands of excess “deaths from despair,” as described by the Case-Deaton study, and other recent studies. That enormous body count makes Medicare for All, at the very least, a moral and strategic imperative. And that level of suffering and organic damage makes the concerns of identity politics — even the worthy fight to help the refugees Bush, Obama, and Clinton’s wars created — bright shiny objects by comparison. Hence my frustration with the news flow — currently in my view the swirling intersection of two, separate Shock Doctrine campaigns, one by the Administration, and the other by out-of-power liberals and their allies in the State and in the press — a news flow that constantly forces me to focus on matters that I regard as of secondary importance to the excess deaths. What kind of political economy is it that halts or even reverses the increases in life expectancy that civilized societies have achieved? I am also very hopeful that the continuing destruction of both party establishments will open the space for voices supporting programs similar to those I have listed; let’s call such voices “the left.” Volatility creates opportunity, especially if the Democrat establishment, which puts markets first and opposes all such programs, isn’t allowed to get back into the saddle. Eyes on the prize! I love the tactical level, and secretly love even the horse race, since I’ve been blogging about it daily for fourteen years, but everything I write has this perspective at the back of it.


  1. Disturbed Voter

    I agree with your caution regarding “generic managers” … these MBA cretins have been destroying industry after industry … and medical care isn’t even an industry. As characters, they are infamous on hospital TV shows.

    It is true that doctors wish that patients could listen to them and do what is suggested … but I know that patients often don’t because it involves non-negotiable lifestyle issues like smoking.

    Patients of course would like lots of time with a doctor, who will tell them what they want to hear. Telling people what they want to hear would be unprofessional. Also this is not economically viable given the hourly cost of a doctor. Hence the employment of less expensive alternatives such as PA, NP, nurse and med tech. But this breaks up the diagnostic communication. To think that a doctor can meet with you, without prior review of your medical record, and pull a competent diagnosis out of nowhere in the 15 minutes of your encounter with him … is delusion. And yes, I really think that doctors, given their patient load, have no opportunity to review your medical record, except to the extent they have photographic memories.

    The CIO “ownership” you are quoting, doesn’t apply in the medical facility where I work. Perhaps the CIO mentioned is one of those generic managers … not a real IT person … who would have no desire for interaction with patients. It is possible if not likely, because control of budget is an egotistical primary, that as the IT budget has grown, real IT people have been moved out of the CIO office and replaced with generic business majors. This is a critical degrade in the capability of the IT shop. Some large facilities have a CTO or Chief Technology Officer … and the same concerns would apply.

  2. anon

    It makes me laugh when I read some of those articles in health management and IT blogs. Soon computers will replace nurses and doctors, I do not think they really know what we do. Everything is changing fast and not for the better. I sometimes wonder if we have outsourced and shipped so many jobs abroad that healthcare is a new area to exploit since it’s local.
    I was able to intern with a new nursing group at my facility, we would data mine patient’s records and make follow up phone calls. Did you do this, did you fill this, etc? All this so they do not come to the hospital till the 31st day so the hospital does not take a financial hit. Yes, patient engagement-I feel like an overpriced babysitter.

  3. Felix

    All of this medical “management” is really about rent seeking and managing doctor productivity. A lot of this is the doctor’s fault for not policing their own. We read in the paper all the time about doctors billing millions per year of eyeball injections (Menendez’ buddy), peripheral artery stents, spine surgery etc. Problem is that the legal and political system has encouraged a lot of this by crippling doctor’s capacity to police themselves (the old medical societies….and antitrust), grossly overpopulating the medical population (wide open immigration thinking it would lower costs.)…….a Pakistani doctor is going to want dynasty creating money for his whole family as well), defensive medicine, out of control malpractice verdicts. My experience has been any doctor making over 250K per year is cheating somehow. How about putting them all on salary and leaving them alone? The sick will be cared for and the worried well might have to wait but “productivity” just makes no sense in medicine. It should be about health outcomes and not “productivity” measured by some suit.

    1. anon

      Measuring health outcomes. I work at a hospital, which is supposed to treat acute conditions. There is a shortage of primary MD because they are paid so little. So, people don’t manage their health, don’t have access to a PCP, causing them to use the hospital for what should be primary treatment.
      CMS is choosing a few chronic conditions and if they aren’t managed right or the patient continues to use the hospital repeatedly (are admitted within 30 days of last visit), the hospital is financially penalized for poor quality outcomes. So, hospitals are giving these frequent flyers: free scripts to hold them over, actual cash for a cab to the clinic, and multiple followup calls to ensure that they (the patient) are trying to stay healthy-following instructions. Not sure if this is the innovation Gruber was talking about in his many videos.
      It is all really a mess and as someone at the lower end of the ladder, I am tired of “doing more with less”, and less, and less.

  4. Jill

    The general system of medicine as practiced in the US is antithetical to human health. Patients frequently do not get the information they need and I know many doctors who are as unhappy as their patients with how things stand. I believe the standard appt. time is now about 10 mins. At 10 mins. the whole idea of patient engagement is ludicrous. So I suppose, in a very cynical way, the managers who mandate the 10 min. appts. are “in charge” of patient engagement–that is, they make it meaningless.

    Studies also show that doctors tend to listen 15 seconds before they start talking to/diagnosing their patients. This further precludes patient engagement. Within 10 mins, 15 seconds isn’t exactly a high percentage of the “engagement”.

    I don’t see another way to confront all that is wrong with the medical system except by rebuilding things from the ground up. Along with that process, any step that can make things better, however minimally, should be taken. But we need our nation’s people to reevaluate the meaning of health care. This includes provision of single payer, universal care–something this nation most certainly can afford, it’s about the price of a just one “kinetic action” by the oligarchy. We too often accept the necessity of “kinetic actions” without thought. It’s time to think about that!

    We need to refashion medicine as the act of taking care of each other, not as a money making opportunity. You may believe what I’m saying is unrealistic and cannot be done, but something will be done and we might as well plan for a health care system which will help people. This system is absolutely going to collapse. It is not a sustainable business model and for that reason alone, it will change. It can change into boutique medicine for the few and the hell with everyone else- (pretty much the current direction) but even that isn’t going to allow for long term profits. There simply aren’t enough wealthy people to pay all that many costs. So, why not rebuild health care in a way we want, one which helps others? The current practices won’t work forever.

  5. Lisa

    I’ve seen this IT hubris over and over…and slapped it down over and over.

    Many simply can’t understand they are a support system, they are there to provide IT systems that support people doing their job, that’s it, end of story.

    But some overstep their boundaries and believe (with negative proof) that they can now do the particular job better than the specialists…it always ends in disaster.

  6. Lune

    I’ll believe hospital CIOs are responsible for patient engagement when they put their life savings on the line and sit with me in the defendant’s table the next time I face a malpractice suit…

  7. H. Alexander Ivey

    “generic manager”. I love the term. The first step in solving a problem is getting the name right. “Manager” or “upper management” doesn’t really get it. “Generic manager” does.

    Thanks for the cross posting!

  8. mark o dochartaigh

    Hopefully everyone is acquainted with the “Birth” sketch from Monty Python’s “The Meaning of Life” which is uncannily accurate 30 years later. I have been a nurse for 35 years and the effect of the element administratium on the healthcare system has been a wonder to behold.

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