Professionals are important, but so is good governance

Professionals in health services are important because without their dedication and enthusiasm patients do not receive the necessary care, especially in times of cutbacks. However, we should not forget that for these professionals to work properly they need their organizations to be well governed and I will exemplify this with two publications, the first of which is the last book of the veteran professor of McGill University Montreal, Henry Mintzberg, and the second is an article on this subject in the New York Times.

One of Professor Mintzberg’s best known lessons has been the conceptualization of the third sector as a balanced element of democratic societies. One sector, he says, called to serve as a counterweight between public and private spheres. Its key differentiator is property that is either collective, such as in cooperatives or is diffuse, such as in foundations or associations, apart of course of their altruistic purposes and their natural space: community services. All this makes the third sector is specially equipped to manage health services in a well weighted basis between the despotic temptations of political power and the interests of private companies.

A couple of important conceptual developments

Mintzberg prefers now to name the third sector as the plural sector thus relieving it from the stigma of appearing less important than the other two and in addition the classical scheme that was once a triangle with an angle for each sector, has now become an ellipse, as you can see on the cover of the book, in which the three sectors have a key role in what is theirs (defending rights for the public sector, work and consumption for the private sector and management of community services for the plural sector).

The importance of good governance

Austin Frack in a New York Times article "In hospital, board rooms are as important as operating rooms", collects several studies showing that both the involvement of government bodies in quality policies and the implementation of strategies and operations by the managers improve indicators as sensitive as mortality from myocardial infarction. Frack says it’s imperative that physicians, nurses and all staff involved to do their job well but now research is warning that clinical results and organizational models in which these professionals move also influences the work climate. "If the quality is not fomented from the governing bodies and senior management, the journalist says, it may be that the best doctors and nurses will not offer their best performance."

Mintzberg says that when in a community there is an organization of the plural sector that does its job responsibly and effectively, it’s very likely that the public sector will delegate its own services while the private sector will provide financial support appropriate for the proper conduct of such services.

An important tip for Mintzberg’s followers: don’t miss the new book by this veteran teacher. You won’t be disappointed because you will find that Mintzberg is an even more radical fighter and nothing is left in the pipeline: not the limitations of public power, not the populist tendencies of the plural sector; but above all, I think that his strong cry against predatory capitalism will not leave you indifferent. As he says, an economy should not be measured by growth but by the value that it brings to citizens and for this to be possible there must be a commitment from each of the three sectors to do their work responsibly and independently.

Jordi Varela

Editor