Page 201 - The Drucker Lectures

182 [ The Drucker Lectures

Today’s administrators all came up in yesterday’s hospital. I
just reread Lewis Thomas [dean of the Yale Medical School and
president of the Sloan-Kettering Institute, who was known for
his graceful essays on a wide variety of subjects]. And the great
advances in medicine were bed centered in the 1930s, ’40s, and
’50s. But since then, the great advances have been outside. And
so I see the health-care center of tomorrow centered around a
diagnostic and research center—research in a broad sense. Edu-
cation may be a better term. And, basically, the administrator
will be more akin to the conductor of an opera than to anything
else. He has the stars. And he has the supporting cast. And he
has the orchestra.
In health care, I’m not even sure that most of it can be deliv-
ered by MDs. A great deal of it will be delivered by nurse practi-
tioners under the supervision of several MDs. And we are going
that way pretty fast—not perhaps in a big metropolitan area like
Boston, but when you go to Nashville or Albuquerque, you see
the hospital there with a rural health center run by nurse practi-
tioners with an MD coming in every week. The nurse practitio-
ner’s main job is to know when she or he—and, by the way, 50
percent of them are men—don’t know enough. And that is one
unit. Another unit is the bed unit. A third is the convalescent
nursing home chronic unit. And there’s an enormous outpatient
business, centered on the diagnostic and educational activity.
The hospital is the coordinator—the place that allocates re-
sources, that sets and maintains standards, that has the tremen-
dous human resources job. That’s not the historical organiza-
tion or the way most hospital people see themselves yet. And
I’m not talking structure; I’m talking about the functions that
have to be performed. They are overlapping, but they are sepa-
rate and distinct.
Another problem that has to be tackled is health-care eco-
nomics. It’s an axiom that no organization can possibly survive if