The original article I wrote for GreenPoint Global, an international business consulting company

The direction of health care in advanced countries is driven in the twenty-first century by three forces:

  • financing,
  • technology, and
  • consumer  access and service on demand.

Do administrators with medical training make the best leaders? Is it time to be changing the light in the attic by preparing health-care leaders for a new age in new ways?

Health-care financing is a much simpler discussion than newspaper stories and editorializing talking heads on TV make out. Government-funded health and medical care is going to continue to expand with an ever-shrinking contribution from private carriers and self-payers.

New financing pathways and technology commix for patients spending less time in hospitals and more recuperation and rehabilitation time at home and rehab facilities. Wearables, robotics, digital medicine, the Internet, and health-care education lead to greater patient self-awareness about body image and health status.

Finally, patient demands are shifting. The wealthy want on-time access to their physicians and are willing to pay concierge fees for personal attention 24/7. Government funding is bringing more people into the health-care system, and though not able to pay as much as other patients, they still demand reasonable access and quality care.

Enormous growth is occurring in the demands for elective plastic and cosmetic surgery usually not covered by insurance. In 2014, there were more than eleven million cosmetic surgical and nonsurgical procedures performed by board-certified physicians. This is a 12 percent increase over procedures performed in 2013. The revenues exceed $12 billion annually. Liposuction and breast augmentation are the procedures most in demand. These figures do not include cosmetic dentistry and implant procedures

A young phlebotomist working in the county hospital tells me she only performs procedures on written work orders from physicians. She is stunned in her new job in an upscale hospital located in a wealthy suburb to find it not uncommon for patients to bring their doctor work orders then proceed to tell the phlebotomist what additional blood tests they want. They usually get what they want without much argument.

Here are some of the shifts in backgrounds of health-care leaders: Hospitals are seeking leaders with MBAs in financing and accounting. Two-thirds of hospital CEOs hired in 2014 are estimated to come from non-health-care backgrounds. Hospitals are using outsourcing firms to complement and support this shift from industries like venture capital, private equity firms, banking, technology, marketing, and pharma/biotech.

In the area of clinical leadership, one study of UK senior health-care leaders finds doctors in training to be very involved in clinical leadership. They see their role to make the best use of resources and harmonize the leadership in public health-care delivery (Journal of the Royal Society of Medicine. 107(7): 227-286. July 2014).

Preparing health-care leaders, some institutions are looking at nurses in new ways for leadership positions. They bring clinical experience and perspective about patient care, demands, workloads, everything decision makers need to know about the architecture of the infrastructure, customer service and satisfaction ingredients, interdisciplinary collaboration, and information flow. They have unique insights into the departments of medicine, nursing, housekeeping, dentistry, pharmacy, and social work.

New health-care leadership is bringing into the system backgrounds in health systems research, data management, organizational behavior management, leadership training and interpersonal skills, health-care policy and economics, business management, human resources management, and ethics.

Centuries ago, Alexander Hamilton offered his vision of organization management. Nathan Raab brings it to our attention in a Fortune article “Alexander Hamilton’s 10 Tips to Organizational Management,” Sept. 23, 2014. Changing the light in the attic does not necessarily mean abandoning what history has to teach. Hamilton’s ten management rules are: communicate consistently and regularly, make it easier for your employees to communicate with you, your people on the ground are your eyes and ears and can help you evolve, expect the unexpected, listen to all criticism, ask for input, fix problems at ground level, encourage innovation and experimentation, set clear expectations early, and collect and analyze data and use it.