“醫療保健不是失敗,而是成功,而且代價高昂,而我們不想為此買單。所以政府,無論是公共部門還是私營部門,都要進行幹預以削減成本,這就是失敗的原因。”在這本肯定會引起爭議的書中,著名的管理思想家亨利·明茨伯格將他的注意力轉向了重新構建醫療保健的管理和組織。問題不在於管理本身,而在於一種脫離業務而又決心控製業務的遠程控製管理形式。它毫不留情地進行重組,瘋狂地采取措施,提倡英雄式的領導方式,在需要合作的地方支持競爭,並假裝醫療保健的使命應該像企業一樣管理。“衛生保健的管理應該是專注和持續的護理,而不是幹預和偶發性治療。”這種專業的組織形式既是衛生保健的強大力量的源泉,也是它使人衰弱的弱點。在它的管理中,就像在它的操作中一樣,它對它所能應用的標準化實踐進行分類,其結果是可以衡量的。當類別匹配時,這種方法非常有效。醫生診斷闌尾炎並進行手術; some administrator ticks the appropriate box and pays. But what happens when the fit fails-when patients fall outside the categories or across several categories or need to be treated as people beneath the categories or when the managers and professionals pass each other like ships in the night? To cope with all this, Mintzberg says that we need to reorganize our heads instead of our institutions. He discusses how we can think differently about systems and strategies, sectors and scale, measurement and management, leadership and organization, competition and collaboration. "Market control of health care is crass, state control is crude, professional control is closed. We need all three-in their place." The overall message of Mintzberg's masterful analysis is that care, cure, control, and community have to work together, within health-care institutions and across them, to deliver quantity, quality, and equality simultaneously.