1. Issel, L. Michele PhD, RN

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I recently stumbled onto Health Resources and Services Administration's (HRSA) Web site listing the organization's vision, mission, and goals. Goal 7 is to "achieve excellence in management practices." I was struck by the simplicity and difficulty of this goal and that it figured so prominently on the HRSA Web page with a video clip of Mary Wakefield, PhD, RN, Administrator, giving an introduction to HRSA. I wondered if management practices were a priority in any of the other national health agencies, so I went looking.

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Besides HRSA, within the U.S. Department of Health and Human Services, the agencies I thought most likely to address health care management were the Agency for Health Care Research and Quality (AHRQ), the National Institutes of Health, the Centers for Disease Control and Prevention, and the Centers for Medicare and Medicaid Services (CMS). These five, I'll call them the Big 5 from the point of view of health care management, receive considerable federal funding for research, health care reimbursement, and training. The National Institutes of Health budget of $30.6 billion (fiscal year [FY] 2009 budget) is nearly four times Centers for Disease Control and Prevention's $8.8 billion and HRSA's $7.5 billion budget for FY 2010, and dwarfs AHRQ's $372 million budget request for FY 2010. The CMS 2010 FY budget was $818 billion, of which $811 billion was earmarked for health insurance and long-term care. These numbers are profoundly staggering, they are also depressing.


The reality is that only HRSA explicitly mentions management as one of its goals, which is odd because none of the HRSA bureaus fund projects related to health care management. Others in the Big 5 address specific health problems-disparities, access, and quality-but none explicitly mention management, although a "transformed and modernized health care system" is part of the vision for CMS. To be fair, my colleagues and friends at AHRQ would argue that a large and substantial portion of the research funded by AHRQ would fit under the rubric of health care management research. However, I do not recall ever seeing a specific request for proposals that asks, for example, a meta-analysis of best practices for managing primary care practice networks. The current focus of funding on comparative effectiveness research and translational research could be spun to address health care administrative approaches, such as institutionalizing quality improvement processes or human resource management practices related to high-quality care in nursing homes. Still, it is likely to be a very difficult sell to the Big 5.


To achieve excellence in management practice requires having access not only to basic research but also to experimental studies and research syntheses as well as the skills and wit to translate that knowledge into excellent practice. The expenditure on research to improve medical care must be complemented by expenditures to develop the most effective infrastructures. Here, I am excluding the program of funding from Robert Wood Johnson Foundation focused on health care financing. How to pay for health care is often a concern of excellent management, but certainly only one of many concerns.


I like the idea of achieving excellence in management practice. It is a laudable goal that needs science and much wider adoption as a goal. I seek to assure that the manuscripts published in Health Care Management Review contribute to achieving this goal: achieving excellence in health care management.


L. Michele Issel, PhD, RN