1. Issel, L. Michele PhD, RN

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As health professionals, we know that despite the level of expenditures for health care in the United States, many of the national health statistics fall below the global 10th percentile. As a nation, we are not particularly healthy. This reality is the backdrop of two recent national initiatives. One comes from the American Public Health Association; "Healthiest Nation in One Generation" seeks to change our global standing with health as the ultimate goal for the population as a whole. The other, "Advancing a Culture of Health," comes from the Robert Wood Johnson Foundation (Lavizzo-Mourey, 2014). The slogan reflects awareness that our health care system is actually an illness care system and that having a culture of health becomes the basis for improving population health.

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Importantly, these initiatives are grounded in the reality that you create what you focus on. These health initiatives ask us to change our thinking from a "fixing the problem" approach, such as reducing costs or eliminating harm, to a "creating health" approach by generating positive attributes, such as walking paths and affordable care. I am reminded of Russell Ackoff's (1981) approach to strategic planning; he advocated for starting with a clear vision of the final product, the flip side of focusing on what to avoid.


To the extent that the Robert Wood Johnson Foundation initiative will have any influence and be reinforced by the population health and prevention focus of the Affordable Care Act, the relevance to health care management could be noticeable. For example, heath care managers may need to find ways to make health promotion (more) profitable. Accreditation criteria could evolve to include a greater emphasis on the variety of services that promote health of populations rather than of individuals. Also, as health care organizations increase the services and programs with an emphasis on health, a corresponding change in the workforce will be needed. An emphasis on the profile of health in the local market could have implications for strategy and capital investments.


A culture of health has relevance and implications for health care management researchers. Some existing lines of research, such as the study of the mission and strategy of health care organizations, could experience opportunities from natural experiments. Many new questions will arise. For example, what do we know about the relationship between costs, profit, and population health? In order to answer more nuanced versions of that question, health care organizations may develop and contribute to new definitions of health, particularly for the served and unserved populations. Health care organizations may seek new metrics about population health that capture the local culture of health and ways to document their contribution to the change. In a culture of health, how will the demand for services change, and what changes to the workforce in terms of skills, knowledge, and motivation are needed to participate in creating and sustaining a culture of health?


The potential changes from these two initiatives provide opportunities for both health care management researchers and Health Care Management Review to generate and disseminate relevant, useful evidence that enable health care management and administration to consciously contribute to a culture of being a healthy nation.


L. Michele Issel, PhD, RN






Ackoff R. (1981). Creating the corporate future. New York, NY: John Wiley & Sons. [Context Link]


Lavizzo-Mourey R. (2014). Retrieved from[Context Link]