1. Issel, L. Michele PhD, RN, Editor-in-Chief

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Managing a health care organization is challenging, but recent events portent of even greater challenges. The horror stories that circulated after Hurricane Katrina about hospitals, health professionals, and nursing homes don't need repeating, although the collective set of stories do deserve reflection and outright strategic and policy analyses. Three themes emerge across the stories that pertain to the mission of Health Care Management Review (HCMR) and to health care management research overall.

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One theme centers on the extent to which the unexpected was anticipated. A substantial empirical body of work delineates ways to create fail-safe organizations. Weick and Sutcliffe1 made this knowledge readily accessible for practicing managers. Yet, many stories detailed the ways in which health care managers had not anticipated the unexpected. Tornados, earthquakes, floods, blizzards, volcanic eruptions, power grid failures, and radioactive and chemical toxic releases are never scheduled. Yet, the possibility exists. None of us like these possibilities in our lives, but we would like the consequences even less if we do not go through the "what if" scenarios and make preventive corrections. Our health care organizations first must have the capacity to self-protect, and second to provide essential health care.


Another theme concerns the reliance on an "official response," which was not forthcoming. Health care organizations, by the nature of their function, are part of the official response. This is another uncomfortable reality. In addition, professional ethics of medicine, nursing, and other health disciplines guide professionals to do what is needed for the health and well-being of their patients. In extraordinary circumstances, this can conflict with self-preservation. Although there is no clear resolution to this, being prepared includes prior discussions of the ethics involved in being part of the official response while experiencing the unexpected.


The last theme is that catastrophes happen every day. A daily catastrophe is the profound health disparities between black and white, between privileged and underserved. The total number of deaths from Katrina was 411 as of September 12, 2005.2 Compare this to the death rates for African Americans versus whites for diabetes (49.5 vs. 23.1 per 100,000), HIV (22.5 vs. 2.6 per 100,000), and infants (13.5 vs. 5.8 per 1,000).3 We pay attention to the catastrophic because it is dramatic. A key heuristics of decision making4 is that we tend to overestimate the importance of rare events. Being aware of this human proclivity ought to alert us that preparedness must focus more on the common events and the chronic illnesses that populate our hospital beds and waiting rooms, and to address the racial and ethnic disparities in health status of patients that populate our hospital beds and waiting rooms.


HCMR aims to provide practicing health care managers and administrators knowledge to not only do the business of health care more effectively, but also to prepare the business of health care for both the expected catastrophes of chronic illnesses and the unexpected events of nature and man.


L. Michele Issel, PhD, RN






1. Weick, K.E., and Sutcliffe, K. Managing the Unexpected. San Francisco: Jossey-Bass; 2001. [Context Link]


2. Dewan, S. (2005). Storm and Crisis: Bodies; Identifying Hurricane Dead Poses Unusually Daunting Challenges. New York Times. September 12, 2004. [Context Link]


3. National Center for Health. Health, United States, 2004: With Chartbook on Trends in the Health of Americans. Hyattsville, MD; 2004. [Context Link]


4. Tversky, A., and Kahneman, D. "Judgement Under Uncertainty: Heuristics and Biases." Science 185, (1974): 1124-30. [Context Link]