Healthcare, management, and the humanities

A recent commentary by Nathan Gerard argues that the humanities can offer new ways of understanding and doing research, teaching, and scholarship in the field of healthcare management. The two fields intersect in the desire to know, to understand, something about the human experience. The paper focuses on three areas in particular: “lived experiences of management”, the “tyranny of metrics”, and “confronting rather than avoiding anxiety”.

The paper’s aim is to “encourage interdisciplinary dialogue”. Gains made through such engagement could include “substantiating critical healthcare management scholarship, collaborating with humanities educators to design novel curricula, proposing alternatives to unduly circumscribed performance targets and competency assessments, creating case studies of formative experiences of practicing healthcare managers, and advancing guidelines for better managing anxiety and its concomitant stress, burnout, and compassion fatigue in healthcare organizations”.

The rationale for integrating the humanities with healthcare management (teaching, scholarship, and practice) follows from the “recognition that both the humanities and healthcare management share a basic desire to understand a complex human world” (p. 1). As noted by Gerard, the humanities perspective complements science, rationality, and evidence-based practice by “plumb[ing] the depths of human nature in a manner that invites a unique and sustained form of reflection” (p. 2).

Lived experience

Gerard suggests that the humanities and healthcare management, two disciplines that do not fit neatly or easily into “the broader ecosystem of academia”, may be able to enrich and enliven one another. For example, “the humanities may help to illuminate the immediate, first-hand encounters of healthcare managers that are often ignored or obscured by more formalized descriptions of the field” (p. 2). He notes that interdisciplinary programs like the health humanities can (re)humanize medical training – for both aspiring medical students and their eventual patients. Thus, “with education in the humanities, we many find greater value in the practice of reflexivity and questioning often overlooked implicit assumptions” (p. 3). This approach may be more important now than ever before as the implicit assumptions that drive health(care) disparities become more visible – offering an avenue for increased awareness of the power and privilege unfolding in medical encounters.

Too often, “standardized knowledge and prescribed training…devolve[e] into ‘homogenizing forms of control’ ” that overlook the lived experience of healthcare managers, medical practitioners, and their patients. The humanities can complicate the tidy packets of knowledge delivered to students in training programs with stories that convey the raw experiences exposed in medical settings. Yet, the rewards of doing so have not yet been reaped. Discussing a novel written by John Berger, Gerard writes: “For the healthcare manager, an equivalent book has yet to be written, presenting an untapped opportunity for the field to benefit from the sustained witnessing of a novelist like Berger” (p. 3).

The full benefits of the humanities for understanding the lived experience of healthcare managers, and for critical scholars in particular, lies in the power of the emotional language that emerges from knowing “human characters”.

The tyranny of metrics

Managing by the numbers is a familiar theme in organizations of all kinds. Healthcare organizations may be particularly vulnerable to falling prey to “the tyranny of metrics”, which is rooted in the assumption that ‘objective numbers’ are superior to human intuition and subjective experience. This, of course, is closely tied to the push for professionalization, which divorces knowledge from experience and yields “bureaucracy of thought”.

Gerard suggests that the humanities offer a mode of learning in which subjective judgment can be developed and the meaning of healthcare management found. For example, he notes that literature and poetry help students and practitioners understand the value of subjective judgment, empathy, compassion, and the complexities of human experience. It is through encounters with the images, feelings, and lived experiences of characters in fictional worlds that we can think through and move towards understanding the encounters in our daily lives from the inside out – learning to take the other’s perspective. Take for example John Keats and the concept of negative capability, which embodies “poetry’s potential for cultivating perspective-taking in leaders” (p. 4) – a critical skill for engaging in both field research and patient care.

As Gerard explains: “Taken together, both empathy and perspective-taking involve the passing of time coupled with a tolerance for suspense. The narrative or character arc of a novel or poem cannot be rushed without distorting the plot, and the arc itself does not easily track to a steady progression of development or the accumulation of measurable abilities suggested by competency model assessments” (p. 4). Instead, what needs to be developed is the ability to “sustain reflective inaction”, to observe, and to listen despite the pressures and rush of healthcare settings. Yet, as Gerard notes, “when the pressure is on…to meet targets based exclusively on the measurement of outputs, the ‘default’ position tends to be control” (p. 5).

In sum, offsetting the tyranny of metrics involves managers, researchers, teachers, and students learning how to tolerate anxiety, stay with the suspense of getting to the right answer, and be willing to be wrong. Citing a study by Lips-Wiersman and Morris, Gerard writes: “As the authors observe, ‘participants had clearly articulated beliefs that coming to terms with an imperfect self in an imperfect world is of existential significance’ and that ‘work is considered to be more meaningful when one can be aware of imperfections, not knowing’ “ (p. 5). And yet, such (not) knowing can be anxiety provoking.

Confronting anxiety

Healthcare workers at all levels face anxiety provoking situations including the pressures of accreditation, the need to perform at a high level of competence at all times, and the suffering of patients. But, according to Gerard, “accessing our incompetence may be precisely what is needed in the face of overwhelming suffering—a reality the current COVID-19 pandemic has made all too real” (p. 5). The pandemic highlighted the vulnerabilities of healthcare systems and simultaneously renewed recognition of healthcare organizations as spaces where individual identity, systemic oppression, power, and privilege intersect and unfold. Gerard notes that “conversations about the field’s complicity with systemic oppression are just beginning, [but] the humanities have yet to be considered as a platform to facilitate such a dialogue” (p. 5). He points out that such dialogue promises to bring “humility, nuance, and psychological depth” to the conversation and “counteract the common tendency to resort to polarizing” (p. 5).

Gerard points out that organizational and institutional demands drain healthcare professionals of the energy required to pursue the “higher calling” that brought them into the field. Yet, he contends that “underneath such ‘managerial fatigue’ is perhaps a more subtle yet institutionally entrenched demand to avoid rather than confront the anxiety stirred up by giving, receiving, and managing care” (p. 6). Here Gerard offers the novel One Flew Over the Cuckoo’s Nest as an example of how anxiety is (mis)managed in healthcare and “particularly the way a debilitating system compromised one’s managerial responsibilities” (p. 6).

Ultimately, such stories are one way we (researchers, teachers, scholars, consultants, practioners) can “put healthcare managers back in touch with their own ‘story’—whether that be the calling propelling them into the profession, the vulnerability that joins them with those in need, or the capacity to absorb the shocks of the pandemic and persevere” (p. 6). Importantly, they also offer a way to “challeng[e] the entrenched view of the healthcare manager (and the organization [they] oversees) as a disembodied entity, free from anxiety, replacing this with a more capacious view that includes hope, despair, and resilience” (p. 6). Thus, reminding us that being effective requires us to bring our whole selves to organizational practice.

In short, the humanities offer space for reflecting, waiting with ambiguity, and exploring creative options – “containing spaces where anxiety can be felt, explored, and worked through as a basic facet of our shared humanity” (p. 7).

We invite you to share your thoughts and stories with us. What is your lived experience of the tyranny of metrics? What happens to your anxiety in your work? What is the last story that inspired you?

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