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Value Added of Management to Health Care Organizations.

A current ideology in health care underscores providing value-based health care. The concept of value-based service has been applied primarily to development of reimbursement models for health care delivery. In contrast, the concept of value-added, although having both marketing and intuitive appeal, has received less explicit attention or application in health care. Questions of the value added by administrative costs has been addressed in health services research by looking at the cost of coding and billing services. Similarly, the value added by health information technologies has focused on benefits to patients or providers against cost of implementation and adoption. Going beyond these specific and bounded examples, we could ask more broadly, what is the value added of managers and administrators in health care organizations? We have partial answers to this question. For example, evidence supports the key role of managers play in maintaining employee satisfaction and minimizing turnover. But, that economic benefit is rarely framed as value added of the managers. Similarly, the role of managers and administrators in supporting quality improvement also has been shown to benefit the organizations, with the value being attributed to the quality improvements rather than the administrative support. Likewise, magnet status certification for hospitals and clinics has benefits for the organization, with implicit attributions of value to the administrative support. Many of us ideologically believe that managers, leaders and administrators add value to the health care enterprise, often based more on anecdotal evidence than longitudinal, rigorous research. This leads one to ask, what does the science of health care management, leadership and