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Weekly UpdatesCurrently the Gerhard Hartman Professor of Health Management and Policy at The University of Iowa, Dr. Samuel Levey, LFACHE, started his healthcare career in 1958 as an administrative associate at University of Iowa Hospitals and Clinics. Since then, he has served the healthcare field in various ways.
He was the division director for the Massachusetts Department of Public Health (1963-1967), the assistant director of medical care planning at Harvard Medical School (1967-1968), and the deputy commissioner of the Massachusetts Department of Public Welfare (1968-1969). While in these positions, he was also a lecturer at Harvard University's School of Public Health. Dr. Levey was a professor in and director of the graduate healthcare administration program at City University of New York (1969-1973) and professor of administrative medicine at Mount Sinai School of Medicine (1973-1977). His teaching credits at The University of Iowa's Graduate Program in Hospital and Health Administration (now the Department of Health Management and Policy) began in 1960, when he served as assistant professor, and resumed in 1977, when he became professor and head (until 1991) of the program.
Dr. Levey has written books on healthcare administration and the history of the University of Iowa's health system. His research articles appear in numerous scholarly journals; these topics are wide-ranging, spanning healthcare coverage for children to leadership development to hospital-quality assessment. He earned an undergraduate degree in psychology from Bowdoin College, a master's degree in psychology from Columbia University, a master's degree in public health practice from Harvard University, and master's and doctoral degrees in hospital and health administration from The University of Iowa.
Dr. Grazier: You have had an illustrious career. Please tell us about your beginnings.
Dr. Levey: I grew up in Cape Town, South Africa, and immigrated to the United States after high school. Those early years triggered my interest in healthcare and continue to influence my view of equity in healthcare delivery. In South Africa, I saw dreadful living conditions among the poor that made me very uncomfortable. There was segregation of course, and prevalence of disease among the non-white population was appalling. South Africa did not and still does not have a universal healthcare program, an unfortunate condition it shares with the United States.
When I arrived here, I majored in psychology at Bowdoin College in Maine. I went on to earn a master's degree in experimental psychology from Columbia University in New York. A faculty member at Columbia told me about Gerhard Hartman, the then superintendent of University of Iowa Hospitals and Clinics, who had started a program in the emerging field of healthcare management at The University of Iowa. Hartman's program offered the nation's first doctorate in healthcare management. In looking into this opportunity, I met with several hospital administrators, including Richard Viguers, the CEO at Tufts Medical Center. Eventually, I left for Iowa. Hartman recognized the need for prospective faculty to obtain experience in the field before they could teach practice-oriented courses, a philosophy I still agree with. While working on my PhD, I served as administrative resident and then as administrative associate for University of Iowa Hospitals and Clinics. In 1961, I received the doctorate and was promoted to assistant professor in the program.
Dr. Grazier: After your doctoral work, you did not stay in academe. Tell us about your work in Massachusetts.
Dr. Levey: In 1962, I enrolled in Harvard University's School of Public Health's master's track because I thought my public health knowledge was limited. While there, I was approached by Dr. Alfred Frechette, the commissioner of the Massachusetts Department of Public Health. He offered me a position that introduced me to licensing and regulation in the health field. After a while, I took on the job of reorganizing the department's division of licensing of nursing homes and related facilities. Later, I participated with Senator Edward Kennedy in developing the framework that created the national requirement for licensing of nursing home administrators. For about a year, I took a leave from government work to be involved in the Harvard Community Health Plan, started by Jerome Pollack and the dean of the Harvard Medical School. Afterward, it was back to government, as I became the first director of Medicaid in Massachusetts, another challenging position.
Dr. Grazier: How have your South African upbringing and American healthcare experience influenced your teaching and research ?
Dr. Levey: As a boy in South Africa, I had visited the local free dispensary, a place for indigent patients to get ambulatory care. In part because of that and similar experiences, I became interested in healthcare reform issues. I have written several articles on universal healthcare, specifically about the uninsured and the fact that in the United States we have been equivocating on national healthcare for a long time. A change in the healthcare system and insurance coverage needs to happen, and I think our new president will take on this challenge.
The first management book I read was The Human Problems of an Industrial Civilization by Elton Mayo. This book was a forerunner in the human relations school of management. It captured my interest because of the injustices I saw in South Africa and because it spoke persuasively regarding the relevance of human factors and the importance of treating individuals fairly.
Since then I have collaborated with many colleagues in an attempt to advance understanding in healthcare management. With Paul Loomba, I coauthored Health Care Administration: A Managerial Perspective which The Lancet referred to as the first text on healthcare administration, not merely hospital administration. More recently, my research has focused on governance, leadership, and quality--areas that need vast improvement.
In the 1950s, quality improvement in hospitals was perfunctory. When problems occurred, not much effort was made to correct them. We have made tremendous progress in performance, productivity, quality, and safety, but we have to do much more because rhetoric often outpaces actions taken. Boards should take more responsibility for quality, but many of them do not have training to take on this task. Greater investment in educating governance is imperative. Several years ago, I and several colleagues from Iowa, CMS, and other organizations began developing an instrument that can give feedback on how hospital leadership is helping to improve quality in their own organization. Called HLQAT[C] (Hospital Leadership and Quality Assessment Tool), this tool is self-administered and may be used by boards, senior leaders, and middle managers. The findings from this assessment tool can then be correlated with quality data in the CMS database or other sources.
Dr. Grazier: In your years as a healthcare insider, what particular management trends or practices have you noticed?
Dr. Levey: The commercialization of leadership training is one trend. Many leadership programs charge large amounts of money to teach questionable theories and approaches. It is a business school effect, so to speak, and it argues that everything can be measured and explained by causal mechanisms. According to this school of thought, the methods of the physical and biological sciences can be applied directly to management practice. The problem with this is that it marginalizes the human and social science factors of healthcare administration. It ignores the basic differences between business and healthcare. As we know, healthcare does not fit conventional models. How much do healthcare leaders know about the management research in their own field? What do they know about the impact of such research on their everyday practice? We are in trouble as a group if our leaders follow management concepts that are not infused with a great measure of common sense. But, as someone else has said, "common sense is quite uncommon."
Another development that has been widely publicized, and frankly has shocked me, is the extent of corruption in the field, brought on by narcissistic and selfish behaviors of some healthcare leaders. AHERF, HealthSouth, and other egregious examples occur far too often.
New trends and challenges will continue to arise in the field. In the 1960s and 1970s, several highly regarded magazines, such as Fortune, Saturday Review, and The Atlantic, expounded on the "crisis" in healthcare. We are still crisis-driven, almost 50 years later. Maybe the reason for that lies in the complex nature of our field. Universal healthcare proponents will argue that enactment of national-coverage legislation will attenuate this crisis mentality.
Dr. Grazier: What can academics and administrators alike do to alleviate this ongoing crisis and in that way advance the practice of good management?
Dr. Levey: Let me respond from a public health perspective. We have to rethink our priorities. Managers in the trenches are so occupied with maximizing returns that they may forget to provide resources for community problems or population health. Meanwhile, schools of public health have often not made sufficient efforts to develop and promote health policy. More faculty should be working closely with federal and state governments to bring about healthcare reform as well as conducting research to upgrade management practice.
Most important of all is that we can all benefit from rediscovering our healthcare roots: We are here to serve.
Dr. Grazier: What are the keys to a long and successful career in healthcare management?
Dr. Levey: My liberal arts background gave me the breadth of knowledge that helped me tackle problems from different perspectives. Management is based on many disciplines, and I emphasize this in my teaching. In healthcare, mentors, interpersonal relationships, and networking are critical, and so are strong technical, analytical, quantitative, and communication skills. Adaptability is a must, because healthcare is filled with authority figures, difficult personalities, fast-paced changes, and different cultures.
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