The business of health

As market forces take root in today's health service, an MBA has become increasingly relevant

Craig Linton looked at a number of possibilities for extending his work-related learning before making his final choice. "But it was the MBA that seemed best for me, and best for the organisation I'm working for. I've learned a lot, and my boss is very pleased with some of the things I've brought back from it."

Linton is one of a growing number of people working in the health sector who are deciding that this hard-nosed qualification - once mainly the province of management consultants and investment bankers - is exactly what they need to move up the ladder in their own rapidly-changing world. In a field where foundation hospitals, public-private partnerships, and dynamic new models of patient care are fast becoming the norm, they figure that people with cutting-edge leadership skills, who understand a broad range of management disciplines, and know how to manage change, are likely to be very much in demand.

Linton, 25, works as corporate fundraising manager for St Teresa's Hospice, in Darlington, but sees himself ultimately as rising to be the chief executive of this or a similar organisation. He is half-way through a specialist MBA (Health and Social Services) run jointly by Leeds University Business School and the Nuffield Institute, and already finding it useful.

"I've been able to apply some of the marketing principles I've learned, looking at our strengths and weaknesses, at our areas of competitive advantage, and how we can improve our relationship with donors. I've become far more critical of what do, and how we can improve it. The charity sector is worth billions a year, and it needs to be well-managed. The donors deserve that."

The course includes general modules on marketing and finance, alongside specialist ones looking at policy, finance and management in health and social services. For him, this blend is exactly right. He enjoys the cut and thrust of seminars with managers from organisations such as the HSBC Bank and McDonald's - "we've had some lively discussions about things like how the health service is perceived" - but also values the chance to study things which are directly relevant to his day-to-day life.

"Some things about health and social services are completely different from the private sector," explains John Lawler, the course's programme director. "The mechanisms for generating income are completely different, and in some areas you've got what you could call deliberate de-marketing. You don't want more children in care, for example. In fact, you positively want to keep the numbers down."

Leeds offers the only specialised health service MBA in the country. However, public sector MBAs - run by a handful of institutions including Imperial College Management School and Cranfield School of Management - attract many healthcare workers. At Aston University, students on the public sector management course can study 60 hours of health-related subjects, including policy, strategic planning, forward planning and finance. Jill Schofield, senior lecturer in the public management and sociology group, says probably half of the health workers who sign up for it are nurses, "ward managers, senior nurse practitioners, clinical specialists, people like that. We also have engineers, pharmacists and lots and lots of all the therapies."

The course has been running for more than 10 years and in that time she has seen the emphasis swing from writing business plans and contracts, to questions of joint working and public-private partnerships. "There's also an increasing amount of user-emphasis. The focus, now, is on the patients."

But even for students on public sector courses, there is much to be learned from pursuing some modules alongside students from the for-profit world. Mark Fenton-O'Creevy, director of the masters programme of the Open University Business School, points out that, just as businesses need to analyse exactly who their customers are, so too do healthcare institutions. "Is it the patient who is the consumer, or the funder, who is paying?" Also, when people work with others from outside their sector there can be, he says, "Those 'road to Damascus' moments when people suddenly see things in quite a different way. There is some quite profound learning which goes on from each other. People customize what they are getting, and apply it to their own organisations."

Former Open University MBA student Mary Roberts, service improvement manager in the Central Manchester and Manchester Children's University NHS Trust, agrees. "I don't think that there's that much difference between public and private sector people any more. We've all got performance targets now. We all focus more on patients and customers. The finance module wasn't that relevant to my work, but doing new things and working with people from different sectors gets you thinking out of the box."

She took the course over three years, partly for interest and partly to strengthen her curriculum vitae. "Most jobs you go for now ask for a higher degree." She also hopes it might ultimately lead her in the direction of a job lecturing in healthcare.

Stefan Cantore, co-director of a modernisation team looking at health and social services in Brighton and Hove, also took the course to support his career, and gain confidence in new fields. "My interest has always been in organisations, and organisational behaviour and change. This course covered that, but also took me in new directions. It also seemed to me to be a robust currency both within the health service and outside, should I want to change."

Some health service workers may opt for an entirely mainstream MBA, believing it to be a more "portable" qualification. According to David Browne, director of MBA programmes at Middlesex University, applicants should remember that almost all MBA students use their own working world as the context within which they study management theories. Middlesex at one time planned a specialised course, but then shelved it. "The aim must be to get the benefits of both generality and 'flavouring'."

However, these days sheer affordability is likely to be the first thing on any prospective student's mind. Doing any sort of MBA is a huge investment for those on a public sector salary. At one time, the Department of Health had money available for such courses. Now funds have seeped away in other directions. New kinds of health care leadership courses are proliferating, and a new health service university, working in partnership with established higher education institutions, is being set up. Meanwhile, MBA fees are rising. Leeds now charges £13,000 for its health management MBA, and numbers are down as a result.

So is it really worth the investment for a cash-strapped health sector worker? Stefan Cantore believes so. "You need to look hard at the design of the programme, and think about whether it fits with your aims. But I'd say nothing now crosses either my desk or anyone else's desk that I'm worried that I'm not going to understand, or don't feel I have a grasp of."