In his usually provocative Web site Health Care Renewal, Roy M. Poses, M.D., writes, in his often mordant style:

“Last week, the New England Journal of Medicine published an article by Bock and Paulus describing an innovative program at Mission Health in Asheville, N.C., to expose health system board members to the real world of healthcare.  The article was nice, but begged an important question: why was such a program {called ‘Immersion Day’} necessary?”

“The article asserted:

‘The U.S. healthcare industry has long been beset by seemingly intractable problems: incomplete and unequal access to care; perverse payment incentives; fragmented, uncoordinated care that threatens patient safety and wastes money; and much more.’

“So the hypothesis on which the program was based was:

‘These challenges are particularly vexing to the people who oversee or set policy for healthcare organizations. The disconnect between health care in its intimate, real-world setting and the distilled information delivered in the boardroom or policy discussions is a key barrier to responsive governance and policymaking. Sometimes seeing with new eyes can l’ead to transformational understanding.’

“So Doctors Bock and Paulus came up with the idea of providing basically provided a one-day clinical immersion program to members of the hospital system’s board of directors.

‘we created ‘Immersion Day,’ when board members and thought leaders could spend 9 to 12 hours in scrubs, behind the scenes, immersed in the nuances of care delivery.’

“But the article begged the questions of why this is news? The article stated that there is a big ‘disconnect’ between what is discussed in hospital board rooms, and the health care that goes on in hospitals day by day.  Furthermore, it stated that many hospital board members had no direct experience with health care.  Instead, the article described the non-physician board members, who were by far in the majority, as ‘educators, attorneys, manufacturers, investors, and bankers.’ It did not say why the majority of people responsible for the governance of a healthcare organization had no direct familiarity with healthcare.  That does not seem to make sense.  So why did it take so long to try to give them such familiarity, and why would a program to do so be newsworthy?”

“Hospital boards whose members are unfamiliar with health care may reflect hospital management that is similarly unfamiliar with health care. In fact, most hospitals and hospital systems, like most U.S. healthcare organizations, are not led by healthcare professionals.  Instead, they are led by generic managers, following the dogmas of managerialism.”