This Professor Wants Healthcare MBA Students to 'Think Like They're Playing Chess'

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As you consider your career in healthcare management, Tom King wants you to "think like you're playing chess... beyond two or three moves." That sort of thinking, he expects, will lead you to the same decision he made 30+ years ago: to pursue an MBA so that ultimately "you'll be in a leadership role where you'll have significant decision-making authority."

King is just one of the many esteemed faculty members you'll encounter when you enroll in the Online MBA with a Healthcare Management Track at the Case Western Reserve University Weatherhead School of Management. He's chair of the accounting department and, as you'll see in the interview that follows, an ardent Case Western Reserve booster.

The Case Western Reserve MBA will "build your management skills, to get you to think like a member of an organization." The program is "strategy and leadership based," focusing more on long-term planning and vision than healthcare administrators' day-to-day responsibilities. Business core courses include accounting, statistics, financial management, economics, marketing and operations. With classes in innovation and entrepreneurship, healthcare decision-making, patient experience and healthcare regulation, the healthcare core zeroes in on the healthcare field and managing healthcare systems.

"I want you to choose our healthcare management program so that, as your career unfolds, you'll be better prepared to serve in a leadership role where you'll have significant decision-making authority. Your actions will set precedents and have all sorts of ripple effects on health policy and practice."

We sat down with King to talk about his career, the challenges and rewards of teaching accounting, the future of online education, and, of course, the Online MBA with a Healthcare Management Track at the Case Western Reserve University Weatherhead School of Management.

You weren't always an academic. How did your journey bring you to the accounting department chair at Case Western Reserve University?

In high school, I wanted to be a historian. About six weeks into my freshman year of college, I realized that I didn't have the temperament for it; I'm too extroverted. I can't spend 10 hours a day, six days a week in a library carrel, reading documents. I'm not wired for that.

One of my summer jobs introduced me to the world of public accounting. Eventually, I wound up at one of the big eight accounting firms in New York City; that was 1982. Within three years, I had figured out that the good Lord did not want me to be an auditor.

Business school was the place to retool, so I went to Harvard Business School. I started interviewing with companies that recruit at HBS, and landed a job at Progressive. It was a great experience, but by the time I had reached my mid-40s, I knew my career trajectory there had reached its limit.

Creating a liberal arts approach to thinking about accounting was always on my bucket list, so I wrote More than a Numbers Game: A Brief History of Accounting and got it published. Because of the book, a professor at Case Western Reserve University contacted me. We started talking, and then I found myself as an adjunct instructor. I was drawn back into the academic world.

I went back to school at middle age to get a doctorate, and I came up with another plan. I would move to a sleepy Southern town, buy a Victorian house with a picket fence, wear a tweed jacket with leather patches and have students come over to sip sherry and discuss politics or history. Well some casual conversations led to my securing an appointment at a CWRU which turned into becoming department chair — almost the last thing I expected to do.

The lesson is: Be careful as you strike up conversation with others. Whether it's a blind date, shopping for a car, looking at new houses, interviewing for a job, it doesn't matter—if you start talking with people, the probability of something unexpected happening is greater than zero.

Accounting is not the easiest subject to teach. It's technically challenging, and some students find it boring, or they may think, "I don't really need this." How do you get through to those students?

I focus on the why rather than the what. Every accounting problem deals with issues associated with human interaction. Accounting is about people, not debits and credits. Accounting is a language that helps people come together to accomplish a common goal.

The fact that there are numbers that go into rows and columns that add across and down causes some people to think that accounting is a science with a “right” answer. We're absolutely not studying science. So if you tell me, "I'm not really quantitative," I say, "You're in luck. This is the perfect venue for you to learn about management." Learning a language simply takes time and effort. If you learned English, you can learn accounting.

To make this language less scary, I try to simplify things. I say: “OK, there are four kinds of controversies that ensnare all of accounting. If you understand these controversies, you can sort through any accounting issue.” Learning accounting isn't about putting numbers into boxes; it’s about finding ways to send and receive information about economic performance and prospects.

So, we study four controversies. First, recognition. Did something happen? Imagine that you keep a journal to record the day’s events. What do you write down at the end of the day? You cannot possibly write down everything that happened to you. There simply isn't enough time. So you decide to commit to paper those things that are sufficiently important. That's recognition.

Next comes valuation. We deal in numbers because we need to make comparisons. Let's say I want to record a value for your house. I could look up what you paid for it. I could go to Zillow and secure an estimate based on an algorithm. I could talk to realtors or prospective buyers. I could ask a home insurance company what it would cost to replace your house. I could speak to the tax authority. So now I have a lot of numbers. Which one is "the answer"? Well, there isn't just one. That's the valuation problem.

That brings us to the third controversy: classification. What terms do we use to describe the number we're recording? Where in the geography of the financial statements do we put words associated with numbers? All recordkeeping is storytelling. What words you use and where you present them is anything but neutral. Look at Enron: They wanted to keep debt off their balance sheet, so they used a lot of classification issues to pretty up their financial statements. Some found the storytelling used by Enron executives as disingenuous.

Finally, there's disclosure, the sharing of information with others. Managers know much more about their organization than do outsiders. What information should be disclosed and when should it be shared? Answering these questions invokes all sorts of economic, legal, and moral questions.

Think about J&J and the COVID vaccine. They give the vaccine to 7 or 8 million people, and a dozen people get blood clots. That's like one in a million, a very low probability. Do you disclose it? The argument in favor is that it promotes transparency and shows you have nothing to hide. The argument against is that now every media article on the J&J vaccine leads with blood clots. Some people freak out, refuse to get vaccinated, and slow efforts to contain the pandemic. What’s the right thing to do? There's no single right answer.

Your research focuses on disclosure policy as it relates to earnings guidance. I take it that's a subject near and dear to your heart. What else should students understand about it?

Earnings guidance is really part of the broader issue surrounding the sharing of projections. As an outsider to my organization, you want to know how I'm doing. If I want you to invest, I owe you some sort of forecast or projection. So I will give you a number. I say we'll hit $1 per share at the end of the upcoming quarter.

When it’s time to close the books and report those quarterly earnings, it turns out we earned 98 cents. And you ask me what's up, and I say, "Well, I was a little off; predicting the future ain’t so easy," and you ask, "What else are you off about?" So you get the challenge here. If I provide guidance and don't meet it, that brings suspicion and more questions. But if I don't provide guidance, that's bad, too, because you’re wondering what I’m hiding. I could offer very conservative projections, but that would create downstream credibility issues, stock price volatility, and other concerns. Or, I could do dumb things to make sure that reported results matched previously issued projections. There are many ways for guidance to send an organization off the rails.

Guidance is a special case of the disclosure controversy: I want management students comfortable with the issues associated with these concerns. I'm not teaching you how to do something or not do something. I'm getting you to open your eyes to the fact that this is a really complicated world populated with all sorts of stakeholders who want different things.

Accounting is the first written language, emerging in the Fertile Crescent. People were raising different animals and crops. They needed a way to keep track of all that: what they had on hand, what obligations they had and so on. Every single problem you can have with a document written in English applies to accounting as well. We need leaders who understand that accounting is not just putting numbers in boxes and that there are real consequences of sorting through this language's nuances.

What happens when things go wrong? Well, let me give one example identified by another academic. There's a concept in psychology known as surrogation. Surrogation means that you confuse a measure with the idea behind the measure. At Wells Fargo, they got the idea that they would make more money if they could cross-sell products to clients. Your customer has a checking account? Try to enroll them in a wealth planning program or a savings account. If we can get you to sign up for three or four products, you're locked in, you'll stay with us.

Wells Fargo used accounting to set goals. They said: "Let's have X number of products per customer. We can create a rewards system to do it." Suddenly, we're now focused on how many accounts the customer has, and we've lost track of the business goal. And then, really dumb things happen, where employees create these fictitious accounts to boost numbers. It's just horrible.

"A well-constructed part-time online MBA degree gets people to think about these issues. And that's the difference."

What's important to me is to offer a liberal arts approach to understanding accounting; not the technical rules, not the debits and credits. It's not the LIFO versus FIFO thing; that's almost incidental to the broader issues of what we're trying to do. Some instructors are so focused on teaching to the CPA exam that students start memorizing and then plugging and chugging their way through tests, and they're not thinking. They don't have any idea why they're doing what they do. What we're trying to do here is to pull the camera back and encourage students to think broadly.

So now you're teaching online. What are the benefits of learning online?

There are cool things about Zoom. First, you can poll the audience quickly, which is powerful. You get rapid feedback on a debate topic and to assess how students are thinking.

The second amazing thing is you can have a student share documents quickly. If someone does a piece of analysis and someone else doesn't get it, the first student can share and show. It's very efficient.

Breakout groups in Zoom are also really cool. What I really love doing is starting fights in the class. You said X, she said Y. You can't both be right, but you can both be wrong. You can separate a class into 10 smaller groups to sort things out. It gets people engaged and thinking.

Also, I love how easy it is to record. Every session gets recorded without any effort, and students can review material afterwards, if they so choose.

On the downside, there can be Zoom fatigue. At some point, people get tired of engaging online. They want human interaction. They don't want to see me; they want to see their buddies.

One thing's clear, though: The genie is out of the bottle. All future education is going to be hybrid in some form. Online instruction is here to stay.

Let's say a student is on the fence, deciding between a healthcare MBA program and a Master of Healthcare Administration (MHA). What is the argument for the MBA?

A specialty master's degree program, like an MHA, is a deep dive into a narrow slice of something. There's no right or wrong answer. It depends on what you want to do.

Specialized master's programs are typically 30 semester hours worth of work, maybe 10 courses. You'll do a very deep dive into specific things there that are extremely useful in the early stages of your career. So in the case of the MHA, that would be a deep dive into healthcare organizations.

A healthcare management MBA has a different goal. That's why it's 48 semester hours. We're going to require coursework that doesn't fit into simple domains, like accounting and finance and marketing and operations, and so on. We're trying to build your management skills, to get you to think like an engaged member of an organization. This organization has a mission. What is the mission? How can I contribute? Management is about bringing people together to accomplish common goals. It sounds so simple, but how many organizations do you know that you would consider well-managed?

It is phenomenally difficult to have a well-managed organization. So for an MBA student, I want you to think like you're playing chess. I want you to think beyond two or three moves. This is a foundational investment for your career. I want you to choose our healthcare management program so that, as your career unfolds, you'll be in a leadership role where you'll have significant decision-making authority in future years. Your actions will set precedents and have all sorts of ripple effects on health policy and practice.

A well-constructed part-time online MBA degree gets people to think about these issues. And that's the difference.

Final question: Why Case Western Reserve University? What makes it unique?

No two schools are the same. This is what makes Case Western Reserve distinctive: Case Western Reserve was formed from the federation of Western Reserve University and the Case Institute of Technology.

Western Reserve dates back to 1826. If you want to talk about inclusion, I will match our heritage with any school you name. We started in Hudson, Ohio, a terminus on the Underground Railroad. In 1854, Western Reserve College invited Frederick Douglass to be our commencement speaker. That’s a century before Brown v. Board of Education was written. Howard University wasn't even a concept in 1854.

Nancy Talbot Clark was the second woman in the United States to get an MD degree. She got it from Western Reserve. Johns Hopkins can't say that. Harvard can't say that. Mayo can't say that. We can.

Case Institute of Technology is about analytics. What made it so special? Albert Michelson, the first American to win a Nobel Prize in Physics, was one of us. We're the home of the Michelson-Morley experiment, which is like a Victorian MacGyver story. These guys used 19th-century technology to measure the speed of light. That was some trick. Results from the experiment helped shape Einstein’s thinking on relativity.

We're also home to T. Keith Glennan, the first administrator from NASA. What is the greatest accomplishment in the 20th century? My vote is Apollo 11, landing men on the moon and returning them safely to the Earth. Who established the organization that pulled off this thing? One of our own.

So imagine what happens when you have inclusion from Western Reserve and analytics from Case, and you bring it together. Whoa!

The Weatherhead School of Management was the first organization to offer a PhD in organizational behavior and the first university to offer a PhD in operations research. These disciplines are at the complete opposite ends of management education. We have been an innovator in a number of fields in management, particularly the study of how business may be an agent of world benefit. That would not have been possible without combining the inclusiveness of Western Reserve and the technical chops of Case Institute technology.

That's what makes us unique.

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