CONTEMPORARY ISSUES IN HEALTHCARE MANAGEMENT RAJU AJMEERA UNIVERSITY OF HYDERABAD

• Healthcare management essentially describes the leadership and general management and administration of hospitals, hospital networks, public health systems and/or health care systems.

• It is also referred to as "Medical and health services management", "Health systems management“, "Healthcare systems management" or 

"Health Administration".

Healthcare Management

HEALTH CARE SPECTRUM

• The Domain of Healthcare is distinct because of the uniqueness of their –

product, people, Processes, Structure, Technology & Quality

Do we require Healthcare Managers?

The variety and range of products may include laboratory, radiology, cardiology , surgical services. The services must be mixed and matched according to the specific need

The process seldom occurs in standardised manner.

Consumption of one product often leads to another.

Products

Hospital environment brings both problems and opportunities, as it deals with knowledge workers in many fields (doctors, technicians, nurses, hospital executives, financing, marketing and material personnel.)

Decision made in hospital are critical to a degree incomparable with any other business as it deals routinely with problems that result in life and death.

People

The healthcare process begins with consulting the doctor about the ailment and can sometimes end in invasive surgery and intensive care in hospitals.

Can never have a standardized process

Process

The organisational structure of a hospital is neither pyramidal, steep, nor flat like a matrix. But is rather like a galaxy where small spheres and clusters comprise a whole system.

The locus of control within the galaxy is continually changing.

Each time, unique teams are assembled from a different combination of specialists, doctors, technologists and expert nurses.

Structure

The greatest medical and technological advancements in the history of hospital care have happened in the past two decades

50% cost goes into technology while setting up a new hospital.

80% have a very short life span.

New diseases and solutions emerge almost daily.

Technology

Quality is the crux of the hospital industry. Providing Quality care at an affordable price for the

steady stream of customers seeking preventive health care check ups or diagnostics or curative is a major challenge.

Quality

Contemporary Issues

The ultimate Objective of Health management is to mold numerous departments with unique person power, unique equipment, unique problems and unique yet differing view points and a general lack of finances into a smooth running machine.

Like any other Organization, Healthcare Industry has its own share of Management problems which can be classified under the following heads -

Issues inHealth

Management

strategic

Financial

Human Resource

Operations

Healthcare reform

QualityMaintenance

• Rapidly Changing Environment• Data Availability• Competition with other healthcare providers• Problems and challenges of increasing complexity, and

decisions taken can have a profound effect on the providers and receivers of care.

• Find a balance between providing outstanding care, Quality expectations and reducing operating costs.

Strategic Management

Concentration on core services that can be provided well and with more efficiency

Plans can be redundant if considered for long term objectives

Evaluation at regular intervals is a must Set realistic goals Provide Direction to the entire Organization Support and concurrence of the Board are essential

for almost every major activity

It is the corner stone for successful hospital management.

Financial Management

Although hospitals and outpatient centers hope to reduce illness and improve client well-being, these institutions are also places of business that must continue turning a profit to stay open.

Preparation of departmental budgets Consolidation Negotiation, Prioritization Decision making on essential and non essentials Precise statement of requirements and their utility -

essential to avoid “drifting in a sea of ambiguity” Make a detailed presentation to the Board and indicate a

monitoring process

BUDGETING

Standard equipment surveillance can pick up minor problems early and easily

A continuous process of training in maintenance and repair procedures is absolutely essential

Every hospital should have a maintenance organization

Records of equipment and the repair status

Annual maintenance contracts

COST CUTTING THROUGH MAINTENANCE

Helps in cost reduction Assures equal quality Effective purchase

planning Good communication

among participating hospitals

A pre-established central clearinghouse to facilitate receipt and dispensing

GROUP BUYING

Use of computers Equipment and drugs lying

un-utilized Fixing responsibilities Cost recoveries Forward planning Basis of calculations Storage Maintenance mechanisms

INVENTORY CONTROL

Avoid under utilization of staff promoting services that are

more cost-effective, yet offer the opportunity to provide more and better-paying outpatient procedures

Plan the methods of marketing – entry points, camps, exhibitions, AV aids, mass media approaches

Using satisfied customers as resources

Hospital image is the most important guiding factor

EXPANDING REVENUES

Ear marking individuals to search for assistance program

Staff inputs International, Governmental

and NGO based aid Running special programs to

generate revenues

• Access to affordable, high-quality healthcare is far from a given for millions of people

Healthcare Reform

• Changes in culture of staff and their expectations

• Shortage of qualified skilled personnel• It is easy to get attached to facts and

figures and we eventually lose sight of the human aspects.

• We some times place too much emphasis on the end result no matter how it is achieved and we inadvertently create a human relations nightmare

Human Resource

In medical facilities, there's usually one leadership position in each specialty. Most of the time, the person promoted into management has technical skills, but not leadership skills.

Because of shortage of staff, scheduling issues and monetary considerations, leadership training isn't a high priority. Therefore, there's a lack of true leadership and good management, which means staff have to rely on learned skills rather than good direction.

Leadership

Finding the right people for the right job Effective communication techniques Formulation of personnel policies Employee involvement and empowerment Your motivation and enthusiasm will determine their

performance The “closed mind – open mouth” syndrome can have

disastrous effects on the working relationships. Communicate directly with your staff and make them feel

that you care for them. Consider innovative ideas from them - Staff, out of their

experiences, have some good ideas and adopting them may enhance efficiency besides improving the self image of employees and ensures their cooperation

Gaining staff approval and support is an important administrative action. Make efforts to sell any changes you wish to propose.

Weekly meetings CMEs Deputations for special

training Acquisition of new

qualifications Ensuring equal opportunities

to all Providing feed back at staff

meetings based on inputs from various sources

IN SERVICE TRAINING

Vital element is creation of a good atmosphere in employer and employee relations.

Taking care of minimal needs will avoid a crisis

Dealing efficiently with the intangibles of human feeling and emotion

Molding a system that is not based on pay cheques.

Loyalty is a bond, which holds an employee to the hospital, is to be nurtured and is an art.

HANDLING COLLECTIVE BARGAINING AND UNION PROBLEMS

Serve as an extended arm Acts as a field practice area

for trainees Aid in research Facilitates early diagnosis

and prompt referrals Enables follow up in the

community Linkages and liaison with the

base hospital essential Boosts the confidence of

patients May result in increase in

clientele at the hospital

COMMUNITY OUTREACH SERVICES

New facilities are getting smaller, specialized, and dispersed.

Managing limited Human resources

Financial ConstraintsPatient SatisfactionProcess flow and improvement -

reduce wait times particularly in the emergency department

Operations

improve operational efficiency – scheduling

employee education of cost / revenue and process improvement

resource tracking and management capital equipment location and

utilization consumable inventory location and

amount supply chain management de-bottlenecking

What can we do?

collaborative planning, forecasting and replenishment

S&OP Reduced product variety for price

leveraging – stents

Dilemma of maintaining high quality of service while holding the cost line.

Demanding Patients With an abundance of medical plan

and health care facility choices, patients do not have to settle for "second-best" treatment. Health care managers must ensure they meet patient expectations if they wish to stay competitive in their profession.

Quality Management

Litigations / Legal disputes between patients, insurance providers and healthcare providers take time and money away from medical research and treating patients.

Patient safety concerns include medical errors and new diseases that are not only dangerous, but can spread easily. One of the biggest worries is the spread of hospital-acquired infections among patients.

standardization of processes and supply items, instead of allowing physicians to pick and choose based on their preferences.

The broad shortage of nurses means that many duties fall to untrained or inexperienced assistants, thereby driving up the likelihood of error.

Discrepancies in pay draw medical students away from certain fields and into others, resulting in a lopsided distribution of doctors and a lack, or surplus, of options for patients.

Maintain Key Ethical Principles like:

Veracity – truth telling, informed consent, respect for autonomy.

Privacy – a persons right to remain private, to not disclose information.

Confidentiality – only sharing private information on a ‘need to know basis’.

Fidelity – loyalty, maintaining the duty to care for all no matter who they are or what they may have done.

Non – maleficence – to do no harm.

THANK YOU!