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Dr.Jabbari-Ph.dDr.Jabbari-Ph.d
Dr.Jabbari-Ph.dDr.Jabbari-Ph.d
ObjectivesObjectives: :
• By the end of the session participants should be able to:
• Discuss the nature of a hospital
• Describe the roles and responsibilities of a hospital manager
• Evaluate the sources of power and manager's work
Dr.Jabbari-Ph.dDr.Jabbari-Ph.d
مدیریت • فراروی های چالش و مشکالت مهمتریننمایند لیست را بیمارستان
بین • تجارب و بیمارستان سازمان تحوالت کلیات باشوند آشنا زمینه این در موجود المللی
در • بیمارستان جایگاه اصالح برای مختلف های گزینهدهند قرار بحث مورد را سالمت نظام
نمایند • بحث را مربوطه المللی بین و کشوری تجاربداخل • ساختار اصالح برای مختلف های گزینه
دهند قرار بحث مورد را بیمارستان
Dr.Jabbari-Ph.dDr.Jabbari-Ph.d
INTRODUCTION
TO
HOSPITAL
MANAGEMENT
Dr.Jabbari-Ph.dDr.Jabbari-Ph.d
What is a hospitalWhat is a hospital??
• OXFORD DICTIONARY (2001): an institution providing medical treatment and nursing care for sick or injured people.
• WHO: It represents the main concentration of health resources, professional skills and medical equipment.
Dr.Jabbari-Ph.dDr.Jabbari-Ph.d
What are the functions of a What are the functions of a hospitalhospital??
• Patient Care :Diagnosis and Treatment , Care and Rehabilitation
• Teaching : Patient Education , Training for medical, nursing and other disciplines ,Continuing education
• Research : Clinical , Nursing , Health Systems , Educational
Dr.Jabbari-Ph.dDr.Jabbari-Ph.d
What are the functions of a hospital?What are the functions of a hospital?ContiConti……
• Health system support : Referrals , Community health service , Outreach to other health units and communities , Supervision of primary care services
• Employment : Employer of health professionals , Employer of locally recruited staff , Purchaser of local goods / services
Dr.Jabbari-Ph.dDr.Jabbari-Ph.d
What are the functions of a hospital? ContiWhat are the functions of a hospital? Conti……
• Market place : Selling of goods, e.g. drugs to patients , Charging fees and determining exemptions , Providing space for commercial enterprises , Contracting out of services
• Societal role : Symbol of local community identity , Community asset , Provider of social care (non-medical cases) a , Medical power base
Dr.Jabbari-Ph.dDr.Jabbari-Ph.d
How are hospitals classifiedHow are hospitals classified??
بيمارستانها • بندي :طبقهجغرافيا : • ، برحسب شهرداري ، استاني ، ايالتي ، فدرال ، مركزي
غيره و اجتماعي ، اي ناحيهمالكيت : • نظر انتفاعي از و ,بيمارستان خيريه بيمارستانهاي
انتفاعي غير خصوصيكاري • معدن ، زرع و كشت ، ارتش جمله از صنعتي بيمارستانهايدولتي • بيمارستانهايدانشگاهي • بيمارستانهاي
فني : • غيره براساسظرفيت و كليه ، كودكان بيمارستان مثلخدمات : • سطح براساسنوع ، اول سطح ارجاعي بيمارستانهاي
سوم سطح ، دوم• ، رواني بيمارستانهاي مثل اورژانس غير ارجاعي بيمارستانهاي
توانبخشي ، نهائي بيمارستانهاي ، نظر تحت بيمارستان
Dr.Jabbari-Ph.dDr.Jabbari-Ph.d
What is the role of a hospital within What is the role of a hospital within other systemsother systems??
هستند . • كشورها اغلب در سالمت نظام كليدي اجزاء بيمارستانهامورد سالمت نظام پيشرونده اصالحات در بيمارستانها اينحال با
شوند . مي واقع توجهي كمسازمان • هاي دستورالعمل ، گذشته سال پنجاه طول های در
بهداشتي مراقبتهاي روي بر سالمت خدمات توسعه براي جهانياند . شده متمركز خانواده پزشكي و اوليه
از • وضوح به بايستي بيمارستانها در شده ارائه مراقبتهايكاركردهاي روي بر ، كنند حمايت اوليه بهداشتي مراقبتهاياوليه بهداشتي مراقبتهاي جايگاه در كه درماني و تشخيصي
شود . متمركز ، نيستند پذير امكان
Dr.Jabbari-Ph.dDr.Jabbari-Ph.d
What is the role of a hospital within other systemsWhat is the role of a hospital within other systems??
و • خريد مسئوليت اوليه بهداشتي مراقبتهاي كشورها برخي دراند . كرده دريافت نيز را دوم سطح مراقتبهاي مالي تامين
تعادل • نقطه كه است اين مانده باقي سئوالحمايت و مردم عالئق و بيمارستاني مراقبتهاي
؟ كجاست عمومي بهداشت از
Dr.Jabbari-Ph.dDr.Jabbari-Ph.d
What is the role of a hospital within other systemsWhat is the role of a hospital within other systems??
بيمارستانهاي • بدون اوليه بهداشتي مراقبتهايموفق تواند نمي ارجاع راسسيستم در قوي
در . مهمي بسيار نقش بيمارستانها بعالوه شوددارند . انساني نيروي آموزش
براي • سمبوليك ارزشهاي با قوي نهاد بيمارستانگذاران سياست و سالمت متخصصين ، مردم
است .بيمارستان • در اي حرفه هاي گروه غالب بعالوه
دارند زيادي عالئق آن قدرت تداوم براي
Dr.Jabbari-Ph.dDr.Jabbari-Ph.d
What are some of the environmental What are some of the environmental influences facing hospitalsinfluences facing hospitals??
• Political forces and donor influence
• · Separating hospitals from the national Civil Service under titles such as autonomy, corporatization
• · Increasing use of preventative and elective procedures over emergency ones.
• · Sums of money allocated to hospitals is a political rather than an economic question
Dr.Jabbari-Ph.dDr.Jabbari-Ph.d
• Conti…
• Health sector reforms, hospital autonomy, decentralized or devolved management,
• local integration of services more contractual relationships, public / private
• Access to clinical information via the Internet
• Changes in perceptions and an increased awareness of possibilities and rights are
• also reforming longstanding patterns of needs and demands
Dr.Jabbari-Ph.dDr.Jabbari-Ph.d
• Conti…• Economic pressures• · Increase in needs and demands• · Changes in length of stay• · Greater health knowledge and higher
expectations for improved quality of services• · Increase reliance on user fees and income
generation• · Fewer external donors• · Impoverished populations increasingly unable
to pay fees
Dr.Jabbari-Ph.dDr.Jabbari-Ph.d
• · Essential care packages
• · Growing interest in Quality Assurance
• · The concept of “hospital” is changing. Policies of decentralization and autonomy
• Demographic changes
• · Population migration
• · Epidemiological transition resulting in changes in profiles and patterns of morbidity
• and mortality, increased life expectancies
Dr.Jabbari-Ph.dDr.Jabbari-Ph.d
• Conti…
• Health policy develops:
• · Change in views of governments and populations on health status and medical and hospital care
• · New social policies toward medical care and hospitals
• · Financing health care and medical technology
• · Management methods for improvement through quality assurance
Dr.Jabbari-Ph.dDr.Jabbari-Ph.d
• Trends of hospital• · Minimally invasive surgery and day surgery concepts• · New pharmaceuticals ,may reduce the need for
hospitalization• · Shorter course treatments (DOTs – TB)• · Changes in secondary and tertiary care facilities.
Growth of accountability and quality assurance of services
• · Decentralized management and flexible employee contracts
• · Staffing – emphasis on competence rather than on credentials
• · Hospitals without walls• · Telemedicine
Dr.Jabbari-Ph.dDr.Jabbari-Ph.d
What is ManagementWhat is Management??• · Getting things done – maintaining momentum
and making things happen• · Finding out what is going on• · Reacting to new situations and problems• · Responding to demands and requests• · Deciding what to do and then getting it done
through the effective use of resources
• ·
Dr.Jabbari-Ph.dDr.Jabbari-Ph.d
• A process which exists to get results by making the best use of the human, financial, and material resources available to the organization and to individual managers
• · Ability to organize complex technology, bring together different people form different professions to deliver service as a team.
Dr.Jabbari-Ph.dDr.Jabbari-Ph.d
How does the work of a hospital manager differ from that How does the work of a hospital manager differ from that
of a manager of some other enterpriseof a manager of some other enterprise??
• Multiple stakeholders
• Complex process
• Organizational culture
Dr.Jabbari-Ph.dDr.Jabbari-Ph.d
The hospital manager's roleThe hospital manager's role
• Lack of control over much of the (technical and professional) work of the organization
• · Lack of clarity about objectives and outcome measures• · Co-ordination of articulate and independent-minded
professionals within the institution, with a primary loyalty to their profession rather than the individual hospital
• · Constant exposure to public scrutiny and comment• · Unlimited demands of users• · Balancing unreliable and insufficient resources with
unrealistic political and public expectations (for government hospitals especially)
Dr.Jabbari-Ph.dDr.Jabbari-Ph.d
• Constant exposure to public scrutiny and comment
• · Unlimited demands of users
• · Balancing unreliable and insufficient resources with unrealistic political and public expectations (for government hospitals especially)
• …..
Dr.Jabbari-Ph.dDr.Jabbari-Ph.d
The hospital manager’s sources of The hospital manager’s sources of available poweravailable power
• · Resource power - access to money, staff time, stationery, transport, senior people
• · Expert power - the one who understands finance, organizational dynamics, law
• · Personal power - influence through charisma, popularity or connections
• · Position power - by virtue of being "the boss"• · Veto power - may be available but is not
recommended
Dr.Jabbari-Ph.dDr.Jabbari-Ph.d
شماره گروهی شماره کار گروهی 11کار
و • بهداشتی سیستمهای برخی شکست دالیل: نمائید لیست را جهان در درمانی
برنامه • طراحی مامور شما کاری گروه چنانکهعنوان به گردد کشور بیمارستانی بخش اصالحات
این فراروی های چالش مهمترین اقدام اولیننمائید مشخص گروهی کار انجام با را بخش
Dr.Jabbari-Ph.dDr.Jabbari-Ph.d
سیستمهای • برخی شکست دالیل: درمانی و بهداشتی
گیر • پا و دست و سخت قوانین و مقرراتخالقیت • برابر در مقاومتساالری • پدر فرهنگپزشکان • مشارکت عدمای • حرفه مدیران وجود عدمفرماندهی • تعدد
Dr.Jabbari-Ph.dDr.Jabbari-Ph.d
مدیران • شغلی ثبات عدماهداف • و سیاستها وضوح عدمبیماران، • های خواهش و نیازها درک عدمکارکنان ”“““““““““““““““““““““““““““““•مستقل • ارزشیابی سازمان وجود عدمو ....•
Dr.Jabbari-Ph.dDr.Jabbari-Ph.d
اصالحاتاصالحات
کسب • راستای در بیمارستان جایگاه اصالحبازار با ومواجهه بیشتر استقالل
بیمارستان • داخل سازمان اصالحو ...•
Dr.Jabbari-Ph.dDr.Jabbari-Ph.d