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How to prepare a clinical practice for family physician?. Session 13. When students graduate from professional schools, they are not stopping just right here. Working. Further education. for what?. Two basic options for employment. A self employed person (alone/group). - PowerPoint PPT Presentation
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How to prepare a clinical practice for family physician?
Session 13
Working
When students graduate from professional schools, they are not stopping just right here
for what?
Further education
Two basic options for employment
A self employed person (alone/group)
Working for someone else
Bussinessman
Bussiness owner Bussiness with other
people
It’s very important to know that,
a family doctor effectiveness depends not only on clinical skills, but also on managerial ability or managing ( to run their business) …… to be a manager
poor practice management can lead to poor patient care, public dissatisfaction, and demoralization on the doctor and her/ his staff
Every family doctor must be involved in the process of assessing needs and demands for care, establishing priorities and allocating resources
MANAGING IS : To get work done through the efforts of
others Producing an output (technical care
and patient satisfaction) from input (manpower, money, materials, methode and market) and processes (operational work, developmental work and organizational work - POAC)
THE DOCTOR IS OFTEN THE
MANAGER OF THE PRACTICE
BASIC FUNCTION, SKILLS SET AND ROLES OF MANAGER
ROLES OF MANAGER: LEADERSHIP ROLES INFORMATIONAL
ROLES DECISIONAL ROLES
BASIC FUNCTION :
PLANNING ORGANISING LEADING CONTROLLING
SKILL SETS OF THE MANAGER : CONCEPTUAL SKILLS HUMAN SKILLS TECHNICAL SKILLS
BASIC FUNCTIONS OF MANAGER IN DETAIL:
PLANNING : IS A PROCESS OF SETTING OBJECTIVE AND FORMULATING THE STEPS WHICH WILL BE NECESSARY TO ATTAIN THESE OBJECTIVE.
ORGANISING : IS A PROCESS OF GETTING ACTIVITIES, PEOPLE, MATERIALS STRUCTURE TO MEET ORGANIZATIONAL OBJECTIVE, INCLUDES SETTING OF JOB DEFINITION, AUTHORITY TO ACT AND DEPARTEMENTALIZATION
LEADING : IS THE PROCESS OF INFLUENCING STAFF TO MEET PREDETERMINE OBJECTIVE. THE EFFECTIVE SKILL ARE COMMUNICATION & FEEDBACK, MOTIVATION OF STAFF AND USE OF APPROPRIATE STYLE TO SPECIFIC SITUATION
CONTROL : IS A PROCESS OF ENSURING THAT THINGS HAPPEN ACCORDING TO PLAN AND TAKING CORRECTIVE ACTION WHERE NECESSARY. IS A THREE-STEP PROCESS : SETTING STANDARDS, COMPARING PERFORMANCE AGAINST STANDARD AND CORRECTING DEVIATIONS.
ROLES OF MANAGER
LEADERSHIP ROLES :
FIGUREHEAD, LEADER AND LIAISON PERSON. IN THESE ROLES, THE MANAGER INTERACTS WITH OUTSIDE ORGANIZATION
INFORMATIONAL ROLES :
MONITOR, DISSEMINATOR AND SPOKESMAN. IN THESE ROLES, THE MANAGER HANDLES INFORMATION
DECISIONAL ROLES :
ENTREPRENEUR, DISTURBANCE HANDLER, RESOURCE ALLOCATOR AND NEGOTIATOR. IN THESE ROLES THE MANAGER MAKE DECISIONS
EFFECTIVE LEADERS SIMULTANEOUSLY SATISFY THESE THREE SET OF INTERDEPENDENT NEEDS (TASK NEED, GROUP NEEDS, INDIVIDUAL NEEDS) AND INTERCONNECT EACH OTHERS.
LEADERSHIP : IS THE PROCESS WHEREBY ONE
PERSON INFLUENCES THE THOUGHTS AND BEHAVIOURS OF OTHERS
PERSONAL LEADERSHIP STYLE :
AUTOCRATIC OR PERMISSIVE
THEORY X OR THEORY Y
PERSONAL EFFECTIVENESS
IS ABILITY TO EXERT A POSITIVE INFLUENCE ON THE TASKS OF MANAGEMENT.
MAKE YOURSELF LOOK GOOD
MANAGING PAPER
MANAGING MEETING
ENTREPRENEURSHIP
THE ROLE IN ECONOMIC DEVELOPMENT
BASIC START-UP TYPES
DECISION PROCESS
CONCEPT & HISTORICAL
DEVELOPMENT
ETHIC & RACIAL RESPONSIBILITY
INTRAPRENEURSHIP
INTRAPRENEURSHIP
IS ENTREPRENEURSHIP WITHIN AN EXISTING BUSINESS STRUCTURE AND ALSO BRIDGE THE GAP BETWEEN SCIENCE AND MARKET PLACE
CREATIVITY
INNOVATIVE
SPIRIT
CONCEPT & HISTORICAL DEVELOPMENT
EARLIEST PERIOD : MARCO POLO ESTABLISHED TRADE ROUTES TO THE FAR EAST. LOTS OF RISKS WITH MONEY PERSON
MIDDLE AGES : DIDN’T TAKE RISKS AND MANAGED PROJECTS WITH RESOURCES PROVIDED
17th – 20 th CENTURY : MOVED FROM GOV’T CONTRACTUAL
ARRANGEMENTS TO INDIVIDUALIZED WORK WAS DISTINGUISH FROM THE CAPITAL PROVIDER ORGANIZED AND OPERATED FOR PERSONAL GAIN
THE MIDDLE OF 20th CENTURY : ENTREPRENEUR AS AN INNOVATOR ( AN INDIVIDUAL DEVELOPING SOMETHING UNIQUE/ INVENTION)
DEFINITION OF ENTREPRENEUR TODAY
IS THE PROCESS OF: CREATING SOMETHING NEW WITH VALUE BY DEVOTING THE NECESSARY TIME AND EFFORT ASSUMING THE ACCOMPANYING FINANCIAL, PSYCHIC AND SOCIAL RISKS. RECEIVING THE RESULTING REWARDS OF MONETARY AND PERSONAL SATISFACTION AND INDEPENDENCE.
ENTREPRENEURIAL DECISION PROCESS
IS DECIDING TO BECOME AN ENTREPRENEUR BY LEAVING PRESENT ACTIVITY OR MOVEMENT FROM A PRESENT LIFESTYLE TO FORMING AN ENTERPRISE.
CHANGE FROM PRESENT LIFESTYLEWORK ENVIRONTMENTDISRUPTIONS
FORM NEW ENTERPRISE
DESIRABLE (ASPECTS OF SITUATION THAT MAKE IT DESIRABLE TO START A NEW COMPANY: CULTURE, SUBCULTURAL, FAMILY, TEACHERS, PEERS)
POSSIBLE (FACTORS MAKING IT POSSIBLE TO CREATE A NEW VENTURE : GOVERNMENT BACKGROUND MARKETING, FINANCING AND ROLE MODELS)
CHANGE FROM GP TO FAMILY PHYCISIAN
CHANGE
PRESENT LIFESTYLENEW VENTURE FORMATION
IS NOT AN EASY ONE TAKES GREAT ENERGY &
EFFORT RESEARCH DEVELOPMENT &
MARKETING
INDIVIDUAL
FAMILY
TYPES OF START-UPS
LIFESTYLE FIRM : A SMALL VENTURE THAT SUPPORTS THE OWNERS AND USUALLY DOESN’T GROW
FOUNDATION COMPANY : A TYPE OF COMPANY FORMED FROM RESEARCH AND DEVELOPMENT THAT USUALLY DOESN’T GO PUBLIC
HIGH-POTENTIAL VENTURE : A VENTURE THAT HAS HIGH GROWTH POTENTIAL AND THEREFORE RECEIVES GREAT INVESTOR INTEREST
GAZELLES : VERY HIGH GROWTH VENTURES
• MUST TAKE RISKS• EXPENDING GREATER
ENERGY• IN ORDER TO INNOVATE• FACED WITH DAILY
STRESSFUL SITUATION & DIFFICULTIES
• ETHICAL EXIGENCIES
• ECONOMIC EXPEDIENCY
• SOCIAL RESPONSIBILITY
BALANCE
• USUALLY DEVELOP IN INTERNAL ETHICAL CODE• TEND TO DEPEND ON THEIR OWN PERSONAL
VALUE SYSTEM WHEN DETERMINING ETHICALLY ACTION
• SENSITIVE TO PEER PRESSURE AND GENERAL SOCIAL NORM IN THE COMMUNITY
• SENSITIVE TO PRESSURE FROM THEIR COMPETITORS.
ETHIC & SOCIAL RESPONSIBILITY
BUSINESS ETHICS
• RELATED WITH THE CONCEPT OF CULTURE
• INDIVIDUAL MORALITY AND BEHAVIORAL HABITS ARE RELATED AND IDENTIFIED AS AN ESSENTIAL QUALITY OF EXISTENCE
1. PEDAGOGICALLY ORIENTED INQUIRY INCLUDING THEORY & EMPIRICAL STUDIES
THE STUDY OF BEHAVIOR AND MORALS IN A BUSINESS SITUATION
3. EMPIRICAL RESEARCH, MEASURING THE ATTITUDES & ETHICAL BELIEFS OF STUDENT & ACADEMIC FACULTY
4. EMPIRICAL RESEARCH WITHIN BUSSINESS ENVIRONTMENTS
2. THEORY – BUILDING WITHOUT EMPIRICAL TESTING
THE FUTURE OF ENTREPRENEUSHIP
DIFFERENT THINGS TO DIFFERENT PEOPLE AND DIFFERENT CONCEPTUAL PERSPECTIVE BUT ARE SAME ASPECT : RISK TAKING, CREATIVITY, INDEPENDENCE AND REWARD
ENTREPRENEURSHIP EDUCATION THROUGHOUT THE WORLD IS ALSO GROWING
AN INCREASE IN ACADEMIC RESEARCH
GOVERNMENT ARE TAKING AN INCREASED INTEREST IN PROMOTING THE GROWTH OF ENTREPRENEURSHIP
SOCIETY’S SUPPORT IS CRITICAL IN PROVIDING MOTIVATION AND PUBLIC SUPPORT AND WILL CONTINUE
SUPPORT
SKILLS SETS OF THE MANAGER
CONCEPTUAL SKILLS : ARE SKILLS OF PERCEIVING HOW THE PARTS OF THE
ORGANIZATION LINK TOGETHER IN STRUCTURE AND PROCESS.
HUMAN SKILLS : THESE ARE SKILLS INVOLVED IN WORKING WITH PEOPLE,
OFTEN AS A MEMBER OF A GROUP. THE ABILITY TO CONSIDER THE INTERESTS OF SUBORDINATES AND CO-WORKERS, TO MOTIVATE THEM TO CONTRIBUTE THEIR BEST AND INVOLVE THEM IN DECISION MAKING ARE IMPORTANT TO GET WORK DONE THROUGH THE EFFORTS OF OTHERS.
TECHNICAL SKILLS : THESE ARE SKILLS IN MANAGING THINGS RATHER THAN
PEOPLE AND ARE OFTEN LEARNED THROUGH ON THE JOB TRAINING PROGRAMMES.
Session 14
WHAT ARE THE DOCTOR PREPARING OF ?
HOW TO DO THAT ?
THE MANAGEMENT PROCESS
FORMULATION OF OBJECTIVE
DEFINITION OF PRACTICE POPULATION
ASSESSMENT OF NEEDS, DEMANDS AND RESOURCES
ALLOCATION OF PRIORITIES (SCARCITY OF RESOURCES)
FORMULATION OF POLICIES/HEALTH CARE
EVALUATION OF PERFORMANCE
1
2
3
4
56
FORMULATION OF OBJECTIVE
OBJECTIVE
VALUES OF THE PHYSICIAN
THE EXPECTATIONS OF THE PATIENTS
ACCESSIBILITY OF THE DOCTOR
AVAILABILTY OF THE SERVICE
PERSONAL CARE CONTINUITY OF CARE PRESERVATION OF THE
DOCTOR-PATIENT RELATIONSHIP
PERSONAL VALUES (SATISFYING PERSONAL AND FAMILY LIFE FOR THE PHYSICIAN)
MORE SPECIFICALLY TO PREVENTION AND
MANAGEMENT OF DISEASE
1
To understand that, clinical practice as a
system
CLINICAL PRACTICE AS A SYSTEM
SOP
PROCESS
P-O-A-C-E
OUTPUT : GOOD HEALTH
SERVICES
INPUT OF CLINICAL PRACTICE
GOAL
MANPOWERMONEY
MATERIALS
METHOD
MARKET
DEFINITION OF PRACTICE POPULATION
The List is compiled by going through the practice records and entering all patients who have need the practice regularly.
Prepaid system
Fee – for - service
Complete picture of population you served
Complete picture of population at risk
2member
Catchment area
To describe how to select a community
for practice
Community selection for a practice
DO/ MAKE RESEARCH IN THREE MAJOR
AREAS :
PERSONAL CONSIDERATION (WHERE DO YOU AND YOUR FAMILY WANT TO LIVE)
BUSINESS FACTORS (WHAT IS THE LOCAL ECONOMY AND DOES
COMMUNITY NEED ANOTHER
PRACTITIONER )
PROFESIONAL CONSIDERATION (AMONG ANOTHER HEALTH CARE FACILITIES AND SPECIALISTS)
GENERAL FACTOR : CLIMATE, DEMOGRAPHIC, ECONOMIC, SOCIAL AND CULTURAL CHARACTERISTICS
ASSESSMENT OF NEEDS
3 To do : ASSESSMENT OF DEMANDS
ASSESSMENT OF RESOURCES
Needs that the patient feels have not been met by
the health care system
Needs of which the patient is unaware
Unmet need
Patient generated demand
Physician generated demand
The resources include the physical plan, communication system, physician, staff, the attached personel, hospital and community resources
ALLOCATION OF PRIORITIES4
FORMULATION OF POLICIES/HEALTH CARE
5
Scarcity of resources : priorities in input
Various of health care according to the need and demand of the population and scarcity of resources (prevention, promotion, curative and rehabilitation )
WHAT TYPE OF PRACTICE
SOLO PRACTICE GROUP PRACTICE
ADVANTAGES FREEDOM TO WORK, WITHOUT RESPONSIBILITY TO ANOTHER PARTY
INDEPENDENCE HAVE GREATER
PRIVACY
TO SHARE OF KNOWLEDGE & EXPERTISE
QUALITY CONTROL THROUGH PEER REVIEW, PEER SUPPORT
DIS-ATVANTAGES
GREATER EXPENSES AND LOWER INCOME
OVERWORK TO SOLVE MANAGERIA
L’S PROBLEM AS WELL AS TO CARE THE PATIENTS
ABSENT OF INDIVIDUAL’S FREEDOM
SHARING OF INCOME GROUP CONTROL OF
INVESTED CAPITAL EQUAL RESPONSIBILITY
FOR EXPENSES, INCURED DEBT AND BANKRUPT
POTENTIAL CONFLICTS
EVALUATION OF PERFORMANCE
- Finance : Balance sheet, income statement, expenditures- total patients : who come for prevention, promotion, curative and
rehabilitation- disease patterns- practice (managerial) procedures: time spent in waiting room, delay
appointments,- audit of records- patient satisfaction etc
1. What kind evaluation tools you need to evaluate performance ? Inputs : resources Processes : POAC Outputs :
6
MANAGING INPUT
SOP
INPUT OF CLINICAL PRACTICE
MANPOWER
MONEY
MATERIALS
METHODE
MARKET
G.P/ F.P
PEOPLES/ HUMAN RESOURCES
RECRUITMENT & SELECTION
JOB DISCRIPTION
TRAINING AND EDUCATION
REWARD AND PUNISHMENT
WORKING TOGETHER TO ACHIEVE THE GOAL
ENTRY EXIT
PLACEMENT
JOB QUALIFICATION
STAFF DEVELOPMENT
SEPARATION
PROMOTION
PLANNING, ORGANIZING, ACTUATING, CONTROLLING, EVALUATING
MOTIVATION
PEOPLE HANDLING: CONFLICT,
ABSENTEEISM
LEADERSHIP
FOLLOWERSHIP
BUILDING SELECTION
RELATIVE COST : BUY/ RENT OR BUILD ?
TRANSPORTATION & PARKING
POSSIBILITIES FOR REMODELLING OR
EXPANSION
IMMEDIATE ENVIRONMENT
BUILDING SERVICES
PROXIMITY TO MEDICAL FACILITIES,
COLLEAGUES
MANAGING INFORMATION SYSTEM - MEDICAL COMPUTER SYSTEMS
HARDWARE : COMPUTERS PRINTERS TERMINALS
SOFTWARE : PATIENT REGISTER MEDICAL RECORD APPOINTMENT ACCOUNTING BILLING SYSTEM , ETC
BRAINWARE : HUMAN RESOURCES, LEGAL ASPECT
FINANCIAL MANAGEMENT IS : Keeping proper records of income,
expenditure/expenses and profit Preparing financial statements at the end of
accounting period : income (profit and loss) statement and balance sheet
Analyzing financial statements and taking the necessary actions
Implementing inventory and stock control processes Acting on discrepancies Ensuring that financial records are audited Developing financial plans (capital, operational) ….>
budgeting Taxes
MONEY
REVENUE
PATIENTS/ CLIENTS
INSURANCE CORPORATES
EXPENDS
SALARY OPERATIONAL MAINTENANCE INVEST “ MARKETING” EXPANSION
UNIT COST & PRICE
RULES
BALANCED
MANAGING PROCESS
PLANNING: INPUT,
PROSES, OUTPUT
ACTUATING
EVALUATION
ORGANIZING
CONTROLLING
0
10
20
30
40
50
60
70
80
90
1st Qtr 2nd Qtr 3rd Qtr 4th Qtr
East
West
North
MANAGING OUTPUT/ QUALITY OF HEATH SERVICES
STANDARDS/ PROTOCOLS
PATIENTS/ CLIENTS SATISFACTION
PROFESIONAL
QUALITY OF CARE
