HEALTH MANAGEMENTHEALTH MANAGEMENT

Amany Rashad Abo-El-SeoudAmany Rashad Abo-El-Seoud

Prof. of Community MedicineProf. of Community Medicine

Zagazig University,EGYPTZagazig University,EGYPT

HEALTH MANAGEMENTHEALTH MANAGEMENTObjectivesObjectives: :

Definitions ,benefits of Definitions ,benefits of managementmanagement

Identify the main management Identify the main management functionsfunctions

How to plan for research studyHow to plan for research study How to manage an organizationHow to manage an organization

Definition of Definition of managementmanagement

Group of activities done for reaching Group of activities done for reaching goals.goals. Management is getting things Management is getting things effectivelyeffectively done to achieve desired done to achieve desired objectives through proper planning, objectives through proper planning, efficientefficient implementation, and evaluation implementation, and evaluation to assess achievements and identify the to assess achievements and identify the needs for re-planning. Management is thus needs for re-planning. Management is thus a dynamic process in the work a dynamic process in the work systemsystem..

AdministrationAdministration implies the use of formal and hierarchical lines and procedures to accomplish a given work.

Strategic managementStrategic management

StrategyStrategy is the art and science of mobilization is the art and science of mobilization the forces into the most advantageous position the forces into the most advantageous position prior to actual engagement with the enemy.prior to actual engagement with the enemy.

ManagementManagement is the handling of tools and is the handling of tools and techniques to achieve a desired goal .techniques to achieve a desired goal .

Strategic ManagementStrategic Management it is an art and it is an art and science of formulating, implementing and science of formulating, implementing and evaluating the cross functional decision that evaluating the cross functional decision that enables an organization to achieve its enables an organization to achieve its objectives. objectives.

Benefits of Strategic Benefits of Strategic Planning Planning

It improves financial performanceIt improves financial performance It provides the organization with self concept, It provides the organization with self concept,

specific goals.specific goals. Encourage managers to understand the present Encourage managers to understand the present

plan for the future and understand when change plan for the future and understand when change is vital.is vital.

Requires managers to communicate vertically Requires managers to communicate vertically and horizontally.and horizontally.

Improve over all coordination and encourage the Improve over all coordination and encourage the changes to meat the challenges of the complex changes to meat the challenges of the complex and evolving environment . and evolving environment .

SYSTEMSYSTEM

A set of interrelated and A set of interrelated and interdependent processes designed interdependent processes designed to achieve common objectivesto achieve common objectives

Each process in the system has various inputs which are processedprocessed to produce certain outputs, that together, accomplish the overall goal of an organization.

There is ongoing feedback among these various parts to ensure they remain aligned with overall organization goals.

SYSTEM

INPUTS PROCESS OUTPUTS

Feedback

There are several classes of systems, ranging from very simple frameworks all the way to social systems, which are the most complex.

The Management Process (System View)The Management Process (System View)

ResourcesHuman

Financial

Physical

Informational

Goal

Achievements

Management Functions

Planning Organizing Directing Controlling

Process OutputsInputs

Health Systems PerspectiveHealth Systems Perspective ((Macro-LevelMacro-Level))

Health Systems PerspectiveHealth Systems Perspective ((Meso-LevelMeso-Level))

InputsInputs• patients• payment• H.personnel•instrument

OutcomeOutcome(Patient)• recovers• under medical supervision• dies

Processor Processor (Hospital)(Hospital) • perform surgery• providing nursing care• feed and house patient

(Hospital is convenient topopulation it services)

(Older patientwith familymembers tohelp supervisecare)

(High inflation impacting indirect cost for supplies)

(Shortage of persons prepared in management information)

Micro level of managementMicro level of management

Health care provider patientHealth care provider patient

Inputs process outputInputs process output

(Factors in doctor) (factors in (Factors in doctor) (factors in patient)patient)

Schools of ManagementSchools of Management

The Classical PerspectiveThe Classical Perspective (Scientific managementScientific management): focuses on ways to improve the performance performance of individual workers.

The Administrative Management Perspective:The Administrative Management Perspective: focuses on managing the total total organization.

The Behavioral Perspective:The Behavioral Perspective: motivation, etc…

The Quantitative PerspectiveThe Quantitative Perspective (Management Science): focuses on mathematical models

The Integrating PerspectiveThe Integrating Perspective (System AnalysisSystem Analysis).The contingency perspective:The contingency perspective: managerial behavior depends on the situation situation elements.

Scopes of H. Scopes of H. managementmanagement

In scientific research, thesis, projects, In scientific research, thesis, projects, program, experiment, medical services program, experiment, medical services (hospital, health units, clinics) to add (hospital, health units, clinics) to add something new (new technique or something new (new technique or treatment) or to improve something treatment) or to improve something already present in these areas and already present in these areas and needs improvement management needs improvement management techniques.techniques.

Management functions:Management functions:

Where are we now? = Where are we now? = situational analysissituational analysis What can we do? formulation of the vision, What can we do? formulation of the vision,

mission, goals, mission, goals, objectives objectives How can we reach these objectives? How can we reach these objectives? ByBy

planningplanning. (or preparation) . (or preparation) How to activate the plan? How to activate the plan? ImplementationImplementation

(execution, to do, to act, to perform): to (execution, to do, to act, to perform): to make plan real. make plan real.

Do I reach my stated objectives? Do I Do I reach my stated objectives? Do I succeed to solve the problem? = succeed to solve the problem? = EvaluationEvaluation

Management cycleManagement cycle

Situational analysis

Plan

Act

Evaluate

Set objectivesPrioritize

MoneyMan powerMaterialsTime

Supervisionmonitoring

Situational analysis SWOTSituational analysis SWOT::

I-internal assessment : strength(S). Weakness(W) .

* Reviewing the current objectives * Reviewing health care units. * Technical facilities. * Services facilities. * The possibilities of integration with training and

research centers * Financial position of the institution * Performance * Human resources * Internal clients' assessment

II- External assessment: Opportunities (O) and Threats (T) * Review demographic & economic data * Market research * Review the health care delivery

regulations and any expected changes * Analyze competitors: ” This is the most

important issue”

Situational analysis for Situational analysis for community health includescommunity health includes

1-Political and administrative rules1-Political and administrative rules2. Demographic features 2. Demographic features 3-Economic resources3-Economic resources4-Social stratification and relations4-Social stratification and relations5-5- Leadership pattern and its influence.Leadership pattern and its influence.6-6- Community organizations and their functions Community organizations and their functions and activitiesand activities7-7- Cultural facets or traditionsCultural facets or traditions8-8- Health, nutrition, and sanitation levels Health, nutrition, and sanitation levels 9-9- Education levelsEducation levels

Criteria for selecting Criteria for selecting priority problems on priority problems on

community basiscommunity basis 11--The extent of the problem (prevalence, incidence The extent of the problem (prevalence, incidence rates)rates)..

2- Seriousness of the problem 2- Seriousness of the problem * Urgency * Severity* Urgency * Severity* Economic costs * Impact on * Economic costs * Impact on

othersothers3-Effect on economy and productivity, and other socio-3-Effect on economy and productivity, and other socio-

economic implications.economic implications.4-Availability of cheap feasible technologies for 4-Availability of cheap feasible technologies for

prevention and control prevention and control 5-Single, or multi-sectoral approach, and the feasibility 5-Single, or multi-sectoral approach, and the feasibility

of implementation and monitoring of the program.of implementation and monitoring of the program.6-Time required for achieving visible results.6-Time required for achieving visible results.

1- Identifying and Defining the 1- Identifying and Defining the problem:problem:

Consider these questions:Consider these questions:

What is the problem? Is it my problem? Can I solve it? Is it worth solving?Is this the real problem, or merely a symptom of a larger one? If this is an old problem, what's wrong with the previous solution? Does it need an immediate solution, or can it wait? Is it likely to go away by itself? Can I risk ignoring it? Does the problem have ethical dimensions? What conditions must the solution satisfy?Will the solution affect something that must remain unchanged?

The Problem StatementThe Problem Statement: a statement of the specific problem or need to be addressed by the service/project.

It should include some basic data (baseline data) that help to explain the problem, including the following information:

•A description of the extent, scope, or severity of the problem, so that the proposed results can be put in perspective.•A description of the geographic area and demographic characteristics of the population in the area in which the problem exists.

•An analysis of the causes of the problem.

•The results of previous efforts, by your program or other programs, to solve the problem.

2. Identify alternative approaches to resolve the 2. Identify alternative approaches to resolve the problem:problem:

At this point, it's useful to keep others involved (unless you're facing a personal problem). Brainstorm for solutions to the problem:

Very simply put, brainstorming is collecting as many ideas as possible, then screening them to find the best idea. It is critical when collecting the ideas not to pass any judgment on them -- just write them down as you hear them.

Weigh Alternatives: After listing possible alternatives, evaluate them without prejudice, no matter how appealing or distasteful. 

3. Select an approach to resolve the problem:3. Select an approach to resolve the problem:

When selecting the best approach, consider:When selecting the best approach, consider:

a. Which approach is the most likely to solve the problem for the long term?

b. Which approach is the most realistic to accomplish for now? Do you have the resources? Are they affordable? Do you have enough time to implement the approach?

c. What is the extent of risk associated with each alternative?

4. Plan the implementation of the best alternative 4. Plan the implementation of the best alternative (this is your (this is your Action PlanAction Plan))

5. Monitor implementation of the plan:5. Monitor implementation of the plan:

Monitor the indicators of success:

a. Are you seeing what you would expect from the indicators?

b. Will the plan be done according to schedule?

c. If the plan is not being followed as expected, then consider: Was the plan realistic? Are there sufficient resources to accomplish the plan on schedule? Should more priority be placed on various aspects of the plan? Should the plan be changed?

6. Verify if the problem has been resolved or not:6. Verify if the problem has been resolved or not:

One of the best ways to verify if a problem has been solved or not is to resume normal operations in the organization. •Still, you should consider:

a. What changes should be made to avoid this type of problem in the future? Consider changes to policies and procedures, training, etc.b. Lastly, consider "What did you learn from this problem solving?" Consider new knowledge, understanding and/or skills.

c. Finally, consider writing a brief memo that highlights the success of the problem solving effort, and what you learned as a result. Share it with your supervisor, staff, ..

Management functionsManagement functions

1- PLANNING1- PLANNING 2- PERFORMANCE2- PERFORMANCE 3- EVALUATION3- EVALUATION

Planning is one of the most important Planning is one of the most important management functionsmanagement functions

Planning is preparing a sequence of actionPlanning is preparing a sequence of action steps steps to achieve some specific goal (s)to achieve some specific goal (s)

If you do it effectively, you can reduce much the If you do it effectively, you can reduce much the necessarynecessary time and effort of achieving the objectives.time and effort of achieving the objectives.

A plan is like a map (Road Mapping):A plan is like a map (Road Mapping):

[[When following a plan, you can always see When following a plan, you can always see how much you have progressed towards your how much you have progressed towards your objectives and how far you are from your objectives and how far you are from your destination (goal)]destination (goal)]

PlanningPlanning is the process of developing and analyzing the organization's vision, mission, goal (s), objectives, general strategies, values, and allocating resources.

Simply, planning is identifying:Simply, planning is identifying:

Where you want to go?Where you want to go?

Why you want to go there?Why you want to go there?

How you will get there?How you will get there?

What you need in order to get there? andWhat you need in order to get there? and

How you will know if you're there or not?.How you will know if you're there or not?.

Basic Overview of Typical Phases in PlanningBasic Overview of Typical Phases in Planning

Whether the system is an organization, program, project, etc., the basic planning process includes similar nature of activities carried out in similar sequence:

1. Reference Overall Vision and Mission

2. Analyze the Situation (needs assessment)

3. Establish Goals

4. Establish Objectives Along the Way to Achieving Goals

5. Allocate responsibilities and time lines with each objective

6. Write and Communicate a Plan Document

7. Acknowledge Completion and Celebrate Success

VisionVision::

vision statement or what the institution vision statement or what the institution strive to be, declares the institutionstrive to be, declares the institution’’s s intent and aspiration to the future (Brown, intent and aspiration to the future (Brown, 2000). 2000).

The vision is to target while strategic The vision is to target while strategic planning is an arrow to it (Coile, 1994).planning is an arrow to it (Coile, 1994).

A vision statement is a concise expression of your organizationyour organization’’s best futures best future, of what it dreams to be.Ex:“ Healthy people in healthy communities”

MISSIONMISSION

While the vision statement sets out a broad picture of what your organization will be in the future, the mission statement is a more practical and precise description of your organization’s reason for organization’s reason for existence.existence.It is concerned with scope of the services and what distinguishes this organization from others (governmental, private, NGOs, etc..).

Many people refer to an organization’s mission statement as its ID ID (Identification Card).

MissionMission::

The mission is a statement of purposeThe mission is a statement of purpose What are the main services?What are the main services? Who is our customer?Who is our customer? How do we offer this service?How do we offer this service? Mission is flexible, dynamic, and Mission is flexible, dynamic, and

capable of responding to services as capable of responding to services as they occurthey occur

Goal and ObjectivesGoal and Objectives

Goals:Goals: are broad statements of what ultimately are broad statements of what ultimately wanted to be achieved. It should meet the wanted to be achieved. It should meet the institution mission and vision.institution mission and vision.

EX:EX: Goal of the government as regard health is to achieve Goal of the government as regard health is to achieve the coverage of basic health care services for each the coverage of basic health care services for each and every one of its citizens (Egypt health Reform, and every one of its citizens (Egypt health Reform, 2000) 2000)

Objectives:Objectives: it represent short term target it must be it represent short term target it must be specific in certain goal area it must be specific in certain goal area it must be measurable by certain indicator.measurable by certain indicator. EX: EX:

1.1. To decrease maternal mortality from 174 per 100,000 To decrease maternal mortality from 174 per 100,000 in1993 to 50 per 100,000 in 2010.in1993 to 50 per 100,000 in 2010.

2.2. To decrease infant mortality from 52.7 / 1000 live birth To decrease infant mortality from 52.7 / 1000 live birth in 1997 to 20/1000 in 2010.in 1997 to 20/1000 in 2010.

3.3. To reduce cigarette smoking to prevalence of no more To reduce cigarette smoking to prevalence of no more than 10% of the population in 2010 it is 21 percent in than 10% of the population in 2010 it is 21 percent in 1998.1998.

ValuesValuesThe value represents organization philosophy, The value represents organization philosophy,

principle and ideals. The values are the basic of principle and ideals. The values are the basic of culture. (Barrett and young, 1999)culture. (Barrett and young, 1999)The following are the value statement given by The following are the value statement given by Egypt health reform (2000)Egypt health reform (2000)

Universality:Universality: covering the entire population with a covering the entire population with a basic package of priority services. basic package of priority services.

QualityQuality: improving and assuring the standard of : improving and assuring the standard of quality to meet public satisfaction. quality to meet public satisfaction.

EquityEquity: all regions in the country and people of all : all regions in the country and people of all income levels will have a fair share in the health income levels will have a fair share in the health system. system.

SustainabilitySustainability: Ensuring the continuity for the future : Ensuring the continuity for the future generationgeneration

Implementation functionsImplementation functions::

OrganizingOrganizing Staffing: Proper selection and training of human Staffing: Proper selection and training of human

resources to ensure good performanceresources to ensure good performance Directing and leadership: Leadership is the art or Directing and leadership: Leadership is the art or

process of influencing people so that they will process of influencing people so that they will strive willingly toward the achievement of a group strive willingly toward the achievement of a group goal.goal.

Coordination of work and team buildingCoordination of work and team building Recording and reportingRecording and reporting Monitoring, and SupervisionMonitoring, and Supervision

Evaluation & monitoringEvaluation & monitoring

MonitoringMonitoring: : is the maintenance of regular is the maintenance of regular checking of ongoing activities or programs checking of ongoing activities or programs with respect to defined objectives. with respect to defined objectives.

The purpose is to record what the system is The purpose is to record what the system is actually doing at present and to detect actually doing at present and to detect possible deviations from the decided course of possible deviations from the decided course of action.action.

Where there are deficiencies, control and Where there are deficiencies, control and correction decisions and measures must correction decisions and measures must follow.follow.

Monitoring is concerned with Monitoring is concerned with Work progress, Work progress, Staff performance, Service achievementStaff performance, Service achievement

Monitoring is done forMonitoring is done for

InputsInputs: e.g. staff availability, supplies, etc.: e.g. staff availability, supplies, etc. ProcessProcess: e.g. standards of performance,: e.g. standards of performance, OutputsOutputs: e.g. records, reports, etc.: e.g. records, reports, etc. Managers and supervisors monitor work through:Managers and supervisors monitor work through: -- Continually observing work progress, staff Continually observing work progress, staff

performance and service achievementsperformance and service achievements -- Using check lists (e.g. supplies against Using check lists (e.g. supplies against

inventories and stock-lists)inventories and stock-lists) -- Examining recordsExamining records -- Discussing difficulties with staffDiscussing difficulties with staff

SupervisionSupervision Is to make sure that the staff perform their duties effectively. Is to make sure that the staff perform their duties effectively. It means that a supervisor helps and guides the staff and trains It means that a supervisor helps and guides the staff and trains

them as necessary in such a way that they become more them as necessary in such a way that they become more competent and keep the standard of work. competent and keep the standard of work.

Objectives of supervision: Objectives of supervision: - To maintain the expected quantity and quality of a health - To maintain the expected quantity and quality of a health

team work.team work. -- To assess the performance of team members.To assess the performance of team members. -- To identify some causes of work deficiency, e.g. To identify some causes of work deficiency, e.g.

insufficiency of resources, lack of training, lack of motivation of insufficiency of resources, lack of training, lack of motivation of employees, personal problems, unclear job descriptions......employees, personal problems, unclear job descriptions......

-- To help resolve dispute among team members.To help resolve dispute among team members. - - To help with personal problems.To help with personal problems. -- To trainTo train.. (On-the-job training) (On-the-job training) Supervision methods: Observation checklist, Record review, Supervision methods: Observation checklist, Record review,

Review of reportsReview of reports In all cases you should discuss with the employee and correct In all cases you should discuss with the employee and correct

deficiencies.deficiencies.

EvaluationEvaluation

Evaluation is a judgment of value based on Evaluation is a judgment of value based on measuring or assessing the achievements of measuring or assessing the achievements of program activities. program activities.

Evaluation is intended to measure the degree to Evaluation is intended to measure the degree to which the objectives of the program have been which the objectives of the program have been achieved; to identify pitfalls, and constraints; and achieved; to identify pitfalls, and constraints; and to help re-planning for correction.to help re-planning for correction.

Evaluation is concerned with effectiveness and Evaluation is concerned with effectiveness and efficiency. Evaluation would thus consider all the efficiency. Evaluation would thus consider all the steps of program planning, and implementation, steps of program planning, and implementation, and will assess input, process, output, outcome and will assess input, process, output, outcome and impact. Evaluation uses Indicatorsand impact. Evaluation uses Indicators

METHODS OF EVALUATIONMETHODS OF EVALUATION

Describe the program/project or activities Describe the program/project or activities to be evaluated.to be evaluated.

Determine the overall goals and specific Determine the overall goals and specific objectives of the program/project.objectives of the program/project.

Identify the indicators to be used.Identify the indicators to be used. Develop the evaluation design.Develop the evaluation design. Collect dataCollect data Analyze and interpret these dataAnalyze and interpret these data Utilize the evaluation results in decision Utilize the evaluation results in decision

making for corrective actions making for corrective actions

QUALITY MANAGEMENTQUALITY MANAGEMENT

ObjectivesObjectives:: Define qualityDefine quality Explain the criteria of quality in Explain the criteria of quality in

health carehealth care Describe quality improvement cycleDescribe quality improvement cycle

Definition of quality

Quality is the degree of adherence to Quality is the degree of adherence to pre-established criteria or standards.pre-established criteria or standards.

Is to do the right thing right at the first Is to do the right thing right at the first time in the planed period.time in the planed period.

Criteria of quality in health Criteria of quality in health carecare

Appropriateness: refers to the balance between user's needs and the capacity of the system from the technical and materialistic aspects. (It is equivalent to functional accessibility).

Accessibility: Four elements are important1. Physical accessibility which means that the

service is located within reach of individuals walking or by using transport.

2.Financial / economic accessibility is the affordability of the cost of service.

3.Cultural accessibility is the acceptability of the service by the clients.

4.Functional accessibility means that the right kind of care is available to those who need it whenever they need it.

Effectiveness: refers to the degree to which care is provided in correct manner to achieve the desired outcome or how successful it was to meet patient’s needs. Equity: refers to fairness in dealing with the clients.Efficiency: refers to the best use of resources to minimize cost and achieve cost containment.Support to health care providers at all levels they need economic and social support to motivate good work.Acceptability: A health care system should be acceptable and attractive to its users.

Continuity: is the harmony and integrity of delivery of care at different levels. Clients are provided with comprehensive, integrated care, without interruption.

Respect and Caring: The degree to which patients are involved in the decision and the provider’s reaction to the patient needs and expectations.

Competency: The degree to which practitioner adheres to professional standards of care and practice. It refers to skills and actual performance of health providers

Safety: ensures minimizing risks of injury and harmful side effects to health services delivery to patients and also to health provider.

Steps for quality improvement

1. Develop a plan with SMART objectives for improvement of service

2-Set standards which include: practice guidelinesadministrative procedure, clear rules and

regulationsSpecifications, distribution of responsibilities.performance standards in relation to time

and resources3-Communicate standards for the workers.4-Monitoring of implementation; continuous

supervision.

5-Identify problems, analyze each problem to identify its root causes and put priorities to these problems to be solved

6-Choosing a team to solve the problem7. Develop solutions and actions for

quality improvement.8.Implement and evaluate the quality

improvement efforts.9-If succeeded repeat the cycle again in

another area.

HEALTH ECONOMICSHEALTH ECONOMICS

ObjectivesObjectives: :

1.1. Define the major aspects of health Define the major aspects of health economicseconomics

2.2. Describe financing mechanismsDescribe financing mechanisms

3.3. Understand cost-effectiveness Understand cost-effectiveness analysisanalysis

Major aspects of Health Economics

11 - -Financing Health CareFinancing Health Care2- 2- Cost analysisCost analysis3- Cost effectiveness3- Cost effectiveness4- Cost containment4- Cost containment

Causes of rise of health care spending

- Demographic changes producing populations that are older on average.

‑A changing pattern of disease towards chronic illness.

‑Advances in medical technology and highly sophisticated equipment.

-Rising public and professional expectations connected with technological advances.

‑Increased utilization of curative health services rather than self or community care.

-Higher wages and salaries.‑Higher cost for drugs and supplies.‑Lack of cost‑conscious behavior by

providers.‑Insurance coverage introducing a third

party in the health financing system (over-utilization & increased cost).

-Inefficiency and inadequate management of resources. Over stuffing, health workers are badly deployed and supervised, hospital beds are underutilized.

Examples of the public health activities Examples of the public health activities that are highly cost-effectivethat are highly cost-effective

ImmunizationImmunization : in the first year of life would have : in the first year of life would have the highest cost- effectiveness of any health the highest cost- effectiveness of any health measure available in the world todaymeasure available in the world today..

School‑based health servicesSchool‑based health services, screening and , screening and immunizationimmunization..

Health educationHealth education for family planning and nutrition for family planning and nutrition.. Program to reduce tobacco & alcohol consumptionProgram to reduce tobacco & alcohol consumption..

for Aids preventionfor Aids prevention..Primary health carePrimary health care is cost effective than building is cost effective than building five star hospitalfive star hospital..Head helmetsHead helmets to prevent complications of to prevent complications of accidentsaccidents..

Measures for decreasing Measures for decreasing costscosts

1.Identify the most cost‑effective actions and re‑orient the resources towards them.

2.Training of managers at all levels: Policy level, top / middle management and health care providers on rules of health economics.

3. More appropriate technology in the more costly services and rationalized use of expensive technology as MRI, CT scan.

4.Rationalized use of drugs.5.The health insurance systems need to be

reformed for better use of resources.