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Management strategies of healthcare institutions e learning course lecture 6_ka
- 1. Course Developed by: Dr. Khaled Abdelhalim, Assistant Professor Public Policy and Administration Department, The American University in Cairo Management Strategies for Healthcare Institutions Lecture Six: STRATEGIES FOR MANAGING HEALTHCARE INSTITUTIONS
- 2. Understand the strategic options for managing healthcare institutions Realize potential roles of the public and private sector in healthcare institutions & their potential partnership Comprehend the required reforms that are necessary to improve the management of healthcare institutions Apply the principles of good governance and innovative management for improved management of healthcare institutions Lecture Six: Objectives
- 3. Management Strategies for Healthcare Institutions Lecture Six: Strategies for Managing Healthcare Institutions Lesson One: STRATEGIC OPTIONS FOR MANAGING HEALTHCARE INSTITUTIONS
- 4. Strategic Options for Management Arrangements of Healthcare Institutions Public Sector: Reformed Private Sector: Regulated Public Private Partnership: Encouraged
- 5. Strategic Option One: Public Sector Reform A National Reform Program for healthcare institutions: enabling environment, resource provision, etc. Strategic Management at healthcare institution’s level: strategic planning process and applying strategic management Setting performance & result-based indicators
- 6. Different modes of management for public healthcare institutions: 1. Direct management: the entity that owns, controls or is responsible for development directly manages it 2. Delegated management: the entity responsible for development delegates the management of the project/program in part on in total to another entity (more expert, closer to implementation or location, etc.) 3. Contracted out management: in part or in total to a relevant service provider management Ownership one Delegated or Contracted Strategic Option One: Public Sector Reform
- 7. Encouraging private sector healthcare service provision Regulating the role through Legislation National health insurance system Monitoring & Evaluation Strategic Option Two: Private Sector Regulation
- 8. Participation of public and private actors in decision- making and resource input Public sector maintains control to ensure public interest & social welfare Private sector brings in professional and strategic management to ensure service quality and resource optimization Strategic Option Three: Public-Private Partnership
- 9. Management Strategies for Healthcare Institutions Lecture Six: Strategies for Managing Healthcare Institutions Lesson Two: PRINCIPLES FOR IMPROVED MANAGEMENT OF HEALTHCARE INSTITUTIONS
- 10. Principles for Improved Management of Healthcare Institutions Subsidiarity Principle Decentralized Decision-making Innovation Customer Orientation Quality Assurance Effectiveness
- 11. Principles for Improved Management of Healthcare Institutions Good Governance Principles: Participation Transparency Accountability Responsiveness Efficiency Integrity Equality
Editor's Notes
- The objectives of this lecture are: Understand the factors within the internal environment of public institutions affecting their strategic management Obtain knowledge of the factors with the external environment impacting the strategic management of public institutions Acquire knowledge and skills of how to analyze the management of public institutions from a strategic perspective
- There are three strategic options for the management arrangements of healthcare institutions, which at that sectoral level similar to other social services management arrangements: The first is public sector reform: Governments own and manage healthcare institutions and management facilities to serve a social welfare function, ensuring the access of vulnerable social groups to the healthcare system. The strategic option here is to keep these institutions, but introduce radical reforms to overcome the typical inefficiencies and poor service quality. The second option is private sector regulation: The private sector provides quality healthcare services through diverse types of healthcare institutions. Yet, these services are beyond the access and affordability of low-income people. The strategic option here is to encourage the role of the private sector in healthcare, but regulate it to ensure access of vulnerable groups of society. The third option is public-private partnership: Public-private partnership can be encouraged in managing healthcare institutions, but the management arrangements need to be tuned to get the advantages of the two worlds. Introducing PPP can be one of the strategic ways of reforming public sector healthcare institutions; i.e. getting private sector on board.
- The reform of public healthcare institutions requires a national reform program that provides the overarching legitimacy for any reforms at the institutions’ level. Such program should ensure the government commitment to creating an enabling environment and providing required resources for improving performance and quality of services. The national program should be complemented by introducing strategic management at the healthcare institutions’ level. This entails applying the 10-step strategic planning process explained earlier in the course, and applying the strategic management approach for dealing with management elements and processes within the internal and external environment. The public sector reform for healthcare institutions necessitates setting performance and result-based indicators that become the benchmark for whether reform efforts are successful or not.
- There are different modes of management for public healthcare institutions: Direct management: the government owns, controls or is responsible for the healthcare institution and directly manages it Delegated management: the government delegates the management of the healthcare institution in part on in total to another entity (private sector, civil society organization, community group, etc.), governed by a delegation agreement. Contracted out management: in part or in total to a relevant service provider. Contracting out is governed by a contract that states the terms and conditions of managing the institution. Each of these modes of management may suit certain situation of healthcare institutions, hence they have to decided upon case by case.
- The second strategic option for managing healthcare institutions is encouraging private sector role in healthcare service provision. This has to be combined with clear legislation that regulates the management of healthcare services provided through private institutions, particularly service charges and rights of patients. In private-sector led healthcare system, the best way to ensure access of vulnerable groups is adopting a national health insurance system that covers the cost of treatment at private institutions. It has to be noted that such systems require huge resource allocation from government and requires rigorous checking of eligibility. An important element in the strategic option of depending on private sector in healthcare service provision is an effective monitoring and evaluation system that ensures abiding by regulations and the right use of the health insurance system.
- The third strategic option for managing healthcare institutions is encouraging public-private partnership, which means that relevant government and private sector actors are represented in the management of healthcare institutions and both sectors participate in resource input and the governance of the institution. The public or government sector maintains control of decision-making to ensure guarding the public interest & social welfare The private sector brings in professional and strategic management to ensure service quality and resource optimization
- Here are some principles that can be useful for improving the management of public institutions, which can be easily applied to healthcare institutions: The management of healthcare institutions should target effectiveness in the services they provide; which applies the customer-orientation principle aiming at customer satisfaction. This process is considered part of quality assurance. As a principle, service provider institutions need to be empowered with mandates and resources that helps them be responsive to customers’ needs and expectations. This requires from higher supervising institution (like the Ministry of Health vis-à-vis a hospital) to allow for a decentralized decision-making mode, which is consistent with the subsidiarity principle that requires decisions to be taken at the lowest possible level closer to implementation or service delivery level. The management of healthcare institutions also requires innovation and more importantly, the cultivation of an innovation culture; rewarding those who try unconventional solutions to issues and problems rather than punishing them.
- In addition, the management of healthcare institutions can also benefit from applying good governance principles, which include: Sharing is Caring: The management of healthcare institutions need to practice transparency (in the form of sharing information with relevant stakeholders) The management should adhere to accountability to higher authorities as well as to customers The management has to be responsive to customers needs and demands, as well as to the demands of partner institutions The participation of employees at all levels of the institution in decision-making, visioning and planning increases their institutional ownership and commitment. Other principles are equally important; applying equality (equal opportunity) and integrity (combating corruption) measures, for example.