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Health Care was identified as one of the potential boom industries for Asia in the APMF's Asia Trends 2000 Review last year. As the middle class increases its demand for high quality services, and health concerns such as the spread of tuberculosis, mosquito-borne diseases, and AIDS increase, so too does the need for high quality medical and health care services. The Health-Care industry in Asia is expanding rapidly in Asia, with the richer countries now boasting some of the finest facilities in the world - with public facilities in Singapore and Hong Kong and special cases such as Thailand's Bumungrad hospital being cases in point. The opportunities in private health care abound, again with great bounds forward in Singapore especially. Drug companies have already discovered the Asia market, yet the costs of their products are often prohibitive, mainly caused by having to recoup expensive Research and Development costs. Yet another opportunity for local companies is in R&D, traditionally ignored by Asian companies in favour of importing foreign drugs. However international wage rates for scientists, medical technologists and researchers mean the down-side of this policy is catching up with us quickly. Effective management in hospital and health-care services is also often seen as a secondary problem, as governments rush to meet the immediate demands of fast growing populations. Yet as several of the feature articles this week demonstrate, including some from Malaysia and Singapore, the problem of management development is recognised now. The excellent case study in a New Zealand hospital may provide good pointers, as too the review of the NHS in the UK - admittedly not an Asia-Pacific case but there are ideas that can be implemented here successfully as well. Just as a reminder, you should note the Volume and Issue Number of the articles you are interested in before entering the database, as there is no search facility for the Journals of the Week - only browse facilities issue by issue are provided for the free download.
Empowerment and the performance of health services Addresses the issue of empowerment and its possible role in promoting the effectiveness of health services. Empowerment represents the ability of people within organisations to use their own initiative to further organisational interests. However, despite its apparent simplicity, the concept turns out to be quite complex and to have unanticipated implications. We explore some of these implications in health service organisations, and their consequences for health policy. Our conclusion is that many health policies may well act to degrade the empowerment of health service workers, and hence the performance of health service organisations.
Keywords: Empowerment, Health care, Management, Professionalism
Implementing change in the National Health Service This paper will outline the current changes being imposed on the National Health Service. The literature on change management will be employed to propose some guidelines for health service managers. The National Health Service (NHS) spent much of the 1980s and 1990s learning about the transition from administration to management and must now make the transition from management to leadership. The emphasis is now focused less on doing and more on being.
Keywords: Organizational change, Role conflict, Resistance, Leadership, National Health Service, United Kingdom
Knowledge and attitudes of Malaysian private medical practitioners toward guidelines-based medicine This paper describes a study of the knowledge and attitudes of a sample of private medical practitioners in Malaysia in relation to questions posed on guidelines-based medicine. The study was conducted through a postal questionnaire sent to a sample of 2,000 private practitioners. Placing the research in context, a description of Malaysia and its health-care system is provided. Issues surrounding guidelines-based medicine in the Malaysian context are discussed. An analysis of the sample population's personal and professional characteristics is presented. Key research findings include identifying a substantial knowledge deficit - less than half of the respondents claimed to understand "guidelines". A majority of doctors (64 per cent) think guidelines are useful. Only 29 per cent of respondents knew where to find guidelines, with 22 per cent claiming to have used guidelines. The paper concludes with a discussion of issues in the implementation of guidelines-based medicine in Malaysia based on the study's findings.
Keywords: Medical professions, Attitudes, Health service, Malaysia
Making bureaucracy work What gives bureaucracy such a bad name? Is it bureaucracy in itself, or the ghosts in the system who, in a million minor drifts, contribute to turning efficiency into red-tape? Undesirable side-effects need not be confused with necessary first-level effects. There is nothing wrong with the bureaucratic system as such. Ultimately we could not work without it as it is the only known way of co-ordinating vast numbers of people to treat mass problems. However, like any tool, it is only as good as the people who use it, and its results are largely linked to the very agendas of the users. Understanding what makes bureaucracy work requires a good look at the implicit biases in the bureaucratic model, mostly seeded by its various founders and theoreticians, as well as tackling pragmatic issues of creating and applying rules - and where and when to change them.
Keywords: Bureaucracy, Standards, Organizational structure, Hospitals, Management
Outsourcing to increase service capacity in a New Zealand hospital Service firms manage variability using both demand-side tactics (levelling customer demand), and supply-side tactics (increasing available capacity). One popular way of increasing available capacity is the outsourcing of non-core services. This article uses a case study to examine the impact of an outsourced non-core service on a hospital's overall service system. Findings show that the outsourced service provides access to more sophisticated technology, increases in-house capacity and saves capital expenditure. However, the outsourcing also increases the scheduling problems that the hospital faces. These problems are largely due to communication delays from the involvement of more than one organisation. These delays decrease the response time available to match changes in demand for the outsourced service. Given the obvious benefits of such outsourcing, the article concludes that management should pay close attention to the communication pathways between organisations, in order to minimise the end effects identified in this study.
Keywords: Outsourcing, Resource efficiency, Supplier relations, Hospitals, New Zealand
Spotlight - Thinking in the old way and trying to live in the new Professor Viatcheslav Alexeev offers freelance journalist Sarah Powell his views of the state of the Russian national health system and the challenges faced as Russia moves from a socialist to a capitalist economy. Viatcheslav Alexeev is Professor of International Health and Management at the Department of International Health of the Russian Medical Academy of Advanced Medical Studies in Moscow. His wide-ranging experience includes teaching management and health administration, health manpower development, and interpersonal relationships at the Central Institute for Advanced Medical Studies. Following this, for over 20 years he was Assistant Professor and Director of the WHO International Courses for Health Administrators. From 1981 to 1987, he worked on the staff of the Health Manpower Development Division of the WHO in Geneva, in which capacity he gained extensive experience of training, research and organization in over 30 countries.
Keywords: Health care, Medical professions, Management, Socialism, Capitalism, Russia
Teamwork in health care: Lessons from the literature and from good practice around the world It is becoming more difficult to provide health care that meets the needs of patients within tight budget constraints. This article suggests that one way forward is to channel the energies of people more constructively to work as teams. Some definitions are shown for teams and teamwork, and four benefits suggested of effective teamwork: learning and development, resource management, task performance and communications. In each of these four areas, examples are given from the international world of health care of how teamwork can be achieved. Finally, it is concluded that teamwork can be difficult, but that it is worth pursuing.
Keywords: Communications, Health care, Learning, Resources, Teams, Teamwork
Working together to develop health services managers The developing emphasis in health and social care on working across traditional boundaries will demand different approaches to staff development. If we are to retain the strengths of expertise in the enormous number of areas represented in health and social care we will need to develop better ways of understanding each other in order to work together more effectively. This paper focuses on some of the issues raised in management development programmes which have multiple objectives demanding educational and developmental support. The emphasis is on identification of issues which arise in collaboration amongst those delivering a programme when they come from the different backgrounds of training and development, personal development and higher education. Some of the issues raised in partnership working between commissioning and providing organisations are also considered.
Keywords: Development, Management education, National Health Service
Workplace health concerns: a focus group study Addresses the workplace health concerns of employees at an Acute Hospital Trust. The research conducted utilised a focus group methodology to investigate the health concerns of multidisciplinary groups of health care workers (n=27). The findings indicate that the concern for the majority was workplace stress. Stressors that were identified as important to the groups were, for example, the nature of the work they were undertaking, staffing levels, volume of the work, management styles and their work environments. Health promotion and prevention topics such as motivation and health status, smoking, alcohol and drug misuse, nutrition and weight control and physical exercise were seen of subsidiary concern. Limitations of the study are given. Future research in the subject area is identified.
Keywords: Focus groups, Problems solving, Stress, Work
Measuring the inappropriate utilization of accident and emergency services? Accident and Emergency (A&E) departments are increasingly popular venues for primary care, causing a serious threat to healthcare quality. This paper reports the development of a comprehensive research method for identifying primary care patients attending A&E. Patients were randomly selected from the four A&E departments across different time periods and different regions in Hong Kong. The definition of GP cases was based on a retrospective record review conducted by a panel of emergency physicians using the standard laid down by the Hong Kong College of Family Physicians. The patients sampled were similar in sex and age distribution to A&E attendees for the whole territory. The level of GP cases was found to be 57 per cent, with a significantly higher proportion of patients in the younger age group. The high level of use reflects the lack of a well co-ordinated development of primary care services and interfacing with secondary care.
Keywords: Hospitals, Health care, General practice, Hong Kong
Practices of excellent companies in the drug industry Examines excellence in three major pharmaceutical companies: Merck, Lilly, and Glaxo. Provides an overview of recent trends in the health care industry. Shows that, although all three companies are facing tough competition and strict cost-containment pressures, they continue to develop innovative strategies for increasing the quality of their product offering. Analyses Merck's recent acquisition of Medco and its implications; also highlights Merck's "Vital Interests" programme. Discusses Lilly's recent purchase of PCS from McKesson Drug and Lilly's recent efforts to concentrate on its core business. Introduces Helix, Glaxo's new computer network for pharmacists and explains the benefits of this unique service, both to its users and the sponsor.
Keywords: Competitors, Exemplars, Pharmaceutical industry
Culturally sensitive mental health services through quality improvement An urban mental health service undertook a quality improvement programme to involve staff in the identification and resolution of cross-cultural issues. The programme involved clinical file audits, staff survey and workshops, and a focus group for consumers and their carers. It was found that non-English speaking patients received a different spectrum of services from English speaking patients. Non-English speaking patients were found to receive more pharmacological treatments and less cognitive behavioural therapy. In seeking to address these issues and improve their service delivery to all patients, the mental health service is now in the process of developing cross-cultural training; revising policies and procedures; and engaging bilingual mental health counsellors in a revision of their roles, particularly to increase their availability to staff as cultural consultants.
Keywords: Mental health, Quality improvement, Organizational change, Ethnic groups, Australia
A developmental performance framework for primary care Primary care in the NHS changed substantially during the 1990s. In recent years, structural changes, most notably the introduction of primary care groups as an administrative centre for planning, have added impetus to the need for adopting meaningful measures of quality of the primary care service. This qualitative study reports the views of a sample of general practitioners, primary care nurses, and practice managers on the development and refinement of current performance indicators. Seven themes were identified as key areas for development of indicators of performance: patient experience, clinical activity, service development and innovation, access, health promotion, cost effectiveness, and quality of life outcomes. These themes are incorporated into a dynamic framework for development where improved outcomes (including quality of life measures) are seen as central to the evaluation of quality, and inter-professional collaboration in the delivery and evaluation of quality of the new primary care is called for.
Keywords: Quality, General practice, Health care, Performance indicators, Nurses, Management
A two-level integrated approach to self-assessment in healthcare organisations Defining quality of healthcare and determining how to improve organisational performance in developed countries is still an unresolved issue among healthcare professionals. However, given that it is an important area of responsibility and accountability it is no longer acceptable to view the issue as discretionary. An increasingly acceptable operative option for achieving continuous improvement and excellence seems to be the self-assessment of an organisation, based on the principles of knowledge management and total quality management (TQM). This article provides an explanation of a two-level self-assessment approach for implementing TQM within the Spanish healthcare system. The first level integrates a client-centred approach using classical healthcare accreditation criteria along with ISO 9000 standards, the aim being to establish quality assurance systems in the whole organisation. The second level uses the European Foundation for Quality Management Excellence Model as a road map for self-assessment and continuous improvement towards excellence.
Keywords: Audit, ISO 9000, Kaizen, Self-assessment, TQM
An analytical approach to determining the competitive advantage of TQM in health care The utilization of total quality management (TQM) is advocated by some experts, as a partial remedy to the ills of the health care industry. However, some healthcare administrators are not yet sold on TQM. Some healthcare administrators still question the impact of TQM on the operational, financial and strategic health of their institutions. They consider the investment in TQM as unjustifiable because the return on such investment in their mind is questionable. This study illustrates how the constant market share model can be utilized to show the competitive benefits of TQM. Based on the results of this study, it is concluded that the fears of some healthcare administrators are unfounded. Not only that TQM does not compromise organizational effectiveness, but it actually improves it, as it contributes to increasing market share.
Keywords: Competitive advantage, Competitiveness, Health care, Market share, Total quality management
Contemporary organizational strategies for enhancing value in health care To a rapidly changing environment, health-care organizations are adopting a variety of value enhancement strategies. Typically characterized as quality improvement activities, these strategies generally include efforts to improve: clinical effectiveness; financial performance; consumer satisfaction; employee satisfaction; and risk management/quality assurance activities. Early efforts involved the use of continuous quality improvement (CQI) or total quality management (TQM) strategies with a focus on improving financial performance, while clinical effectiveness has been a greater emphasis more recently. This study examines the manner in which 14 US health-care systems, noted for innovation in quality improvement and value enhancement, are utilizing these activities to promote productive organizational change. An interview format, for use with key informants in each organization, was developed using a model with four dimensions - strategic, cultural, technical, and structural.
Keywords: Value, Kaizen, Management, Organizational change
Improving organisational culture through innovative development programmes Recognising that changing culture is the most important role of a leader, the authors provide a diagnostic description of the culture within the nursing directorate of a National Health Service Trust. When the characteristics of the prevailing culture are compared with those associated with one that is ideal, many gaps are identified. In an attempt to address and overcome these gaps, the leaders within the organisation worked with the staff of the nursing directorate and in turn identified that learning and development was a priority if improvements were to be attained. Consequently two innovative development programmes were designed and the necessary steps taken to effect their implementation. The details of the programmes are provided along with the benefits and drawbacks attributed to this particular initiative.
Keywords: Corporate culture, Development, Learning, Nurses, Organizational change
Improving performance through self-assessment Wakefield and Pontefract Community Health NHS Trust uses the European Business Excellence Model self-assessment for continuous improvement. An outline of the key aspects of the model, an approach to TQM, is presented. This article sets out the context that led to the adoption of the model in the Trust and describes the approach that has been taken to completing self-assessments. Use of the model to secure continuous improvement is reviewed against Bhopal and Thomson's Audit Cycle and consideration is given to lessons learned. The article concludes with a discussion on applicability of the model to health care organisations. It is concluded that, after an initial learning curve, the model has facilitated integration of a range of quality initiatives, and progress with continuous improvement. Critical to this was the linking of self-assessment to business planning and performance management systems.
Keywords: Kaizen, NHS, Performance management, Self assessment, Strategic planning, TQM
Q methodology, risk training and quality management The results of a Q methodological study of professional understandings of the notion of risk in mental health services within the UK are discussed in relation to the relevance for staff training and quality assurance. The study attempted to access the diversity of understandings of risk issues amongst a multi-professional group of staff (n = 60) attending inter-agency risk training workshops in 1998. Q methodology is presented as both an appropriate means for such inquiry and as a novel experiential technique for training purposes. A tentative argument is advanced that the qualitative accounts generated by Q research could assist in systematic reviews of quality, complementing the singularly quantitative approaches typically represented in the audit process.
Keywords: Risk, Mental health, Training, Quality assurance, Quality management, United Kingdom
See also our previous review on Health Care Management
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