Health Management

Management€

It is a purposeful & efficient utilization of the resources,in an organized manner, so as to achieve desired objectives.

€ Health

Management ± It is defined as the organization of health care facilities to the people in the most effective manner.

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TEXTBOOK OF COMMUNITY MEDICINE-AH SURYAKANTHA

Terminology
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Mission : The mission of an organization is described as the very reason why that organization exists. Objectives - Action orientation of the mission¶ and form the basis for taking action in appropriate direction and for measuring the performance. Goals : Intermediate time-bound and specific targets which are necessary for achievement of objectives in the organization. Policies-guidelines for decisions and actions. Strategy -Any decision, plan or action which takes into consideration the actions of competitors and other factors in external environment, with the aim of achieving the objectives. Procedures : Procedures are chronological steps involved in performing any action or taking any decision.
Textbook of public Health

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Utilization of resources

Planning

GOALS

Motivation of personnel

Monitoring

Basic Principle of Management

Basic resources (Inputs) Men Material Machines Methods Money Markets

Fundamental Functions (Managerial Transformation Process) Planning Staffing & Directing

Objectives (outputs) Products Services Profits Satisfaction Goal Achievement Others

Organizing

Controlling

Principles of management1. Division of work according to the ability, capacity and aptitude of the workers is essential in any organization or optimal utilization of scarce human resource and to maximize productivity in any form.

2.Well-defined responsibility leads to accountability and thus enhances performance of individuals.

3.Discipline in any organization is essential and a hallmark of compliance and mutual cooperation between various functionaries.

Team spirit (spirit-de-corps) is essential for any organizational work.

4.An employee should ideally receive his/her orders only from one superior since multiple commanding authorities would lead to confusion and chaos. 5.Employees should function in well defined functional chain of senior-subordinate relationships, called scalar chains, ideally depicted by a line organization.

6.Organisational goals should receive preference and are more important then individual goals. 7.Centralization of important policy decisions and key matters is essential in any organization to provide a well defined direction to efforts of individuals.

8.Equity in an organization removes conflicts and ensures compliance & cooperation.

9.Remuneration in form of pay and allowances should be pre-determined for all personnel, to avoid uncertainty.

10. Stability of working period (tenure) ensures certainty in minds of workers and enhances performance by inculcating a sense of belonging & responsibility among individuals.

Management Techniques

Quantitative methods Methods based on behavioral sciences

Quantitative methods
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COST ANALYSIS INPUT OUTPUT ANALYSIS MODEL SYSTEMS ANALYSIS PLANNING, PROGRAMMING & BUDGETING NETWORK ANALYSIS WORK SAMPLING Decision making

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TEXTBOOK OF COMMUNITY MEDICINE-AH SURYAKANTHA

Quantitative methods
Organizational management € Personnel management € Communication € Information system € Management by objectives € Total Quality Management (TQM)
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COST ANALYSIS
Cost Accounting € Cost benefit € Cost effectiveness € Cost minimization analysis € Cost utility Analysis
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TEXTBOOK OF COMMUNITY MEDICINE-AH SURYAKANTHA

Cost Accounting€

(1)

Cost of health programme or intervention can be calculated.
y Cost=Inputs i.e.-materials, salaries ,expenses of

training activities. y Uses-First step of cost analysis used in cost projections. y Creates awareness about financial aspects of the programme. y Can compare costs of various programme components.

y TEXTBOOK OF COMMUNITY MEDICINE-AH SURYAKANTHA

Cost benefit Analysis
Cost of programme is identified. € Benefit in estimated in monetary terms. € Saving of direct & indirect cost.
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TEXTBOOK OF COMMUNITY MEDICINE-AH SURYAKANTHA

Cost effectiveness Analysis€

(3,4)

Cost of programme is identified. € Benefit in estimated in terms of results obtained. € Ex-No of lives saved,number of disabilities prevented. € Uses-Help in identification of best option out of health intervention € Identifying type of treatment modality.

Cost-minimization analysis:
a determination of the least costly among alternative interventions that are assumed to produce equivalent outcomes. Ex-If two interventions have the same individual health effects, then the one which can be judged as the most value for money will be the intervention which minimizes the net costs. € Ex -use of generic drugs.
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Cost-utility analysis (CUA):
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a form of cost-effectiveness analysis that compares costs in monetary units with outcomes in terms of their utility, usually to the patient, measured, e.g., in QALYs

Comparison of various methods
Method Cost benefit Analysis Input Output

$ $ $ $

costs and benefits are both valued in cash terms

Cost effectiveness Analysis

natural units, such as mmHg, symptom free days, life years gained.

Cost-minimization analysis

minimum$
composite metric of both length and quality of life, the Quality-adjusted life year (QALY).

Cost-utility analysis

INPUT-OUTPUT ANALYSIS
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(1)

Economic model of the health care system which is capable of characterizing financial flows, describing health system interrelationships and predicting the impacts of policy alternatives on the entire health care system. € Input-man ,materials, money & time. € Output-Cost effectiveness analysis.

Model
Symbolic representation of idealized system. € Indicates probable results & outcomes.
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System Analysis
Identify problem

Investigate

Search out for objectives

Finding out alternative solutions Cost effectiveness analysis of alternatives & selecting the most cost effective alternative

Network AnalysisA project is broken up into small operations

Activities arranged into logical sequence.

Formulating an action plan
Activities ±Serial, Parallel & Dummy activities. Events-Initial, Intermidiary & Terminal. Slack-Time duration to which events can be delayed without affecting project duration.

Network Analysis-CPM & PERT
Critical Path Method (CPM) : It is assumed that durations of individual activities in a project are known with certainty.
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The method thus helps to determine the earliest possible start time & latest possible start time for each activity. Identifies the critical activities, which are critical because if any of these activities are delayed by even a short period, then entire project will be delayed. CPM is also the standard method of communicating project plans, progress and costs. Used in repetitive projects.

Project Evaluation & Review Technique (PERT) (2)
It involves planning, monitoring and controlling of projects where time taken for each activity in the project is not known. It uses probability to estimate the timings of various activities in the project and linear programming for maximizing the achievement of objectives. PERT uses probabilistic and linear programming methods to assist a manager in planning schedules. Ex-used in long-term projects like construction of hospitals, launching of new health programs, products & services, where exact time for each phase is not known with certainty.

Time-estimates under PERT- :
(a)

Most Likely Time- is the time taken most frequently in completing a particular activity.

(b) Optimistic Time- Time in which an activity can be completed, if all goes as per the pre-determined plan. (c) Pessimistic Time-Time taken to complete an activity under most adverse conditions. This is thus the longest possible time taken to complete a project. Expected Time for an activity= Optimistic Time+(4XMost Likely Time)+Pessimistic Time 6

Work Sampling€

(1,3)

Technique for determining the proportion of time spent by workers in various defined categories of activity (e.g. setting up a machine, assembling two parts) € In a work sampling study, a large number of observations are made of the workers over an extended period of time. For statistical accuracy, the observations must be taken at random times during the period of study, and the period must be representative of the types of activities performed by the subjects. € It permits quick analysis, recognition, and enhancement of job responsibilities, tasks, performance competencies, and organizational work flows. € Hence helps in determination of the standard time for a manual manufacturing task.

Decision-Making
Outline your goal and outcome

Gather data

Brainstorm to develop alternatives

List pros and cons of each alternative

Make the decision

Immediately take action

References
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1.TEXTBOOK OF COMMUNITY MEDICINE-AH SURYAKANTHA 2.Text book of public health

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3.Health economics-www.wikipedia.org 4.Textbook of PSM ±K.Park

€THANKS