DEFINITION OF HEALTH CARE SYSTEM 

:
A health system, also sometimes referred to as health care system or as healthcare
system, is the organization of people, institutions, and resources that deliver health care
services to meet the health needs of target populations.
There is a wide variety of health systems around the world, with as many histories and
organizational structures as there are nations. Implicitly, nations must design and
develop health systems in accordance with their needs and resources, although
common elements in virtually all health systems are primary healthcare and public
health measures. In some countries, health system planning is distributed among
market participants. IHowever, health care planning has been described as often
evolutionary rather than revolutionary. As with other social institutional structures,
health systems are likely to reflect the history, culture and economics of the states in
which they evolve. These peculiarities bedevil and complicate international
comparisons and preclude any universal standard of performance.

HOSPITAL ADMINISTRATORS :
Hospital administrators are individuals or groups of people who act as the central point
of control within hospitals. These individuals may be previous or current clinicians, or
individuals with other healthcare backgrounds. There are two types of administrators,
generalists and specialists. Generalists are individuals who are responsible for
managing or helping to manage an entire facility. Specialists are individuals who are
responsible for the efficient and effective operations of a specific department such as
policy analysis, finance, accounting, budgeting, human resources, or marketing.
It was reported in September 2014, that the United States spends roughly $218 billion
per year on hospital's administration costs, which is equivalent to 1.43 percent of the
total U.S. economy. Hospital administration has grown as a percent of the U.S.
economy from .9 percent in 2000 to 1.43 percent in 2012, according to Health Affairs. In
11 different countries, hospitals allocate approximately 12 percent of their budget
toward administrative costs. In the United States, hospitals spend 25 percent on
administrative costs.

Generally, hospital administrators must do the following:

• Set budget and departmental goals
• Strategize to improve efficiency and quality of care
• Oversee finances such as patient fees, billing and fundraising
• Ensure the facility’s compliance with laws and regulations
• Communicate effectively with departments and staff regularly
• Represent the organization to investors or governing boards
• Oversee work schedules, supplies and budgets
• Educate the community on important health
A successful hospital manager adapts to change and stays current on healthcare laws,
regulations and technology, and coordinates with staff.

Defining and measuring performance

In general, performance measurement seeks to monitor, evaluate and communicate the
extent to which various aspects of the health system meet their key objectives. Usually,
those objectives can be summarized under a limited number of headings – for example,
health conferred on people by the health system, its responsiveness to public
preferences, the financial protection it offers and its productivity. Health relates
both to the health outcomes secured after treatment and to the broader health status of
the population. Responsiveness captures aspects of health system behaviour not
directly related to health outcomes, such as dignity, communication, autonomy, prompt
service, access to social support during care, quality of basic services and choice of
provider. Productivity refers to the extent to which the resources used by the health
system are used efficiently in the pursuit of effectiveness. Besides a concern for the
overall attainment in each of these areas, The world health report 2000 (7) highlighted
the importance of distributional (or equity) issues, expressed in terms of inequity in
health outcomes, responsiveness and payment.
Various degrees of progress have been made in the development of performance
measures and data collection techniques for the different aspects of health
performance. In some areas, such as population health, there are well-established
indicators – for example, infant mortality and life expectancy (sometimes adjusted for
disability). Even here, however, important further work is needed. A particular difficulty
with population health measures is estimating the specific contribution of the health
system to health. To address this, researchers are developing new instruments, such
as the concept of avoidable mortality .

Aspects of health performance measures :

Measuremen Description of measures Examples of indicators
t area
Population health Measures of aggregated data on the Life expectancy
health of the population
Years of life lost
Avoidable mortality Disability-
adjusted life-years
Individual health Measures of individual’s health status, Disease-specific measures:
outcomes which can be relative to the whole
population or among groups • arthritis impact measurement
scale
Indicators that also apply utility
rankings to different health states
Clinical quality and Measures of the services and care Outcome measures:
appropriateness of patients receive to achieve desired
outcomes • health status
care
Measures used to determine if best • specific post-operative
practice takes place and whether readmission and mortality rates
these actions are carried out in a Process measures:
technologically sound manner
• frequency of blood pressure
measurement
Responsiveness of Measures of the way individuals are Patient experience measures
health system treated and the environment in which Patient satisfaction measures
they are treated during health system
interactions
Measures concerned with issues of
patient dignity, autonomy,
confidentiality, communication, prompt
attention, social support and quality of
basic amenities
Equity Measures of the extent to which there Utilization measures
is equity in health, access to health
care, responsiveness and financing
Productivity Measures of the productivity of the
health care system, health care
organizations and individual
practitioners
Tips for Running an Effective Hospital :
Rates of access
Use–needs ratios
Spending thresholds
Disaggregated health outcome
measures
Labour productivity
Cost–effectiveness measures (for
interventions) Technical
efficiency (measures of
output/input) Allocative efficiency
(measured by willingness to pay)
1. Make sure your records don't accumulate unwanted depreciation. If a piece of
equipment or other asset is no longer in use, or in existence, it should be physically
disposed of and removed from the books.  For instance, if the hospital once owned a
building and it wasn't remove from the records when it was replaced or sold, the
hospital may have paid several years worth of insurance on the old building.  In addition
to placing a strain on the hospital's finances, this carries accumulated depreciation on
the hospital balance sheet making it appear older than it really is. "Having fully
depreciated assets, such as old MRIs, on the books make hospitals seem like they are
dated and worn," says Adam Lynch of Principle Valuation. "You have to clean them
out."

For one client, Principle Valuation identified $31 million in disposals to remove from the
books, and almost all of it was fully depreciated. When the disposals are removed, the
hospital's books more accurately reflected their real situation. "Taking care of the books
puts you in the best light," says Mr. Lynch.

The amount of expensed and accumulated depreciation effects a hospital’s financial

statements. For audit purposes it is important that processes and procedures are in
place to maintain an accurate asset record.  In addition, when hospital or health system
executives are seeking debt financing, financial intermediaries, capital sources and
rating agencies scrutinize the financial statements impacting the cost of capital and
possibly access to capital.

2. Minimize staff turnover. Best practices across the board say that high staff turnover
is bad for business because it takes time and energy to train employees, and losing
their expertise is a drain on hospital resources, says Alex Rintoul, CEO of Medical
Center of Elizabeth Place in Dayton, Ohio. There are several reasons why a surgical
hospital might have high turnover rates, including low employee satisfaction and higher
wages at competing facilities. To meet these challenges head-on, hospital CEOs must
have a sophisticated HR professional who is able to work with employees and
executives to keep the turnover rate low.

The HR professional from MedHQ that visits Mr. Rintoul's hospital every week is able to
deal with these types of issues because he doesn't have to deal with the day-to-day
payroll and benefits issues. "I had my services increased out of MedHQ's central office
so that I could contract with MedHQ to have the seasoned HR professional that I
couldn't afford every day to visit once per week and handle the challenging HR issues,"
says Mr. Rintoul. "As my needs changed and new problems developed, MedHQ worked
with me to solve my immediate problems and then looked at how to plan going forward
to meet potential new HR complications."

3. Develop a strong managed care team. Failure to develop and utilize a well-

managed care team is one of the most damaging practices when it comes to OR
efficiency, says Steven M. Gottlieb, MD, CEO of TeamHealth Anesthesia. If a surgical
team is delayed from starting their next case because the anesthesiologist is still
finishing up one patient or the next patient isn't ready for surgery, it creates an
unnecessary roadblock that derails the surgical schedule and can leave both surgeons
and patients dissatisfied. The concept of care team should also be extended to include
a strategic partnership with OR leadership and care providers. For example, the
anesthesia team can often partner with the OR circulating nurses to streamline
throughput and reduce redundant activities. A care team approach allows
anesthesiologists and OR clinicians to coordinate patient care to optimize OR time.

4. Take control over the elements of competition that you can influence. There are
certain competitive strategies that the hospital can't influence — including geography,
demographics and payor competition — but they can influence the relationship between
the hospital, payors and area physicians. Many times, this includes a physician-hospital
alignment strategy. The hospital can also explore alignment with other tertiary providers
in the community to provide a seamless continuum of care.  All of this requires access
to information across the continuum, says Luke Peterson, a National Director of Kurt
Salmon's Healthcare Strategy Group.

Additionally, hospital executives can influence how they develop the different
departments. Many departments are modernized when the hospital partners with
surgeons to perform new procedures, purchases new technology and updates data
collection capabilities. "Timely access to the right information is key, but don't forget to
have the right human resources assets in place and the right people in leadership
positions to focus on advancing care and improving the department's culture," says Mr.
Peterson.

5. Conduct department evaluations before lay offs. One of the biggest mistakes

hospitals can make when cutting jobs is establishing a fixed percentage cut in each
department, according to Sherilynn Quist, workforce efficiency practice leader at
management and consulting company Quorum Health Resources. This tactic may
exacerbate staffing issues by eliminating positions in departments that are understaffed,
which may jeopardize quality and patient safety. "It never works," Ms. Quist says. "You'll
end up right back [where you started]."  Instead, she suggests using benchmarks and
thorough evaluations of departments to identify areas where cuts would have the least
negative impact or have a positive impact. "Understand what departments [you] can go
after without affecting clinical quality or patient satisfaction," Ms. Quist says.

6. Consider partnering with a BPO. When deciding on a Business Process

Outsourcer, it's important to understand the strength of each company's balance sheet
and compare their performance to others in the industry, according to a report from
National Patient Account Services. A good BPO should focus on healthcare, have
early-out services and use state-of-the-art technology to serve you.

Tips for Managing a Successful Small Hospital :

1. Devise a strategic plan. Once you've gathered a great deal of information about the
needs of the community, develop a strategic plan for enhancing or implementing
needed services. "Every hospital needs to have a very thorough and thoughtful
strategic plan that examines the environmental factors that a hospital might be facing in
any given market," says Mickey Bilbrey, vice president of Eastern operations for
Quorum Health Resources (QHR). "Listen to the medical staff and professionals
because they know what is sustainable from a clinical and financial standpoint."

Hospital executives should listen to the medical staff and their community members to
assess what services are needed most at the hospital. "Talking and listening with the
medical staff is important because they work with patients from the community every
day," says Mr. Bilbrey. "Also, listen to board members because they are out there in the
community and they can be a voice of what they are hearing." To best collect this
information, create a forum for the community to easily interact with the hospital.

2. Keep employees engaged. Employee engagement is an important aspect of

employee satisfaction and low turnover rates. Several factors can spark malcontent
among the employees that require delicate HR handling. In some cases, as was
mentioned in the previous point, the central administration can cause stressors on the
employees that need fixing. In other cases, department heads or managers may lack
the necessary leadership skills to keep their employees happy, even if they are brilliant
medical professionals.

"When appointing our department heads, we look at individuals who have outstanding
clinical skills and patient satisfaction, but these people aren't always good managers,"
says Alex Rintoul, CEO of Medical Center of Elizabeth Place in Dayton, Ohio, who
outsources many HR services to MedHQ. "When I see a manager who has rusty
leadership skills, I ask our HR professional to speak with the manager about meeting
employee needs and keeping their department engaged."

3. Work with a good BPO. When deciding on a Business Process Outsourcer, it's

important to understand the strength of each company's balance sheet and compare
their performance to others in the industry, according to a report from National Patient
Account Services.

Here are four other important aspects of a good BPO include:

1. A focus on healthcare entities—not all industries are the same and companies
focused on healthcare can help hospitals with their unique needs.
2. Early-out services—the company should be able to work accounts during the first 90
days after discharge at a reduced rate, according to the report.
3. Use state-of-the-art technology—success is incumbent on the ability to employ
modern technology for increased efficiency.
4. Recorded calls—recording calls allows you to review work done by your BPO and
examine customer complaints.

EFFEICENT MANAGEMET STRUCTURE :

 BORD OF
DIRECTORS
PRESIDENT
OF THE
BORD

VP/DIAGNOSTI VP/ADMINISTRA
VP/THERAPEUTIC VP/FINANCIAL VP/SUPPORT
C SERVICE TIVE SERVICE
SERVICE CENTER SERVICE CENTER CENTER
CENER CENTER
EMERGENCY
THERAPY RADIOLOGY FACILITIES BILLING
PREPAREDNE
CENTER CENTER CENTER CENTER
SS
CLINICAL
PHARMACY CARDIOLOGY INFORMATIO
ACCOUNTING ENGINNERIN
CENTER CENTER N CENTER
G
FACILITIES
NURSING NEUROLOGY ADMISSIONS PAYROLL
AND
CENTER CENTER CENTER SERVICE
PLANING

DIETARY
HR CENTER SAFETY
CENTER

PURCHASING