Health management

IV study year

Study program: Medicine

Health management. Health managers

Defining health management
• If only the basic and general principles of management were taken into
account when trying to define health management, without special
emphasis on health and health care, then we would have the WHO
definition from 1980:
• "Management is about the efficient use of resources and enabling
people to work together to achieve specific goals".
• However, when management refers to health, health management,
health system management, management of health institutions or
programs, projects and health teams, in addition to general principles,
management should keep in mind all the specifics of working in the
health system and with people in it.
Defining health management
• Therefore, health management basically seeks to satisfy and balance the
interests of all participants in a health organization: clients (people, especially
when they are sick), workers - health personnel in the organization, institution,
the community in which they live and the environment to which the
organization relates.
• Health management:
1. It covers the entire process of planning, organizing, implementing, controlling
the work of health programs, etc.
2. Coordinates resources (personnel, money, funds, capacities, equipment,
information, knowledge, technology, regulations, laws)
3. Monitors the development and implementation of health programs
4. It provides support, influences the participation of the community and people
5. It influences the making of appropriate decisions at all levels
6. It works to achieve the set goals in order to improve the health of the entire
Health manager
• Health managers are persons - health experts who perform managerial
functions and tasks and who are responsible for creating resources, their
rational use in order to achieve the set goals of their organization,
institution, program, without taking into account their free time and
effort.
• Health managers can be of various profiles: doctors, nurses/technicians,
directors of health institutions, health insurance managers, other health
care providers and all others who deal with health policy issues at the
level of administration, health service and the level of passing laws,
regulations and other decisions.

• There are two groups of administrator managers, namely: generally

oriented (generalists) and narrowly specialized oriented (specialists).
Health manager (generalists and specialists)
• Generalists can be divided into three subgroups:
1. Chief administrators working at the national, regional or collaborative
level with organizations. They are top managers. They usually decide.
2. Mid-level administrators who manage special programs, projects,
institutions or situations. They usually coordinate.
3. Manager administrators who manage departments of institutions,
smaller institutions, parts of the program, peripheral parts of the
project.

• Specialists are focused on certain parts of management, such as for

finance, system analysis, resource management, personnel, etc.
Health manager (types of managing)
• In relation to the types of managing, healthcare managers can be divided
into five basic groups:
1. Managers - officials,
2. Managers of health care or patient care programs (mainly managers of
clinical work),
3. Heads of institutions (various types of health institutions),
4. Project managers,
5. Representatives or chairpersons of various associations or agencies
(medical societies, Red Cross, health associations, etc.)
Health managers
• Healthcare executives (managers) also include those who deal with:
1. By providing health services,
2. Analyzing needs and planning programs,
3. Staff development,
4. By monitoring other resources (material means of health insurance,
equipment, etc.)
5. Education (subject, program, area, etc.)
• Bearing in mind that the functioning of the work of a health institution,
program, team, largely depends on the health manager, it is necessary for
him to go through appropriate education, so that on the basis of acquired
knowledge and appropriate skills, along with well-managed professional
experience, he would be successful and effective manager.
Health managers (tasks)
• In principle, health managers must, based on their knowledge, professional
experience and appropriate skills, perform the following functions:
1. They plan the work of their institution, department, team, etc.
2. They organize and implement the work of the institution and corresponding
programs,
3. They control the implementation of activities,
4. They coordinate the work of the staff, communicate and resolve conflicts,
5. They motivate and lead their people,
6. Collaborate with other organizations, support community and people
participation,
7. Delegate appropriate authority and responsibility, and
8. They make the right and timely decisions based on analysis, in order to achieve
the set goals of the institution, program, project, and team in the most efficient
and effective way.
What do health institutions look for from managers? Skills
• The job of a manager is varied and complex.
• Managers need certain skills to perform their duties and activities related
to their managerial function.
• When looking for employees who can be good company managers, they
look for individuals who possess:
technical skills,
interpersonal skills,
conceptual skills and
motivation for management.
What do health institutions look for from managers? Skills
• Technical skills refer to specific procedures, techniques, and knowledge
that are necessary to perform a job.
• For sales managers, technical skills mean finding new leads, preparing
precise and convincing sales pitches, and closing sales.
• For a head nurse, the technical skills are to set up infusion line or operate
emergency equipment if a patient goes into cardiac arrest.
• Team leaders and first-line managers need to have the technical skills to
train new employees and help solve problems.
• As managers advance to higher positions, the importance of technical
skills diminishes, but they are still important.
What do health institutions look for from managers? Skills
• Interpersonal skills can be defined as the ability to work well with others.
• Managers who possess these skills work successfully in groups,
encourage others to express their thoughts and feelings, understand the
needs of others, listen and communicate very well.
• People skills are equally important for all levels of management, from
first-line supervisors to CEOs.
What do health institutions look for from managers? Skills
• Conceptual skills include the manager's ability to see the organization as
a whole, to understand how different parts of the company affect each
other and to understand how the company fits into the external
environment, and how it is affected by the local community, social and
environmental factors, customers, competition.
• Managers with above-average intelligence have on average about 48%
better results than managers with average intelligence.
• Therefore, smart workers should be managers.
• However, what if that above-average person doesn't have the necessary
technical skills, people skills, or motivation to manage?
What do health institutions look for from managers? Skills
• Management motivation shows how motivated employees are to
communicate and cooperate with superiors, to compete, to behave
confidently, to tell others what to do, to reward good behavior and
punish bad.
• Managers are usually more motivated to manage than their
subordinates.
• Managers who are more motivated to manage get promoted faster, are
rated as better managers by their workers, and earn more money than
managers who are less motivated to manage.
 er ci se
m ex
JOINT WORK Tea

• Up to this point in your life, you have all had to work with individuals in
leadership positions (or have been a manager), either through work
experience or through other experiences (social, hobby, religious, interests...).
• What do you think makes some managers better than others?
• Are there certain characteristics that distinguish good managers?
WORK IN SMALL GROUPS OF 3-4 MEMBERS
• Talk about your experiences with managers – good and bad.
• Make a list of the characteristics of those individuals who you have found to
be good managers. For each characteristic, indicate which management
function it belongs to and which managerial skill it is.
• As a group, be prepared to share your list and explain your choice!
 Development of health management
• Health management, that is, the management of the health system and
institutions, did not accept all the ideas, principles and theories that were
developed in management theory during the 19th and 20th centuries.
• That difference was a consequence of the specificity of health systems compared
to classic large corporations and commercial enterprises.
• Among the characteristics in the development of the health system, the most
significant are:
• The health care system did not have its own "industrial revolution";
• Significant medical discoveries began only in the late 19th and early 20th centuries;
• This system became an important subsystem of the social system only after the 1st World
War, and especially after the 2nd;
• At the beginning of its development, it was neither complicated nor complex;
• It was not suitable for the development of management because of its predominantly social
and not commercial activity;
Development of health management
o It must be seen as one coherent whole consisting of many connected parts;
o It must be created so that all its parts work together and adapt to each other;
o The Health Information System (HIS) developed relatively late, and is still
developing;
o Assessing the success of this system, that is, its efficiency and effectiveness, is not
easy to measure.

• In some developed countries, the healthcare system is treated more like a

healthcare industry that increasingly applies the principles and attitudes of
management.
• In such systems, the main managers of health institutions are usually not
doctors, unless they have been educated for that purpose.
Development of health management
• Health management can be defined as a process that covers:

Development of health
Planning, organization, Improving
programs based on
= the health
direction, control and + community
of the
coordination of participation and
resources people
people's health needs
Forerunner of planning and health management
• Ancient peoples thought about how to measure the health of their
populations (Hippocrate's description in 460 BC of the "occurrence of
disease in the population").
• Johan Grount, although he was not a doctor, was the first to come up with
the idea of using indicators (most often mortality) to assess the health
situation.
• William Farr, the first health statistician, began in 1839 to study mortality
in England and Wales and to publish analyzes of the phenomenon.
• On the basis of his collection, grouping and classification of data, together
with Marc D'Espine, he established the principles of classification of
causes of death and disease in 1855.
Health care planning
• Health planning was based mainly on mortality.
• In the former USSR, health care and services were planned and
programmed in the 20s.
• The GOS plan was a typical centralized plan that was prepared by the
Ministry of Health and its authorities and applied throughout the country.
• It included a list of indicators (the broadest list had 300 indicators) and
served to monitor its execution, but also to control and take necessary
measures.
• Exampes of indicators on the next slide.
Health indicator examples
Life expectancy at birth Healthcare coverage
Infant mortality rate Hospital beds per capita
Neonatal mortality rate Doctors per capita
Maternal mortality ratio Nurses per capita
Mortality from cardiovascular diseases Hospital readmission rates
Cancer incidence Health expenditure as percentage of GDP
Diabetes incidence People with HIV aware of their status
Depression incidence... Breast cancer screening rate
Alcohol consumption Birth registration rate
Smoking in adults Death registration rate
Physical exercise habits
Condom use
Obesity rate
Asthma rate
High blood pressure rate
Air pollution levels...
Indicators and assessment of health status
• They are gaining more and more importance.
• In the mid-1930s, more serious work began on identifying indicators and
using them to assess the state of health (League of Nations).
• These assessments were used to analyze the situation found, but also to
take the necessary measures to solve the observed problems and
weaknesses.
• The work on the development of health indicators and assessment of
health status gained special momentum after World War II, in the 1950s,
when, in addition to a large number of researchers, the UN and WHO
made a major contribution through their groups and committees.
• During the 60s and 70s, increasingly developed health administrations
prepared plans and programs.
• This period is considered the beginning of health management.
Примјена системског планирања и менаџмента. Национални
здравствени развој
• This period is characterized by the need to observe the entire health system
including its parts and levels, as well as their management and leadership.
• Among the techniques that are increasingly used are computers and various
computer modeling, simulations and analysis of system design.
• During the 1980s, WHO promoted national health development that included:
1. Policy formulation and definition of priorities,
2. Program budgeting,
3. Preparation of action plans,
4. Creation of detailed programs for each action,
5. Application of programs and their implementation through health
infrastructure,
6. Ensuring the necessary information.
• The national system must be decentralized to the middle and local levels!
Strengthening of management (since 1990)
• Bearing in mind that the health system is becoming larger and more
complex, costs more and more, and is not considered a weak system, on
the contrary, there is a need to manage it better and more efficiently.
• In the last two decades, due to the transition of the entire social system,
health management becomes not only a need but also a necessity.
• This period of development is characterized by the following:
• Necessity of education of health personnel,
• Further strengthening of the application of evaluation methods,
• The increasing need to solve problems at the primary level,
• Focus on health and healthcare,
• Better data,
• Increasing application of innovation methods: trends, predictions, dynamic
modeling, future health research, etc.
 mma
al di le
PREPARATION FOR: My career Ethic

• One study showed that about 44% of people lie about their work experience.
• Another showed that 93% of managers who found a lie in a job candidate's
resume did not hire that person.
• A survey of 358 executives and directors at 53 companies found 7 cases of
claiming to have an academic degree they did not actually have.
• Such mistakes cost the CEOs of Radio Shack, Herbalife, USANA Health
Sciences, MGM Mirage.
• Why do you think lying about your academic qualifications is considered
wrong?
• Which is worse: lying about your academic qualifications or lying about
your work history? Why?