Veiklos planavimo technika

Report
Human Resource
Management in
practice
Ass. Prof. Danguole Jankauskiene
Mykolas Romeris University
Lithuania
Structure of the presentation

Global challenges for human resources management





HR Management problems



Public health challenges
Market changes
Changing roles
Health reform
National level
Local level
Benchmarking example – NGO’s “Project HOPE” experience
in CEEC
Social exclusion
Marginalized groups
 Aging of the population
 Percent of population over 65 years will
continue to rise

Aging population will create additional health costs.
Almost 30 % of population will be > 65 years by 2025.
How to manage those related costs?
Broad Age Groups, Trends and Projections
80
70
60
50
40
30
20
10
0
-10
1995
2000
2005
2010
2015
2020
Pop<15
2025
Pop 15-64
Pop>60
Health Challenges



Increase in noncommunicable diseases, injuries, and
violence
In particular cardiovascular diseases, depression are major cause of death and Disability Adjusted Life
Years (DALYs)
Unfinished agenda of communicable diseases
All Causes
Circulatory System
Cerebro-vascular
EU-15
average
Slovenia
Slovakia
Poland
Lithuania
Latvia
Hungary
Estonia
Czech
Republic
SDR per 100,000
Health challenges
1200
1000
800
600
400
200
0
CEEC population health status remains poor
Changing role of the State
Fast pace of privatization
 Creation of market incentives
 Less involvement of State in delivery of
services

Number of PHC institutions during
1998-2007 in Lithuania
450
400
370
350
283
300
250
200
150
214 198
160152
177 164
85
0
8
198
198
172
198
197
198
211
187
203
201
124
100
50
404
398
322
306
198
383
13
108
16
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Total
Private
State
Health expenditure in CEEC (2007)
Responsibilities of governments

Financing and allocation of resources so as to
maximize the health impact

Attention to ethical issues involved in the new
biotechnologies and genetics

Application of new knowledge and technologies
based on scientific evidence and cost effectiveness
considerations: demonstrable contribution to health
gains
Responsibilities of governments

Correct inequity in access to health and
health care

Access for the poor and vulnerable

Health is a basic need and a primary good
that enables people to be productive and
contribute to society
Decentralization

Trends to have responsibilities for
implementation at local level

Central functions to emphasize more
coordination between central policy direction,
monitoring - as well as shared responsibility
for implementation at the local level
Citizens’ empowerment

Patients‘ rights

Empowerment in patient choice and
participation in decision making

This is a continuing theme in health care
reform
New public management
and modern public health
OIP (organization, innovation, personnel)
model
 Recognition, that demand for services may be
controlled by health promotion measures that
improve environment, lifestyles
 Emphasis on intersectoral action for health
(private sector, civil society, media)

Shift to Primary Health care
Recognizes the importance of integration of a
variety of services at the local level
 Provision of efficient services as first line of
care
 Coordination of health promotion,
environmental activities at the local level
 Engagement of citizens and communities in
the needs assessment and in the planning and
evaluation of services

Human resources at the heart of
health care reforms

Costs of health care personnel rising fast in
Europe

Spending for personnel has followed the
general pattern of public spending for health

Deployment mix of human resources varies
widely
- Example: the nurse to doctor ratio is 3 to 1
in the UK and Ireland, but 1 to 1 in Southern Europe
Salaries (in percent) have increased very rapidly
in Lithuania
Changing roles: Nurses
 Lithuania:
1.8 nurse per physician.
 A ratio of 2:1 is considered a minimum
and 4:1 is more satisfactory for cost
effective and quality care
 OECD - 3:1 on average
Changing roles: Physicians
450
400
350
300
250
200
150
100
50
0
Number of Physicians
per 100000
 Number
of physicians per
capita is 60% higher than
new EU members’
average
 23% of physicians have
some private practice, of
which 8% are mainly
private
 25% in primary care
(France 50% )
Promotion of multidisciplinary health care
teams

Key new roles of nurses and medical
practitioners

Need to learn new skills, in prevention, health
promotion, management of health services
Globalization
Need for global solutions
 Free movement of personnel and patients

 Example:
to control tobacco use there is a need to
harmonize policies and legislation to deal with
market forces
Gap from theory and practice
Fundamental changes in new public
management and new public health
 Restructuring of the system

 Structural
changes
 Training
 Planning
 Mentality
of numbers
Problems in National level
Inequities
 Migration
 Planning
 Doctors/nurses ratio and allied health
personnel
 Management training

Level of poverty level in Lithuania
(2006 data)
Residence place
Poverty level %
Total
20
Urban
13,1
Big cities
8,6
Other cities
19,4
Rural
34
Social welfare system provides enough coverage in EU
countries (by opinion of respondents in percent)
Source: EC Special Eurobarometr 2007 “European Social Reality”
Bulgaria
Portugal
Latvia
Poland
Cyprus
Lithuania
Romania
Estonia
Slovakia
Greece
Italy
Italy
Hungary
Czech rep
Sweden
Malta
Slovenia
Ireland
EU
Germany
The Netherlands
Spain
UK
Austria
Denmark
Finland
Belgium
France
Luxemburg
8
10
18
19
20
22
22
23
30
32
36
36
39
45
47
48
49
50
51
55
59
61
64
64
66
68
72
74
75
0
20
40
60
80
100
Social welfare system as an example for other countries in EU
(by opinion of respondents in percent)
Source: EC Special Eurobarometr 2007 “European Social Reality”
Bulgaria
Portugal
Latvia
Romania
Greece
Poland
Slovakia
Estonia
Hungary
Cyprus
Lithuania
Czech rep
Slovenia
Italy
Malta
Malta
Ireland
Germany
Spain
UK
Austria
Sweden
Netherland
Luxemburg
Belgium
France
Denmank
Finland
2
5
6
7
8
8
10
10
11
11
13
15
23
28
30
30
32
40
47
53
58
62
63
64
70
73
74
79
0
20
40
60
80
100
Migration of specialists
RIGHTS TO MOVE, RESIDE
AND EXERCISE PROFESSIONS
2,5 % POSTRAGUATES AND
3,8% PHYSICIANS RESOLVED
TO EMIGRATE
Willingness of Lithuanian medical specialists
to work abroad in percent 2005
Source: KMU survey, 2005
70
60,7
60
50
40
30
26
Doctors
Resident doctors
Pharmacists
26,5
20
10
3,8 2,5 2,3
0
Willing to
work abroad
Emigrated
Planning of human resources







“Is a neglected topic in the most countries
Significant methodological weaknesses which have been discussed for decades
but not resolved.
Workforce planning policies, where they exist, tend to assume that existing
healthcare delivery systems are efficient, and the forecasts made are rarely
costed systematically.
In most healthcare systems, workforce planning is driven by healthcare
expenditure, with resources dictating volume of provision.
Typical workforce planning systems ignore variations in practice and the
possibility of changing productivity, skill mix and substitution.
Healthcare policy makers increasingly recognize the need for more integrated
planning of human resources in healthcare, in particular making the management
of human resources responsive to system needs and design, instead of vice
versa”.
(Karen Bloor, Alan Maynard. Planning human resources in health care:
Towards an economic approach. An international comparative review.
University of York March 2003).
In Lithuania we do have national strategic HR planning program since 2003
Comparison of effectiveness and efficiency
Indicator
Lithuania
2006
EU
2006
Inequity
1.
Physicians per 100 000 inhabitants
398
315
Moderate
2.
Family doctors per 100 000 inhabitants
76,6
97,7 (2005)
Moderate
3.
Hospitals per 100 000 inhabitants
5,13
(acute 2,5)
3
Big
4.
PHC institutions per 100 000inhabitants
29,37
66,22
Big
5.
Hospital beds per 10 000 inhabitants
79,9
57,6
Big
6.
Private beds % out of all beds
0,39
20,9
Big
7.
Hospitalization rate per 100 inhabitants
23,23
18,06 (2005) Big
8.
Average outpatients Visits for 1 inhabitant
6,56
6,8 (2005)
Small
10.
Average length of stay in the hospital/
days
10
9,17 (2005)
Moderate
11.
Bed occupancy rate in percent.
76
76
None
Hospital beds (2007)
900
800
700
600
500
400
300
200
100
EU
Lithuania
Czech Republic
Latvia
Hungary
Slovakia
Estonia
Croatia
Poland
Netherlands
Slovenia
Norway
-
Denmark
Despite downsizing, there
remains plenty of room for
rationalization
 Hospitals below 200 beds
too small to provide full
range of general hospital
services
 Distances are not an issue,
patient safety is.

Number of beds
per 100,000
Hospital productivity
25
20
In-patient care admissions
per 100
15
10
0
TFYR…
Netherlands
Denmark
Croatia
Poland
Slovenia
Norway
Estonia
Slovakia
Hungary
Czech…
Latvia
Lithuania
EU
5
 Too
many admissions
 ALOS in smaller
hospitals is twice as long
and is larger ones (and
not all are nursing)
 Efforts to develop daysurgery need to be
sustained.
Hospital productivity (2007)
Bed Occupancy
100.0
Average Length of Stay
12
90.0
80.0
70.0
60.0
50.0
40.0
30.0
20.0
10.0
-
10
8
6
4
2
0
Shift to Primary care in Lithuania
Family medicine
 Family
doctor (GP) and Team of doctors (internist,
pediatrician, gynecologist, surgeon)
07
20
06
20
05
20
04
20
03
20
02
20
01
20
00
20
99
19
98
3500
3000
2500
2000
1500
1000
500
0
19

The Need For Balance
Effective Care
Appropriate
Care
Efficient Care
Equity
RESTRUCTURING APPROACHES
STATUS QUO
BIG BANG
Health care quality
Positive evaluation of inpatient care in EU countries
(by opinion of respondents in percent)
Source: EC special Eurobarometr 2007 “Health and long term care in EU”
Romania
Poland
Bulgaria
Hungary
Greece
Latvia
Lithuania
Portugal
Slovakia
Italy
Ireland
Estonia
Cyprus
EU
Slovenia
UK
Germany
Czech rep
Luxemburg
Spain
France
Malta
Denmark
The Nertherlands
Finland
Sweden
Austria
Belgium
42
42
43
43
48
55
57
58
62
63
64
67
69
71
76
77
79
80
82
82
83
84
85
87
88
90
92
93
0
20
40
60
80
100
Positive evaluation of specialist ambulatory care in EU countries
(by opinion of respondents in percent)
Source: EC special Eurobarometr 2007 “Health and long term care in EU”
Hungary
Poland
Bulgaria
Romania
Portugal
Latvia
Lithuania
Ireland
Estonia
Greece
UK
Sweden
EU
Slovenia
Italy
Denmark
Germany
Slovakia
Luxemburg
Estonia
Malta
The Netherlands
Cyprus
Finland
Czech rep
Austria
France
Belgium
53
57
58
59
59
61
62
66
68
70
71
71
74
75
75
75
77
78
80
81
83
83
84
85
86
87
87
93
0
20
40
60
80
100
Positive evaluation of GP practice in EU countries
(by opinion of respondents in percent)
Source: EC special Eurobarometr 2007 “Health and long term care in EU”
Portugal
Sweden
Bulgaria
Romania
Latvia
Poland
Greece
Lithuania
Italy
Estonia
Slovakia
Finland
Czech
Hungary
Slovenia
EU
UK
Germany
The
Spain
Luxembu
Ireland
Denmark
Cyprus
Austria
France
Belgium
Malta
62
68
69
71
72
73
73
77
77
78
81
81
82
83
84
84
88
88
89
89
90
90
91
92
93
93
95
96
0
20
40
60
80
100
Institutional level
Shortage of doctors
 Salaries
 Organizational behavior and conflicts
 Management of health care quality
 Knowledge in management

MRU Study: What are the organization’s
current management practices

What does the organization currently do with
respect to managing people:
 How
does it recruit?
 How does it select?
 How does it pay people?
 What training is provided?
 How does it evaluate performance?
 What organization structure is used to organize
work?
Problems of HR in the HC
institution
23 percent of respondents feel respected and
evaluated well by their manager, 20 percent
feel evaluated badly
 20 percent of respondents feel that their
salary correlates with the qualification, 40
percent - don’t

“….Job is too demanding and stressful” in EU countries
(by opinion of respondents in percent)
Source: EC Special Eurobarometr 2007 “European Social Reality”
Netherland
Finland
Belgium
Czech rep
UK
Denmark
Ireland
France
Estonia
Germany
Slovenia
Hungary
Spain
EU
Poland
Luxemburg
Austria
Romania
Slovakia
Italy
Latvia
Sweden
Portugal
Cyprus
Malta
Bulgaria
Greece
Lithuania
24
25
32
33
34
35
36
37
39
39
40
41
41
41
43
45
46
47
47
52
53
54
55
62
67
70
70
71
0
20
40
60
80
100
Modern health policy and management
technologies
1.
2.
3.
4.
5.
Team work and team training
Program supervision
Evaluation of individual needs
Socialization in the community
Case management
“5 star” health care specialist





Service provider
Decision maker
Communicator
Community leader
Manager
Training of health care managers
Biomedical approach should be changed into
Biopsichosocial


Knowledge and skills requirements
Project HOPE
Health Care Management Training Program


Program Goals:
 1) increase management skills,
 2) improve the effectiveness
and efficiency of health care
facilities through better
management,
Program Structure
 four weeks of off-site training,
 each day comprised of the
following sequence:
 concept lecture,
 exercise,
 case study,
 project work.

Program Participants
 Multidisciplinary teams;
 Multisectoral health care
institutions.

Program lecturers
 International academic
staff
 Local academic staff
 Local case studies
Program Curriculum




Module I: Health policy, Role of Management, Strategy and
Implementation.
Module II: Operations Management/Quality Improvement
Module III: Human Resources
Module IV: Finance/Budgeting
4 ECTS credits - 120 hours ,
360 participants
in Lithuania
Evaluation of good practice



A comprehensive management training initiative in
Lithuania, together with international partners such as
Project HOPE’s Executive Health Care Management
Program, offers a highly leveraged evidence-based
strategy to improve patient care from a total quality
perspective.
The opinion of participants is favorable towards the
program. Projects selected by participants have the
potential to improve the organizational systems in which
care is delivered, setting the stage for a broad base of
improvement in clinical processes.
The partnering strategy used to administer the program
and the networking that occurs from bringing together
managers from diverse organizations promotes the
emergence of new ideas and opportunities for sharing
and leveraging existing resources.
SUSTAINABILITY

4 MASTER STUDY PROGRAMS IN THE
COUNTRY with 80 credits
 Health
policy and management
 Health law
 Health economis
 Management of health care institutions
In Summary . . . .
Human resources is a key issue in transitional
EU countries facing a lot of global and national
challenges
 Human resources practices are often
inconsistent with its strategies.

In Summary . . . .
Global actions for HR migration focusing on
legal requirements should be taken
 Exchange of information and benchmarking of
good examples and problems should be more
active

In summary. . . .

Health care system recognize the need to plan
health human resources better EU

Joint projects from EU funds on human
resources training, information exchange and
new strategies should be initiated
“The problem is the system and
the system belongs to
MANAGEMENT”
Edward Deming

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