Developing leaders vs training administrators in the health services.

In these difficult times, health care institutions need leaders, not simply managers. Leaders' breadth of skills and perspective come from understanding the values involved in health care delivery; managers know the right way to do things, but leaders know which are the right things to do. Schools of public health are moving away from their potential contribution to leadership development in health services administration. The result is a lack of accountability to the community. Leadership skills and an examination of values should be part of health services administration programs in schools of public health, which should see their mission as helping to identify and train leaders, not simply technical specialists in management.     

Leadership Competences in Slovenian Health Care

Background

Leadership competences play an important role for the success of effective leadership. The purpose of this study was to examine leadership competences of managers in the healthcare sector in Slovenia.

Methods

Data were collected in 2008. The research included 265 employees in healthcare and 267 business managers. Respondents assessed their level of 16 leadership relevant competences on a 7-point Likert-type scale.

Results

Test of differences between competences and leader position of health care professionals yielded statistically significant differences between leader and non-leader positions. Leaders gave strongest emphasis to interpersonal and informational competences, while regarding decision making competences, the differences between leaders and other employees are not that significant. When comparing competences of healthcare managers with those of business managers, results show that healthcare managers tend to give weaker emphasis to competences related to all three managerial roles than business managers.

Conclusions

The study showed that in Slovenian health care, leaders distinguish themselves from other employees in some leadership competences. In addition, all three dimensions of leadership competences significantly distinguished the group of healthcare managers from the business managers, which indicates a serious lag in leadership competences among leaders in Slovenian healthcare.     

Health for all: a public health vision.

The approach of a millennial passage invites public health to a review of past performance and a preview of future prospects toward assuring a healthy public. Since the 1974 Canadian Lalonde report, the best national plans for health progress have emphasized disease prevention and health promotion. WHO's multinational Health for All by the Year 2000 promotes basic health services essential to leading a socially and economically productive life. Healthy People 2000, the latest US guide, establishes three goals: increase healthy life span, reduce health disparities, and achieve universal access to preventive services. Its objectives can be used to excite public understanding, equip program development, evaluate progress, and encourage public accountability for health initiatives. Needed is federal leadership in defining requisite action and securing necessary resources. Elsewhere a "new public health" emphasizes community life-style and multisectoral "healthy public policy." In the United States, a national health program is needed to achieve equity in access to personal health care. Even more essential is equitable sharing in basic health determinants in society--nutritious food, basic education, safe water, decent housing, secure employment, adequate income, and peace. Vital to such a future is able and active leadership now from governments and public health professionals.     

Health literacy in health systems: perspectives on patient self-management in Israel

Health systems will face new challenges in this millennium. Striking the balance between the best quality of care and optimal use of dwindling resources will challenge health policy makers, managers and practitioners. Increasingly, improvements in the outcomes of interventions for both acute and chronic patients will depend on partnerships between health service providers, the individual and their family. Patient education that incorporates self-management and empowerment has proven to be cost-effective. It is essential that health care providers promote informed decision making, and facilitate actions designed to improve personal capacity to exert control over factors that determine health and improve health outcomes. It is for these reasons that promoting health literacy is a central strategy for improving self-management in health. The different types of health literacy--functional, interactive and critical health literacy--are considered. The potential to improve health literacy at each of these levels has been demonstrated in practice among diabetics and other chronic disease patients in Clalit Health Services (CHS) in Israel is used as an example to demonstrate possibilities. The application of all three types of health literacy is expressed in: (i) developing appropriate health information tools for the public to be applied in primary, secondary and tertiary care settings, and in online and media information accessibility and appropriateness using culturally relevant participatory methods; (ii) training of health professionals at all levels, including undergraduate and in-service training; and (iii) developing and applying appropriate assessment and monitoring tools which include public/patient participatory methods. Health care providers need to consider where their patients are getting information on disease and self-management, whether or not that information is reliable, and inform their patients of the best sources of information and its use. The improved collaboration with patient and consumer groups, whose goals are to promote rights and self-management capabilities and advocate for improved health services, can be very beneficial.     

Capitation and integrated health care systems

Integrated health care systems: a concept being discussed throughout Russia and the world. A concept with three different applications and a confusing interaction with the concept of "capitation payments." The health reform debate in Russia and the NIS can only advance if greater clarity is found for these concepts, and if medical leaders are prepared for the substantial changes in provider behavior that are required with integrated health care systems fueled by capitation payments. This article explores the twin concepts of capitation and integrated health care systems, and then the leadership challenges for Russian health sector managers as they prepare for these challenges of the twenty-first century.     

Future trends affecting public health: challenges and opportunities.

Many accomplishments of public health can be cited, yet public health professionals face unprecedented challenges and opportunities in the coming decades. To assist public health practitioners, researchers, and educators in preparing for current and future changes affecting the population's health, the authors describe several important "macrolevel" trends. These trends include: the aging of the population, changing patterns in the U.S. racial/ethnic composition, changes in health care delivery systems, the explosion of information technologies, changing needs in the public health work force, the growth in health-related partnerships, and anti-government sentiment and polarization. A series of implications for each of the major trends is provided. It may be important for public health leaders and policy makers to take these trends and implications into account as they plan and prioritize future approaches to disease prevention and health promotion.     

Health care leadership in the public interest

Successful institutional leaders articulate a sense of organizational purpose and mission, and establish and maintain an organizational culture that fits with that purpose, while anticipating and responding to external and internal dynamics that will affect the organization's capacity to meet its role. In health care, the organizational purpose is necessarily directed to the broader community, and the dynamics that must be anticipated include not only technological and economic change, but also changes in public attitudes and expectations. In order for the institution to thrive over time, it must both be near the front of the curve of those changes while protecting and preserving excellence in its core activities. The key to effective leadership in health care organizations is effective two-way communication with internal constituencies, with the organization's communities, and with the broader public policy process. Health care leaders must take a more active role in responding to their communities' health needs and in shaping public policy toward health care.     

Developing leaders in public health: the role of executive training programs

The growing complexity of the nation's health care system is creating new challenges and opportunities for public health officials, and a renewed concern for leadership training among these officials. A focus group conducted with public health officials at local, state, and national levels reveals perceptions about the predominant trends effecting public health practice, the leadership skills required for effective public health practice, and the strategies that are needed for providing appropriate leadership training to public health executives. Officials indicate that public health practice is undergoing substantial changes in response to the growth of managed care and integrated delivery systems, changes in public health funding sources and levels, and efforts to privatize the delivery of public health services. The skills identified as critical for effective leadership in this environment include the ability to guide organizational behavior and cultivate interorganizational relationships; apply scientific knowledge to public health problems, and build and sustain community coalitions. In light of these skills, public health officials identify four essential components of an optimally effective executive training program in public health leadership: exposure to the core scientific disciplines within public health; exposure to organization theory and management science; training in community development and empowerment; and training in ethics and social justice. All of the officials agree with the need for distance learning programs for executives in public health leadership, and most officials also support the need for doctoral-level training in public health practice.     

How can performance standards enhance accountability for public health?

This article focuses on how a national system of measuring public health performance can help enhance accountability for public health. It describes the trend toward increased accountability in public health; provides an overview of the issues and challenges public health practitioners face in demonstrating how the resources they spend and programs they operate contribute to improved community health status and suggests how the results of participating in the National Public Health Performance Standards Program can help.     

Is evidence-based medicine useful for public health?

Evidence-based medicine is a fashionable topic although the discussions is open regarding whether it has any practical interest for daily medical practice or public health policy. One needs therefore to focus on the way evidence-based medicine can improve matters for physicians, but also on some serious challenges facing health professionals. Upon close examination, it appears that evidence-based medicine provides us with concepts and methods likely to be useful in three directions: improvement of the health care decision-making process, reinforcement of professional accountability dedicated to the promotion of human rights, implementation of fair health policy regulations taking into account the intricate relationships between participants dealing with individual or community oriented interventions. When facing these challenges, evidence-based medicine certainly deserves further attention in the field of community and public health.     

Community group practices in Canada: are they ready to reform their practice?

INTRODUCTION: Governments and healthcare organizations in Canada are reforming the clinical practice structures and policies to deliver primary care to the population. A key component of primary healthcare reform is the establishment of an interdisciplinary, community-based team approach to patient care. This study was undertaken to provide in-depth insight regarding primary healthcare providers' beliefs and attitudes in regard to their current group practice, what changes they believe are occurring and those necessary to reform group practice settings, their willingness to embrace changes, and the challenges they face to realize the proposed reform. METHODS: This study employed a mixed-method research design (qualitative and quantitative data collection techniques) through day-long focus groups of primary healthcare professionals (eg, family physicians, specialists, dieticians, psychologists) from across Canada. RESULTS: There is considerable variation in the composition of primary care group practices across Canada. Respondents report that group practices are little more than an economic convenience to facilitate sharing of resources. Even when a practice is composed of several disciplines, there is little to no organized or systematic interaction among healthcare professionals aimed at improving patient care, lack of clarity as to identified leaders/managers of the team, and inconsistencies in the model of care provided to patients. However, there is a perception of value and benefit in working in a cohesive group practice to improve patient care. DISCUSSION: Findings revealed that although healthcare providers report themselves ready to make the necessary changes and willing to move to interdisciplinary team-based practices, there are substantive challenges that impede a movement to truly effective interdisciplinary team practice and functioning. These challenges include the type and allocation of funding, interprofessional healthcare provider education, changing the healthcare provision model, and barriers among healthcare professionals regarding shared and equitable team accountability for patient health outcomes.     

Health care information services in Ireland

Against a background of fundamental change in the Irish health care environment, a research project was commissioned to determine the information needs of all health care practitioners (including physicians, allied health professionals, managers, scientists, and technicians) as well as the public, patients, and their caregivers. The research, including a study of international best practice, revealed serious deficiencies in access, awareness, and availability of information for both staff and patients in Ireland. Recommendations include the establishment of a panel to develop a comprehensive national health information strategy and plan to coordinate the future development of health sciences information services.     

The crucible of public health practice: major trends shaping the design of the Management Academy for Public Health.

Public health leaders and managers need new leadership and management skills as well as greater entrepreneurial acumen to respond effectively to broad demographic, socioeconomic, and political trends reshaping public health. This article asserts that the need for such training and skills was the impetus for the conceptualization, design, and launch of the Management Academy for Public Health--an innovative executive education program jointly offered by the schools of business and public health at the University of North Carolina at Chapel Hill.     

Managing change in the era of health reform: organized delivery systems of public health.

As U.S. Medicaid managed care programs proliferate, it appears that traditional clinical training and practice often provide insufficient preparation for physicians to meet the care requirements of Medicaid beneficiaries adequately. State and local health departments have extensive experience with this population's need for preventive care, social support services, care coordination, and referral. Organized delivery systems of managed care can merge the expertise of primary care practitioners, public health professionals, and other community resources to deliver comprehensive care. Although the described model includes Medicaid as the payer, it would remain viable should Medicaid be terminated and universal coverage enacted.     

Information technology and today's health care management

With the move to CPR, health information managers will be challenged to reengineer the ways they manage processes within the medical record department. A lot of age-old health information problems (i.e., missing documents, lost test results, and missing records) can be solved and productivity improved with imaging. The digitized records will allow simultaneous access to readily available, legible, and usable information for patient care, research, audits, and correspondence. However, the transition from a manual to computerized record presents many challenges. Health information managers will have to monitor the changeover carefully, anticipating the needs for new information and developing the necessary mechanisms to produce it, as well as implementing new technologies as they emerge. Conditions are right for an advance in health care information systems. Pressures and changes in structure in the health care industry require better management tools. Acceptance of HIS as a management tool is growing rapidly among the health care provider community. The technology to realize the CPR and advanced decision support systems is available. All the pieces are there--they just need to come together. As the health care organization's view of and need for information systems change, medical record professionals must draw on their knowledge and experience and make the transition from managers of record systems to managers of health care information systems.     

The pharmacy leadership competency gap: diagnosis and prescription

The purpose of this paper is to inform the health administration community and its educators about the importance of pharmacy leadership, the competencies associated with the role, and a suggested path to achieve a greater number of pharmacy leaders. The role of the pharmacy leader is often unrecognized or undervalued, yet it has significant implications for many facets of the healthcare delivery organization, including the cost of care, patient safety and quality, the influence and potential involvement of the pharmacist in the hospital or health system. Hospitals and health systems should recognize the power of an effective pharmacy leader, and strive to fill those positions. Unfortunately, should care leaders demand high performing pharmacy leaders, they will find that such individuals are in short supply, and will become more rare with time because of an aging pharmacy workforce. The health administration education community must respond to the demand by marrying pharmacy management education with the Master's in Health Administration degree (MHA). This article proposes the creation of a PharmD/MHA dual degree program, giving clinically trained pharmacists the skills they need to be effective managers and leaders in hospitals and health systems.     

Health professionals' views of the effectiveness of nutrition care in general practice setting

Aim: The current qualitative study aimed to explore the perceptions of key health professionals relating to the effectiveness of nutrition care provided in the general practice setting. Methods: Twenty‐eight health professionals across a range of disciplines (general practitioners (n = 11), practice nurses (n = 3), dieticians (n = 5), naturopaths (n = 5) and exercise physiologists (n = 4)) individually participated in a semistructured telephone interview, guided by an inquiry logic informed by the literature. Interviews were transcribed verbatim and analysed thematically using a constant comparison approach. Results: Health professionals, including general practitioners, perceived that nutrition care provided in the general practice setting was mostly ineffective at improving patient nutrition behaviour. This was reported to be due to nutrition care competency deficits among general practitioners, a general practice reimbursement system that encourages practices inconsistent with quality nutrition care, and a low prioritisation of nutrition care in general practice. Tensions were apparent between health professional groups, which may be hindering the successful implementation of interdisciplinary nutrition care for patients with chronic disease in this setting. Conclusion: Without systematic changes to Australian primary health care model, the demand on general practitioners as primary providers of nutrition care will continue, therefore mandating support for general practitioners providing care in this context. Further research is required to identify strategies to improve nutrition care and opportunities to facilitate integrated health care provided to the general public within the general practice setting.     

Health workforce policy and Turkey's health care reform

The health care industry is labor intensive and depends on well-trained and appropriately deployed health professionals to deliver services. This article examines the health workforce challenges in the context of Turkey's recent health reform initiative, Health Transformation Program (HTP). Reformers identified shortages, imbalances in the skills-mix, and inequities in the geographical distribution of health professionals as among the major problems. A comprehensive set of policies was implemented within the HTP framework to address these problems. The article argues that these policies addressed some of the health workforce challenges, while on the other hand exacerbating others and hence may have resulted in increasing the burden on the workforce. So far HTP's governance reforms and health human resource policy have not encouraged meaningful participation of other key stakeholders in the governance of the health care system. Without effective participation of health professionals, the next stages of HTP implementation that focus on managerial reforms such as restructuring public hospitals, improving the primary care system and implementing new initiatives on quality improvement could be very difficult.