Competencies for public health finance: an initial assessment and recommendations.

The purpose of the study in this article was to identify The needs of public health managers with regard to public health finance. A survey of public health practitioners regarding competencies was conducted and a review of course offerings in finance among schools of public health was performed. Most public health practitioners surveyed believe that a broad array of management competencies are required to administer the finances of a public health facility or department. Respondents added 35 competencies to those initially given to them for review. Most added competencies that were more specific than the original competencies or could be viewed as subpoints of the original competencies. Many schools offered no courses specifically addressing public health care finance, with a few offering at most only one public health finance course. All schools offered at least one corporate finance course, and the majority offered two or more courses. We conclude with a number of recommendations for education and competency development, suggesting several next steps that can advance the field of public health's understanding of what managers need to master in public health finance to effectively function as public health managers.     

Decentralisation of general management within the New Zealand health system.

The radical organisation changes implemented in the New Zealand health system in recent years are discussed and analysed in this study which is based upon a review of documents and interviews with general managers of area health boards. Service management, which involves the decentralisation of general management to programme or product groupings (medicine, child health etc) has been widely implemented in almost all boards completely replacing the traditional disciplinary hierarchies. It is also leading to a population-rather than an institutional-based system of management. General managers report positively on the achievements of service management including greater accountability and commitment of clinical staff, innovation and team building, improved performance and service quality, the integration of hospital and community-based care and a customer rather than an occupational orientation. There is an increasing trend towards the recognition of primary health care as a key service entity.     

Challenges for psychosocial rehabilitation services in the Lisbon Metropolitan Area: A qualitative approach

In Portugal, a mental health reform process is in place aiming to redefine the model of service provision. In 2008, a National Mental Health Plan (NMHP) was approved to provide policy guidance over the transition period. The NMHP intended, among others, to develop community‐based services, with a specific focus on rehabilitation and deinstitutionalization. This study aims to explore the perspectives of service managers of psychosocial rehabilitation services regarding the main challenges to support the community living of persons with severe mental illnesses (PWSMI) in the Lisbon Metropolitan Area (LMA). The paper also contextualises the provision of psychosocial services within the country's mental health reform process and characterises the profile of service users in socio‐occupational units (SOUs) of the LMA. Semi‐structured interviews were performed with all SOUs’ managers of the LMA (n = 13). Information regarding service user characteristics was collected based on service records (n = 344). Interviews were analysed according to the framework methodology. The results of the interviews were triangulated using document analysis. Fieldwork took place between June and July 2016. The findings suggest that the development of the mental health reform ensured significant changes to service delivery. Community‐based mental health organisations are an important actor for service provision. However, important asymmetries were identified in the provision of psychosocial care within the LMA. At the same time, family carers are perceived as responsible for ensuring a large part of the social needs of the PWSMI but there is an increasing concern with their own ageing processes. As a conclusion, it is highlighted the current inequality between services and the need to contemplate a life‐course perspective that comprehends the ageing process of caregivers poses an emerging challenge for psychosocial rehabilitation. These findings are also important for other low‐ and middle‐income countries passing through similar reforms.     

Cost of employee assistance programs: Comparison of national estimates from 1993 and 1995

The cost and financing of mental health services is gaining increasing importance with the spread of managed care and cost-cutting measures throughout the health care system. The delivery of mental health services through structured employee assistance programs (EAPs) could be undermined by revised health insurance contracts and cutbacks in employer-provided benefits at the workplace. This study uses two recently completed national surveys of EAPs to estimate the costs of providing EAP services during 1993 and 1995. EAP costs are determined by program type, worksite size, industry, and region. In addition, information on program services is reported to determine the most common types and categories of services and whether service delivery changes have occurred between 1993 and 1995. The results of this study will be useful to EAP managers, mental health administrators, and mental health services researchers who are interested in the delivery and costs of EAP services.     

The management of health services in Tanzania: a plea for health sector reform

There are essentially four main approaches used in attempts to strengthen the management of health services in developing countries. These are: information system development; management training; use of planning and evaluation methodologies; and, health sector reform. As part of a collaborative research project based in Kisarawe District, Tanzania, we tested the hypothesis that a combination of the first three of these approaches would be sufficient to ensure that decisions and actions were taken to bring about major improvements in the management of health services. It was assumed that the decentralization, which took place as part of the 1982 reorganization of local government responsibilities, had provided managers with sufficient decision-making autonomy to allow them to bring about improvement in health service performance, provided that the other conditions were met. In fact, it was found that despite being presented with clear evidence of serious inefficiencies and inequities in the allocation of health resources, managers were often highly reluctant to decide upon actions which would alleviate the problems in situations where there were potential losers as well as winners, even if the benefits greatly outweighed the costs. This article argues that interventions based solely on training, information systems, or planning and evaluation protocols will make only marginal improvements to health service management, and that changes to the system as a whole are needed in order to provide managers and health professionals with incentives to rectify performance failings. Some ideas for health sector reform, to give managers power and incentives for improving efficiency and quality of care, are put forward. Since it is likely that the systemic problems of the health sector in Tanzania are shared by many other developing countries, the lessons drawn from this study probably have more general applicability.     

社区卫生服务机构综合评价的质性研究

目的 了解社区卫生服务管理人员对社区卫生服务机构综合评价过程的感受、看法、观点、建议,为社区卫生服务机构考核管理科学化、规范化提供借鉴.方法 通过访谈形式,访问了12名社区卫生服务中心主任,将获得的资料进行分析、整理,提出问题.结果 社区卫生服务机构管理人员对年度考评的重要性高度认可;考评中的问题主要集中在考评方法、指标、内容、方式等方面;在社区卫生服务发展的建议方面主要集中在政策落实、人才建设及经费到位等.结论 综合评价对社区卫生服务机构的发展方向有引导作用;人才素质和稳定是发展社区卫生服务的关键;深圳社区卫生服务中心考评从探索阶段正在向规范阶段发展.     

The changing role of hospital prices: a framework for pricing in a competitive environment

The increasing price sensitivity of the health service marketplace makes appropriate a review of hospital pricing methodology. A new framework for pricing can help managers maintain a competitive market position as well as stimulate the development and articulation of policy and facilitate internal managerial control.     

据管理方意向分析医改对职工卫生服务需求行为的影响

通过分析医保管理机构管理者和医疗机构医保管理者对医改前后职工卫生需求行为的变化及其相关影响因素显示,现行的医保政策有利于控制医疗费用的过快增长,医改政策实施后,职工的卫生服务需求行为趋向合理化,但对供方行没有显著影响,从而影响了需方行为和费用控制效果,管理方不规范操作作对职工卫生服务需求行为也有显著影响。     

Trust matters: A narrative literature review of the role of trust in health care systems in sub-Saharan Africa

This article makes a contribution to the debate about health service utilisation and the role of trust in fostering demand for health services in sub-Saharan Africa. It is framed as a narrative literature review based on a thematic analysis of nine empirical, qualitative studies. For the purposes of this article trust is defined as a voluntary course of action, which involves the optimistic expectation that the trustee will do no harm to the trustor and is increasingly perceived as an important influence on health system functioning. The article looks at trust issues in interpersonal, intergroup and institutional situations. The findings of the review point to four elements that are important for trust to develop in health sector relationships: the sensitive use of discretionary power by health workers, perceived empathy by patients of the health workers, the quality of medical care and workplace collegiality. When trust works in health sector encounters, it reduces the social complexity and inherent uneven distribution of power between clients and providers. The article concludes that understanding and supporting trust processes between patients and providers, as well as between co-workers and managers, will improve health sector collaboration and stimulate demand for health care services.     

我国卫生人力资源需求分析与预测

在对我国人口结构变化以及卫生服务需求进行分析的基础上,利用卫生服务需求法,对未来10年我国卫生人力资源需求情况进行了分析和测算,提出2020年我国卫生人力资源需求量为1288万人,每千人口医生、护士、药师、技师、卫生管理人员以及专业公共卫生机构人员数分别达到2．34、3．51、0．60、0．33、0．36以及0．82。除了数量上的分析,还需对各类卫生人力资源的素质水平提出要求,通过管理制度和机制的不断创新完善,优化我国卫生人力资源配置。     

Managerial epidemiology in the health administration curriculum

With the rapid changes in health care delivery systems an appreciation and specialized understanding of epidemiology is a necessary requirement for health care administration practitioners. Managed care compels health care managers to focus on delivering health care services to populations and not individuals. The health care administrator today must focus on population-based management, and no longer can afford to ignore epidemiologic measurements. This article presents the development and implementation of a specialized course in managerial epidemiology. The specific phases of course development, course content, and course framework are presented and discussed.     

Workforce development. Deep impact

To be effective, the DoH's 10 high-impact changes for HR will require engagement from all NHS managers. The changes are the culmination of years of strategy development in NHS staffing issues. The changes will form a key plank of the wider health service efficiency agenda in coming years.     

军队离休干部医疗需求分析

目的：分析军队离休干部医疗服务需求与利用变化情况，为改善其保障绩效提供依据。方法随机抽取2所中心医院保障的6个干休所，利用自制调查表对随机抽取的65位离休干部进行调查，并对干休所管理人员进行访谈。结果离休干部平均年龄83．5岁，人均患3．57种疾病且分布涉及各系统，各种失能现象占10％～30％。离休干部日常保障和慢病保障以干休所为主，但发病后离休干部倾向到医院就治。结论离休干部的医疗保健需求呈现全方位特点；应进一步拓展干休所医疗保障功能，特别以医院为重点实现其医疗服务改善；同时，应继续关注干休所卫生经费的使用效果。     

Postregistration training and education: the NAGE experience

Background: This paper reviews the NAGE postregistration course and describes how it has responded to the changing demands of the major stakeholders in the health and social care sectors. It demonstrates how the course team have fulfilled the stated aims and objectives and sought to provide a rich experience for the course participants while being aware of the changing needs of the National Health Service (NHS) and expectations of dietitians, other health professionals and the wider community, particularly with the formation of Primary Care Groups (PCGs). Evidence to inform this review is drawn from a range of sources including dietetic managers, dietitians working with older people, past participants and course evaluations. Aims: The overall purpose of the course has been to enhance the ability of the participants, i.e. dietitians working with older people, to reflect on their professional practice and become more effective in their membership of the multidisiciplinary team, with the ultimate goal of improving the provision of health care for older people and enhancing their quality of life. This ultimate goal is in line with the government Quality Agenda as reflected in the First Class Service and clinical effectiveness and the future National Service Framework for Older People. Structure: The review is divided into three broad sections: detailed reflection of the courses held; nutrition and dietetic managers views; changes in the external environment that directly and indirectly influence the course.     

The outcomes of partnerships with mental health service users in interprofessional education: a case study

This paper reports findings from a 5-year evaluation (1998-2003) of a postqualifying programme in community mental health in England which made a sustained attempt to develop partnerships with service users. Users were involved in the commissioning of the programme and its evaluation, as trainers and as course members. The evaluation employed mixed methods to assess: learners' reactions to user-trainers and users as course members; changes in knowledge, attitudes and skills; and changes in individual and organisational practice. Data were collected from participant observation of training, 23 individual and 18 group interviews with students and their managers (n=13), and student ratings of knowledge and skills at the beginning and end of the programme (n=49). The quality of care provided by students was rated by service users (n=120) with whom they worked, using a user-defined questionnaire. The quality of care, and mental health and quality of life outcomes were compared to those for two comparison groups (n=44) in areas where no training had taken place. In general, the students reported positive learning outcomes associated with the partnership orientation of the programme, and learning directly from and with service users. A higher proportion of programme users reported good user-centred assessment and care planning, and showed greater improvement in life skills compared to the comparators. This case study provides evidence of the value of partnership working with service users in interprofessional postqualifying education in mental health. The success is attributed to the design of the programme and the responsiveness of the programme board, which included service users. It may provide a useful model for programmes elsewhere and for other user groups. The case study itself provides a possible model for the systematic evaluation of partnerships with users in education and training.     

How physical therapists perceive physicians: a stakeholder analysis

Physicians and physical therapy service units are facing a different health care climate than 5 to 10 years ago. Managed care, changes in Medicare reimbursement, and other financing issues are causing turbulence for the industry. This article reports on more than 1,300 physical therapy service unit managers of hospitals, long-term care facilities, outpatient clinics, and home health agencies who determined the most important stakeholderoftheir physical therapy service unit and the perceived degree of power the various stakeholders had over the physical therapy service area. This study indicates that historical roles and alliances in health care are undergoing major alterations.     

Toward Executive Support Systems in Health Management: Strategic Leadership Imperatives

Executive support systems (ESSs) complement information technologies and add value to the work of senior health executives by enhancing management effectiveness, efficiency and productivity. This article examines the characteristics of executive support systems and their promising implications for executives in health services delivery. The systems' critical success factors are highlighted through a review of key development and management implementation strategies. The article concludes with a commentary on the fundamental significance of ESSs for health service leaders and managers.     

卫生机构管理者岗位胜任力研究

将人力资源管理的方法——胜任力研究引入卫生领域，研究建立《卫生机构管理者岗位胜任特征词典》，以医院院长、疾病预防控制中心主任、社区卫生服务中心主任、乡镇卫生院院长为研究对象，遵循经典的胜任力建模思路，运用行为事件访谈法，建立四类机构管理者胜任力模型，为卫生机构人力资源管理的改革与实践提供科学依据。     

Teaching and learning teamwork: competency requirements for healthcare managers

This paper addresses an essential element of postgraduate health service management education - development of individual competencies to enhance teamwork among health service managers. A survey of qualified health service managers in the state of Victoria, Australia revealed a set of individual competencies that the managers felt made a positive contribution to the success of workplace teams. The identified competencies included skills in leadership and communication; clinical knowledge and knowledge of organizational goals and strategies; motives such as commitment to the organization, to quality, to working collaboratively and to a consumer focus; and respect for others as a trait. Building on acknowledged teaching and learning theories, a teamwork teaching and learning model was successfully introduced into the postgraduate health services management curriculum at La Trobe University in Melbourne.     

Current Practice in Meeting Child Health Needs in Family Support Services: Variation by Service Type and Perspectives on Future Developments

The needs of all service users include those related to physical, emotional, sexual and mental health. This article documents where child health needs are recognised and being met within family support services in the west of Ireland, investigates whether there is variation across different types of family support services and presents the views of service providers as to how health needs could be more fully addressed. Four randomly selected service managers were interviewed; followed by a census survey of managers within the region. Thirty-three managers returned questionnaires (80% response) on their formal briefs in relation to health, perceived health needs being met and unmet, approaches to meeting health needs and resources required to adequately meet client health needs. Emotional and mental health needs were most frequently being met within current services, while group work, one-to-one work and referring on were all popular approaches. Systematic differences emerged by service size and client group. Access to expertise and staff training were perceived as the most popular approaches to improving service provision. These data illustrate that there is a need to develop guidelines for practice, foster links between services and provide for specialised staff training in relation to child health issues.