Review of the Management System within the Health Care Administration in Arkhangelsk Region

ANNEX I. G:

Review of the Management System within the Health Care Administration in Arkhangelsk Region

V. A. Tchernets

Table of Contents

1 Methodology Used for Review of the Management System.. 2

2 Summary of Management System Review.. 2

3 Suggestions on Improved Management Methods and Structure for the RDoH in Arkhangelsk Region. 3

4 Tentative Questions for Review of the Management System of the RDoH. 5

2  Methodology Used for Review of the Management System

The management methods and arrangements used by the Regional Department of Health (RDoH) in Arkhangelsk region were reviewed to identify the problems and develop guidelines for improved health care management.

Pursuant to this, an investigative interviewing technique was used to examine current difficulties and problems in the work of health care managers as well as respective guidelines to solutions. The developing interview is designed to both obtain relevant information and put the respondent in a proactive position, survey proactively by action and search for problem solution during the interview. Problems are detected, in particular by such questions as “What is the cause of it?”, “Who is to gain?” or “What are the obstacles to solution?” Confidentiality is secured, i. e. survey results will be presented to the RDoH only in summary.

The questions, which may be used in interviews, are provided in Chapter 4.

3  Summary of Management System Review

The review conducted showed that the RDOH structure is balanced as to its centralized and decentralized components. Such balance is observed in authority and responsibility division between the structural units. No duplication of duties was found. The respondents did not note any gap in horizontal relations. There is no dual subordination. The employee to manager ratio is 6-8 to one.

All the RDoH managers and employees interviewed appreciated:

fairly clear division of authority between the managers; lack of problems in the description of their duties.

The following obstacles should be mentioned, though:

Personnel

Lack of reserve managers for vacancy filling.

Recruitment service

Lack of a Head for the Personnel Department. The Personnel Department does not conduct recruitment or plan promotions for lack of relevant standards. Lack of lawyer at the Personnel Department does not allow to offer legal advice to health institutions.

Institutional deficiencies

The RDoH is lacking:

a position to develop and implement directly strategic plans and specific innovations. legal consultants and financial managers. a position to process letters and claims taking much work time of primarily the managers.

Management

Through changes in the health care management hierarchy, resulting in decentralising the subordination of municipal health institutions away from the regional administrations towards municipal health care authorities, resulted in weakened control over the majority of health care institutions. The RDoH has no financial control over the municipal facilities since it is not the funding agent. Municipal health departments are not directly under the RDoH, so they may make decisions contradicting the health restructuring policy, primarily in such improved health care delivery areas as reallocation of services to the outpatient setting and rational bed capacity reduction.

Thus, the RDoH is responsible effectively for health in Arkhangelsk region, but does not have all the appropriate financial and administrative levers to manage health care provision.

4  Suggestions on Improved Management Methods and Structure for the RDoH in Arkhangelsk Region

The following key areas of improved health care management may are identified:

1)  Personnel (recruitment policy, qualifications).

2)  Co-ordination between the RDoH and regional health care facilities.

3)  Management information support for the RDoH and health care institutions in the region.

4)  Optimised structure for the RDoH.

5)  Implementing the arrangement for strategic planning.

6)  Arrangement for managing the municipal health institutions.

1) Personnel (recruitment policy, qualifications)

Optimise the staff of Personnel Department (identify additional requirements in employees and search for those). Develop incentives to self-improvement and proactive self-realization. Build a reserve for:
RDoH managers and staff managers and personnel of health institutions managers of municipal health care facilities (Chief Doctors of Central District Hospitals, heads of city health departments)
Implement methods of employee evaluation, recruitment and planning promotions. Conduct training for business communication (telephone conversation, visitor reception, etc.). Develop corporate (office) culture, i. e. single office finish, uniform, legends and heroes, rites and other.

2) Coordination between the RDoH and regional health care facilities

Interview periodically managers of health care facilities to identify their requirements in support by the RDoH, obstacles and difficulties in coordination between the RDoH and the health care facilities. Make arrangements for feedback and co-ordination (meetings, field workshops, mutual performance review by health care facilities and the RDoH. Develop operating standards for health care facilities, including management standards. Draft agreements on division of authority between RDoH and regional health care facilities, financial independence of health care facilities and mutual commitments. Develop procedures for collaboration, review of and reward for health care facilities and their managers and employees, which comply with the procedures. Supervision of health care facilities by the RDoH.

3) Management information support for the RDoH and institutions in the region.

Implement the operating information procedure for RDoH managers regarding health sector status within Arkhangelsk region. Develop methods of reporting:
health sector status in any period; individual medical services; individual health institutions; estimated health sector needs in equipment, beds, professionals and other.
Implement the procedure for data provision on requests by managers and professionals (reference database). Develop an arrangement for identifying health institution needs in technical assistance and information by the RDoH. Identify the types and volume of the above technical assistance and information to health institutions (practical guidelines, instructions, standards, information on local and international experience, etc…)

4) Optimised structure for the RDoH

Reconcile the structure with the strategic objectives of the RDoH. Establish appropriate RDoH units. Improve manageability (optimised allocation of deputies by components). Optimise allocation of duties between RDoH employees.

The following changes may be made as top priorities:

Strengthen personnel management services:
introduce a head for the Personnel Department; introduce a counsellor (advice to reserve personnel) at Personnel Department or the Organisational Department; re-subordinate the recruitment service to the RDoH director or his/her deputy on personnel or the head of Organisational Department.
Establish a visitor reception service. Establish departmental units for:
collaboration of the RDoH with its partners (other departments of the regional administration, government institutions and others); contacts with mass media; strategic planning and control over goal implementation (primarily restructuring, GP service development); standard setting.
Optimise the allocation of duties between managers and medical professionals and improve the morality.

Prospective optional changes:

Establish a strong clinical block including the departments or divisions engaged in:
medical and preventive care to adults; maternal and child health; strategic planning; standard setting; visitor reception.
Strengthen the drug supply service by establishing a respective committee or department including the divisions engaged in:
drug supply; medical equipment supply drug supplier network development and monitoring.
Establish the personnel management block. Introduce the RDoH deputy director for personnel, or establish respective department in charge of, in particular:
representation and PR; international relations; co-ordination (for representation) with regional health facilities and municipal health care authorities; personnel management, including recruitment, personnel development and training, planning promotions, optimised teamwork/ethics, team building in newly-established departments.
Establish a support block including the departments engaged in:
logistics; technical monitoring (construction/repairs); drug supply; medical equipment supply.
Establish a marketing department for:
drug/equipment market analysis and monitoring; procurement and competitive bidding.

5) Implementing the arrangement for strategic planning

Develop a strategic plan for . Establish the strategic planning and forecast department. Set strategic performance indicators for departments and employees. Make an arrangement for the monitoring of the implementation of the strategic plan.

6) Improving the management within municipal health care authorities

Reconcile the legal status of health care providers with the Civil Code of the RF (district hospital, feldsher/obstetrician station). Improve the arrangements for co-ordination between the RDoH and municipal health care authorities. Define the status and responsibilities of the head of the municipal health care system. Develop contracts between the RDoH, the Central District Hospitals, the regional compulsory health insurance fund and the municipal administration. Tailor the arrangements for feedback between the RDoH and municipal health care authorities.

5  Tentative Questions for Review of the Management System of the RDoH

Structure of the RDoH

What strategic objectives do you envision for your department in the current year? Who in your department is in charge of 1) health sector restructuring and 2) GP service development? What key objectives of the department are priorities for your division? List 3 to 5 priority objectives of your division in the current year. Who issues assignments to your division? What is the procedure? Who and based on what criteria reviews the performance of your division? What is the product of your division? Who is the user of the product of your division? Do you have to duplicate sometimes the work of other divisions? Do other divisions duplicate sometimes the work of your division? Is there any duplication between other departments of the ministry? Are there any inappropriate duties of your division? Are there any cases on record of the performance by other divisions of the duties being inappropriate for them? Do you have any suggestions on changing the role of your division in the departmental structure? Is it possible to delegate part of the duties of your division to other divisions? Do you have any suggestions on improved structure for the RDoH as a whole?

Co-ordination between divisions

What divisions are your most common contacts? What issues? What data and in what form do you provide to these divisions? What data and in what form do you receive from these divisions? Do you often need to verify and adjust the data coming from one division to another? Do you receive the data required for decision-making? If not, what data are you lacking? What obstacles arise in data transfer and receipt? What procedures are used for coordination between the RDoH divisions? How efficient are these procedures?

Management

Is your authority sufficient for your duties? If not, what additional authority should be provided (delegated) to you? What is the procedure for approval of management documentation? What obstacles are there? Is there any arrangement for RDoH division oversight? What it the arrangement for monitoring of decision implementation within the RDoH? What obstacles do emerge in monitoring of decision implementation within the RDoH?

Current obstacles and problems

What obstacles or problems does your division encounter? What has been done to overcome these obstacles? Why no success? What solutions to these problems do you see currently? What obstacles or problems does the RDOH encounter? What has been done to overcome these obstacles? Why no success? What solutions to these problems do you see currently? How long does it take to fulfill operating assignments (preparation of replies to letters, non-routine memos, etc…)? Is your authority sufficient for your duties? If not, what additional authority should be provided (delegated) to you? Are there any important objectives requiring a division, which is missing currently in the RDoH?