Human Resource Management in practice Ass. Prof. Danguole Jankauskiene Mykolas Romeris University...
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Transcript of Human Resource Management in practice Ass. Prof. Danguole Jankauskiene Mykolas Romeris University...
Human Resource Management in
practice
Ass. Prof. Danguole Jankauskiene
Mykolas Romeris University
Lithuania
Structure of the presentation
Global challenges for human resources management Public health challenges Market changes Changing roles Health reform
HR Management problems 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
-10
0
10
20
30
40
50
60
70
80
1995 2000 2005 2010 2015 2020 2025
Pop<15 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
Health challenges
0
200
400
600
800
1000
1200C
zech
Rep
ublic
Esto
nia
Hun
gary
Latv
ia
Lith
uani
a
Pola
nd
Slov
akia
Slov
enia
EU-1
5av
erag
e
SDR
per
100
,000
All Causes Circulatory System Cerebro-vascular
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
160
8
152177
13
164
214
16
198
283
85
198
306
108
198
322
124
198
370
172198
383
197198
398
211
187
404
203201
0
50
100
150
200
250
300
350
400
450
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 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 systemStructural changesTrainingPlanning of numbersMentality
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”
7574
7268
666464
6159
5551
5049
4745
393636
3230
232222
2019
18
8
48
10
0 20 40 60 80 100
LuxemburgFrance
BelgiumFinland
DenmarkAustria
UKSpain
The Netherlands Germany
EUIreland
SloveniaMalta
SwedenCzech rep
HungaryItalyItaly
GreeceSlovakiaEstonia
RomaniaLithuania
CyprusPolandLatvia
PortugalBulgaria
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”
7974
7370
6463
6258
5347
4032
30
2823
1513
1111
1010
88
76
52
30
0 20 40 60 80 100
FinlandDenmank
FranceBelgium
LuxemburgNetherland
Sweden Austria
UKSpain
GermanyIreland
MaltaMalta
ItalySlovenia
Czech repLithuania
CyprusHungaryEstonia
Slovakia PolandGreece
RomaniaLatvia
PortugalBulgaria
2,5 % POSTRAGUATES AND 3,8% PHYSICIANS RESOLVED
TO EMIGRATE
RIGHTS TO MOVE, RESIDE AND EXERCISE PROFESSIONS
Migration of specialistsMigration of specialists
Willingness of Lithuanian medical specialists to work abroad in percent 2005
Source: KMU survey, 2005
26
60,7
26,5
3,8 2,5 2,30
10
20
30
40
50
60
70
Willing towork abroad
Emigrated
Doctors
Resident doctors
Pharmacists
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) 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.
Hospital productivity
Too many admissions ALOS in smaller
hospitals is twice as long and is larger ones (and not all are nursing)
Efforts to develop day-surgery need to be sustained.
Hospital productivity (2007)
Bed Occupancy Average Length of Stay
Shift to Primary care in Lithuania
0500
100015002000250030003500
Family medicine Family doctor (GP) and Team of doctors (internist,
pediatrician, gynecologist, surgeon)
The Need For Balance
Effective Care
Efficient CareAppropriate
Care
Equity
STATUS QUO BIG BANG
RESTRUCTURING APPROACHES
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”
9392
9088
8785
8483
8282
8079
77
7169
6764
6362
5857
5548
4343
42
76
42
0 20 40 60 80 100
BelgiumAustria
SwedenFinland
The NertherlandsDenmark
MaltaFrance
SpainLuxemburgCzech rep
GermanyUK
SloveniaEU
CyprusEstoniaIreland
ItalySlovakiaPortugal
LithuaniaLatvia
GreeceHungaryBulgaria
PolandRomania
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”
938787
8685
848383
8180
7877
75
7574
7171
7068
6662
615959
5857
75
53
0 20 40 60 80 100
BelgiumFranceAustria
Czech repFinlandCyprus
The NetherlandsMalta
EstoniaLuxemburg
SlovakiaGermanyDenmark
ItalySlovenia
EUSweden
UKGreeceEstoniaIreland
LithuaniaLatvia
PortugalRomaniaBulgaria
PolandHungary
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”
9695
9393
9291
9090
8989
8888
84
8382
8181
787777
7373
7271
6968
84
62
0 20 40 60 80 100
MaltaBelgium
FranceAustriaCyprus
DenmarkIreland
LuxembuSpain
TheGermany
UKEU
SloveniaHungary
CzechFinland
SlovakiaEstonia
ItalyLithuania
GreecePolandLatvia
RomaniaBulgariaSwedenPortugal
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”
717070
6762
5554
5352
4747
4645
414141
403939
3736
3534
3332
25
43
24
0 20 40 60 80 100
LithuaniaGreece
BulgariaMalta
CyprusPortugalSweden
LatviaItaly
SlovakiaRomania
AustriaLuxemburg
PolandEU
SpainHungarySloveniaGermany
EstoniaFranceIreland
DenmarkUK
Czech repBelgiumFinland
Netherland
Modern health policy and management technologies
1. Team work and team training
2. Program supervision
3. Evaluation of individual needs
4. Socialization in the community
5. 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 creditsHealth policy and managementHealth lawHealth economisManagement 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