Editorial: An Urgent Need for Investment in Health Management Education
Internationally the agenda for healthcare reform has moved rapidly. In Australia, the health care system has recently undergone significant structural changes to target sustainable improvements to the performance of health service delivery. Throughout this process there has been growing attention to the importance that leadership and management can play in the ultimate success of improved health service delivery. The quality of the management and leadership education within the health services and state health authorities has been shown to be crucial to better patient outcomes. Despite leadership being integral to the success of reform, the national strategies have failed to address the leadership and management education, development and training needed at the health care and health services level. The Australian health service reforms ignore the critical issues of planning and investment towards the education and development required for a system targeting management and decision making at the hospital level. The two prominent professional bodies which nationally promote health management education, research and professional development are the Society for Health Administration Programs in Education (SHAPE) and the Australasian College of Health Service Management (ACHSM). Both groups have recently sought commitment from the government, health departments and healthcare providers to invest in health management education through supporting the continuing professional development and training of the health management workforce.
Open access
The Blacktown Mt Druitt Hospital Imaging Department wanted to find a clinical practice improvement solution to the escalating endemic and common public hospital problem of long waiting times for x-rays, Access Block, cancelled examinations, inefficiency and poor service capacity. A multi-disciplinary team was formed, the workflow analyzed, request form and patient flow were mapped from time of requesting the x-ray examination to final report delivery. After the main causes were identified the steps deemed unnecessary were eliminated to create a revised request pathway (arriving with patient instead of prior) and patient flow. Patients arriving with the request form were given immediate access. Radiographers from other modalities methods provided support to ensure streamlined patient flow within the department. Patient Services Assistant (PSA) roles were redefined and the referring ward became responsible for contacting the PSA when patient was ready to be transported. This new process was called 'Open Access'. The issues identified were receiving and distribution of the request form to imaging areas providing x-ray service and the excessive, uneven workflow demands of the PSA. As a result of original request form pathway and the patient flow system, radiographers were inefficient and underused, many examinations were cancelled, service capacity was poor and imaging contributed to hospital Access Block. Through implementation of 'Open Access', average ward x-ray availability reduced from 15 to 1 h, with 91.9% of all examinations completed in less than 3 h. Average Emergency Department x-ray availability reduced from 3 h to 30 min. Average of 80 cancelled x-ray examinations/month reduced to zero. Patients requiring x-ray have immediate access to services when they arrive with the request form. 'Open Access' has led to efficient patient flow, improved availability of images, assisted patient clinical management, discharge processes from hospital and bed availability. 'Open Access' has reduced Emergency Department Access Block, allows more effective use of staff resources and higher staff, patient and referring ward satisfaction.
Finding brilliance using positive organizational scholarship in healthcare
Purpose - Positive organizational scholarship in healthcare (POSH) suggests that, to promote widespread improvement within health services, focusing on the good, the excellent, and the brilliant is as important as conventional approaches that focus on the negative, the problems and the failures. POSH offers different opportunities to learn from and build resilient cultures of safety, innovation, and change. It is not separate from tried and tested approaches to health service improvement - but rather, it approaches this improvement differently. The paper aims to discuss these issues. Design/methodology/approach - POSH, appreciative inquiry (AI) and reflective practice were used to inform an exploratory investigation of what is good, excellent, or brilliant health service management. Findings - The researchers identified new characteristics of good healthcare and what it might take to have brilliant health service management, elucidated and refined POSH, and identified research opportunities that hold potential value for consumers, practitioners, and policymakers. Research limitations/implications - The secondary data used in this study offered limited contextual information. Practical implications - This approach is a platform from which to: identify, investigate, and learn about brilliant health service management; and inform theory and practice. Social implications - POSH can help to reveal what consumers and practitioners value about health services and how they prefer to engage with these services. Originality/value - Using POSH, this paper examines what consumers and practitioners value about health services; it also illustrates how brilliance can be theorized into health service management research and practice.
Health Service Managers in Australia Part 3: field of study, level of education and income
This article is the third by the authors in a four-part series. They deal with the composition and characteristics of health service managers in Australia of relevance to policy and decision-making for the health service labour force in general and health service managers in particular. The first article provided analyses on the specific characteristics of service, geographical and category distribution of health service managers, while the second imparted factual perspectives on age and sex characteristics. The analyses in this third article involve the fields of study, levels of education and income of health service managers in Australia, at the time of 2006 Census of Population. Findings show that health service managers tended to have a higher degree of concentration in health and management/ commerce fields of study than the average for all industries. This also applied to managers in aged care residential services. The majority of females in the health labour force was reflected in most fields of study, with notable exceptions such as engineering and architecture/building. Health service managers had higher levels of education than the average for all industries. This was especially so in the case of hospital managers but also applied to other health services and to a lesser degree in aged care residential services. A larger proportion of female managers in health services had qualifications at bachelor and postgraduate levels than male managers, particularly in hospitals. The same applied to aged care residential services. Following their higher level of academic qualifications, the average income of managers in health services was higher than the average for all industries. There were substantial gaps between the average income of male and female managers in health services and aged care residential services. Some factors that contributed to this difference could be attributed to the higher proportion of female managers working less than full time but other factors must also have been responsible for this difference. The article raises policy and training questions and suggests a related agenda for research.
Leading and Managing the Implementation Process: the key to successful national health reform
Introduction: The Australian Government recently announced major reforms to the health system - A National Health and Hospitals Network for Australia's Future. The national health reform plan involves substantial structural change which the Government expects will deliver 'better health and hospitals' for future generations. Approach: A review is undertaken of the proposed set of reforms to determine whether its frame of reference can contribute to the effective achievement of the desired health and hospitals outcomes. Findings: The national health reform plan was found to have two striking weaknesses. Firstly, it fails to account for the political, cultural, behavioural and professional aspects of change. Secondly, it fails to position leadership and health management as central to the implementation of reform. Conclusion: The complexity of major structural change is such that major health reform strategies need to incorporate proper assessment of organisational behaviour aspects within a system which values the central roles of leadership and health management. A new leadership model for introducing health reform is presented.
Health Service Managers in Australia Part 4: hours worked, marital status, country of birth and Indigenous status
This fourth article adds to the findings of the three previous articles in a four-part series. These articles are concerned with the composition and characteristics of health service managers in Australia. The data and analyses present factual bases with a bearing on policy formulation and planning of the health labour force in Australia and the training of managers. The first article provided analyses on the specific characteristics of service, geographical and category distributions of health service managers, the second on age and sex, and the third on fields of study, level of education and income characteristics of health service managers. This fourth article investigates hours worked, marital status, country of birth and Indigenous status of health service managers in Australia. Findings confirm that a large proportion of health service managers worked part time and female managers more so than males. Partly as a result of this difference, male managers worked on average longer hours than females, but even full-time female managers worked on average shorter hours than males. The average hours worked was lower than the average for managers in all industries in Australia. When adjusted for differences in age from the average for all industries, a larger proportion of health service managers than average had never married and were divorced or widowed. Conversely, a lower proportion than average were married. More than the average proportion of managers in hospitals were born in Australia, while the inverse was the situation in medical and other health services. The share of Australian-born was about average in aged care residential services. Indigenous health service managers constituted a larger percentage of managers than the average in all industries. Their participation in hospitals was lower than in medical and health services; and about the average for all industries in aged care residential services. In all cases, their participation in the management of health services was lower than their proportion in the adult population. The article presents challenges in policy formulation regarding working conditions and the participation of varied segments of society in the management of health services. It also points to a related research agenda.
The competency of innovative thinking: challenges within the Health Management course curriculum
An evidence-based approach was used to examine the recent salient systemic changes in the Australian health system and from these the related main management issues and the pertinent competencies and skills of health managers were defined. One key competency identified was that of innovative thinking. Studies have shown that effective health care requires innovation in processes and systems to address the increased demand and quality issues (Berwick 2003; Guo 2009). Innovation is regarded as a necessary component for effective public health program implementation (Frieden 2014). As health care is undergoing a most significant period of change and reform in decades: are our postgraduate programs in health management preparing adequately our future health sector leaders and managers to promote a management environment in which innovation is fostered and a resort to meet these challenges? Are graduates being provided with the appropriate competencies and skills? This paper reviews the need to close the gap between the identified need for innovative thinking as a competency to deal with current management issues and the current curricular offerings in health management education.
The Pathology Workforce Crisis: future solutions
Introduction: A recently released report, the National Survey of Pathology Workforce 2011, has painted a bleak future for clinical pathology services in terms of a looming major workforce shortage. Approach: A review is undertaken of the current pathology workforce situation to determine the key contributing issues, future demands, workforce needs and strategic solutions. Findings: A workforce crisis in pathology is upon us, with approximately a third of the total workforce expected to leave within the next five years. This represents a real threat to the future capacity of the workforce to sustain quality services at current levels and the likely growth of demand for pathology testing into the future. Conclusion: Four strategies are recommended to address the future pathology workforce needs in Australia through leadership and workforce development. These are; increasing supply of the workforce; redistributing the workforce from areas of lower to higher demand; improving productivity; and reducing demand for pathology services.
Human dimension of health service management
This article identifies three relevant and valid constructs that are associated with personal and organisational performance that can be used in the training of current and future health service managers: personal engagement at work, emotional intelligence and conflict resolution. A review was undertaken of the literature in human resources management to identify key concepts that bind and strengthen the management of organisations. A curriculum content analysis was then performed of postgraduate health management courses in Australia to assess the extent of inclusion in these areas. Three concepts and practices of relevance to the human dimension of health management, namely personal engagement at work, emotional intelligence and conflict resolution, were found to: (1) have concept validity; (2) be associated with personal and organisational performance; and (3) be capable of being imparted by training. The analysis indicated that none of the competencies and/or skills identified has been given emphasis in postgraduate health management courses in Australia. Competence in the management of human relationships in health services has been given low priority in university postgraduate training in health management in Australia. The current situation poses challenges to all stakeholders of health services.
Health Service Managers in Australia Part 1: service, geographical and category distribution
This article is the first of a four-part series in which the authors provide analyses on the composition and characteristics of health service managers in Australia of relevance to policy and decision-making in dealing with these issues. This first article provides analyses on the specific characteristics of service, geographical and category distribution in both the public and private sectors. It gives an estimated number of managers in health services and aged care residential services in relation to the population they serve, as well as their relationship to people employed. It compares these ratios to those for all industries in Australia. The analyses also document and review managers by category and specialisation and compare their composition to the average for all industries. Substantial differences in composition between hospital, medical and other services, aged care residential services and the average for all industries arise from the analyses. Disparities in ratios to population and composition were also found among the various states and territories. The article also discusses the wide range of ratios of health service managers to population in some countries and their lack of consistency. The discussion of findings includes an agenda for future research.