Publications IPH Magazine IPH Magazine 13th: Annals Hospitals, networks and sustainability
- Editorial - 13th
- HEALTH MANAGEMENT: Efficiency, Innovation and Sustainability
- Health Management Focused on Efficiency, Innovation and Sustainability!
- CONGRESS FOR COST AND FINANCIAL MANAGEMENT
- Hospitals, networks and sustainability
- Cost Reduction through Process Review
- Integrating Business Management to the Assistance Management
- International experience on the compensation models
- The Future of Hospital System - The Sustainability Challenge of Small Hospitals
- Advances in Patient Safety: Indicators and Impact on Cost Assistance
- Prospects for Public Private Partnerships and the Partnership Arrangements with Health Social - Critical Analysis of the PPP Brazilian Experiences in Health
- ENGINEERING, ARCHITECTURE AND LOGISTICS CONGRESS
- Hospital Logistics: Intelligence at Service for the Health Manager
- PEOPLE MANAGEMENT AND LEADERSHIP CONGRESS
- Illusionist Performance: Transformation and Innovation in Tough Times
- Implementation Careers & Salaries: New Paradigms and Opportunities
- The Art of Leading Generations X, Y and Z - How to retain talent?
- Giving Back Over the Organizational Climate - Talent Retention Strategies
- Creative Practices to Innovate in HR
- HEALTH MANAGMENT CONGRESS
- Efficiency
- Efficiency (2)
- The Process of Change in Bolivia "Hospital Arco Iris" from Solid Hospital to Liquid Hospital
- PATIENT'S QUALITY AND SAFETY CONGRESS
- Impact of External Assessment in Brazil
- Impact of External Assessment in Brazil (2)
- Quality and impact of patient safety in the hospital financial result - Santa Casa de Misericordia de Maceió
- Quality and Safety Integration on Education Process
- Management
- The Apthapi as Innovation Strategy in the Humanization of Healthcare Hospitality
- The experience of the State Hospital Sumaré / Unicamp in management by care
- HOSPITAL HOTEL CONGRESS
- Hospitality in Patient Perspective
- Hospitality at the Service of Humanization
- Hospitality and Humanization
- Hospitals Infrastructure Trends aimed at Physical and Mental Comfort for Patients and Families
- The Multidisciplinary Integration of Beds Management as a Way to Seek Effectiveness
- Spirituality in Hospitals Focusing on Healthcare Hospitality
Hospitals, networks and sustainability
Osvaldo Artaza
Health systems are currently stressed by a number of factors related to environment changes occurred in recent decades, and it is known that much of the income and high hospital costs are due to a previous failure of health and social system. These considerations imply a profound change in the work of healthcare organizations that must modify themselves from being organizations dedicated to heal and rehabilitate the damage to organizations able to contribute to keep people healthy. PAHO is committed to contributing to the development of the health systems based on Primary Health Care - PHC - and modeling from them Integrated Health Services Delivery Networks - IHSDN - in order to provide more accessible, equitable, efficient health services, with better technical quality and that meet the expectations of citizens .
| Hospitals today | Hospitals network |
| Work in isolation, in a disintegrated way within the establishment (stagnant processes) and outpatient settings. | They are components of integrated health services that support the response capacity of primary care networks. |
| Privilege activities related to hospitalization. | Privilege outpatient care activities and procedures, thus avoiding unnecessary hospitalizations. |
| Organize their processes concerning the well-being off their staff, particularly the specialists who exercise power. | Organize their activities - processes - having as core axis the people. |
| High rates of adverse events and accidents concerning their staff. | They provide a safe environment for their users and employees, besides being friendly to the environment. |
| The hospital staff have high rates of poor physical and mental health. The context is stressful and overloading with insufficient protective factors. |
They are concerned with their staff's health, wellness and competence development, because they are the hospital's main resource. |
| Tend to take on technologies under pressure of the industry, without prior cost-effectiveness evaluations. | They use only cost-effective technology and are based on evidence-based medicine to modify and improve their skills. |
| Important quality losses and waste by inefficient and redundant use of resources. | They are efficient in using their resources and contain costs to contribute to equity. |
| Opaque management of resources and lack of evaluation of results and impacts. | Incorporate evaluation and accountability as part of a continuous improvement cycle. |
Integrated Health Services will not be feasible unless hospitals understand that healthcare processes begin and finish outside its walls. It implies that protocols and clinical guidelines should be participatory co-constructions among different actors trough the network. This requires forming cross-professional teams of specialists, family physicians, among others actors, for the management of each integrated care process, not belonging to different levels but to a single organizational model sharing the patient as an unified path based on shared clinical practice guidelines.
In any case this involves the strengthening of coordination mechanisms between levels (ideally within transverse and integrated multidisciplinary teams). Both in terms of searched results and as standardization and normalization way of working (guidelines, standards, work methods, evaluation mechanisms, management control and learning). It will require to gradually go from processes indicators (the most appreciated at hospitals) to results indicators (positive change in the epidemiological pattern of the population). This require a clear vision of population and territory from the network and hospital managements, working from health plan of this population and territory as well changing the traditional ethical principle of doing good effectively (doing all possible for the sick) as it is usual at hospitals for equity (much more embedded in the PHC core). Doing everything possible for the sick person focusing on the individual can be the source for inequality for many others.
Along with healthcare integrations, it is required explicit definitions on bypass rules; information systems, management control and public income statement.
Allocation policies and incentives should encourage networking. For an example, economic resources for the purchase of intermediate products, such as imaging and biochemical examinations and buying the first consultation referral to specialists, may be in the budgets of the PHC in order to stimulate this resolution capability and instill in the hospital the idea of the PHC as a client. In this same line of thought, established incentives for meeting goals should be shared by one and another level since to have access to them is required cooperative action of each other. For the latter, it will be important to establish incentives for integrated service delivery network planning. The latter because, currently, a central aspect hindering the integration of health services is due to the fact that health goals are not shared by different network nodes. Thus, the organization of integrated network hospitals should consider formal instances of planning and common goals with the other network nodes to assess their performance and efficiency according to coordination and cooperation with other network levels.
It will be difficult to talk about network without the network manager receives a capitation allocation corrected depending on the characteristics of the population and territory, so that it in turn makes contracts or distribution agreements between the network devices based on the definition that the network itself makes concerning the type of care activities of each establishment. Network through the institutions of government that should have - regardless of "ownership" of the various establishments - the ability to model the different nodes via the definition of service portfolios, decisions on network investments, capacity to mobilize human and technological resources from one to another level to integrated care and cost-effectiveness. Without this ability to generate a flexible adaptability to demand it is difficult to imagine an effective network management.
It is key that the network contracts with the establishments that comprise it are constructed "bottom - up" in order to engage clinical teams in compliance and that there are mechanisms for monitoring compliance and generate feedback. The contracts must be promises that are impeccably fulfilled, in order to strengthen confidence among the actors in a network. The budget should be strongly aligned with the strategy of the network and generate strong incentives to shift.
The objective of a funding aligned with an integration strategy, is to drop limits and boundaries between PHC and hospital care, because these borders are often pretext to reinforce compartments and hinder continuity of care.
The key element to the aforementioned are the Tics, which have come to help with the ease of real-time communication between hospitals and the different network nodes.
The integration model should be a "business unit" to cross-cutting teams that are responsible for the integrated process ( PHC - hospitals - tech Outpatient Centers etc.); which must be connected and complemented with long stay devices, partner health services, among others, all of which must not go outside the network.
It is the PHC - the needs of people - that must set - through government networks - the profile of each node so that the distinction between acute and long-stay hospitalization or home care are not mechanisms for "the hospital to take over patients' problem" but a logical, cooperative, humane and cost-effective way to manage care, so that the users of the network are always in right time and place according to their needs and it is the rational modeling that makes their resource network.
The goal of having organized and managed network hospitals must be paid by different mechanisms. Corporate governance must be established in the network and not only on its nodes (and hence ability to plan, coordinate, evaluate and provide feedback), the management of clinical processes must be unified so that clinical hospital units should gradually give cross-step equipment, intermediate products must be of the network and not a particular node (business units should be network). Also support services, logistics, maintenance, among others, should aim to integrate into shared business units in order to generate economies of scale and enhance the identity of collaborative work. Having users in the center of the business, devices that support and diagnostic, therapeutic or logistical support, having as clients nodes that give open or closed attention, informing the network manager, who has skills and capabilities to model the network and generate assignments and incentives aligned with this new organizational architecture.
All this will be possible in LAC whenever we have the capacity to broad national consensus in the field of health; flexibility to articulate establishments of different ownership and dependence; understanding that it is necessary to strengthen health institutions particularly in the ability to design, implement and regulate persistent public policies; leadership and expertise to support complex change processes; alignment between objectives, funding and implementation tools and, finally, ability to learn what works and generosity to share mistakes and best practices.
Share
Send by e-mail: