National Healthcare Services Management - Essay Example

A Comparison of Strategic and Operational Approaches to Management Health care is one of the most important and vital, resources necessary in all social systems. It takes a variety of forms, and may be provided formally or informally through households or specialized institutions. National healthcare services (NHS) comprise a range of different methods of assistance and intervention, corresponding to different concepts of health, illness and disease. Professional medical and surgical treatment, especially in hospital settings, is commonly regarded as the conventional model for modern health care systems, but this is only part of a more complex and differentiated pattern (Moran 1999). The NHS is generally regarded as one of the core components of the British welfare state. It provides comprehensive health care universally on the basis of need, and is financed out of general taxation and national insurance. It is one of the largest employers in the country, and is a major consumer of public expenditure. In UK, NHS undergoes drastic changes which have a great impact on the structure, functions and effectiveness of healthcare delivery. These failures are caused by lack of strategic vision and lack of budgeting, inadequate structure of NHS and inability to meet coming changes. Strategic Failure The main problem of the strategic level is lack of coherence and consistency in planning process and goals. Government agencies seek to achieve their goals by attempting to build political consensus, and by incorporating key strategic actors in the creation and execution of policy. Thus, public administration cannot provide the co-optation of all institutions and groups, and state policy (in education, health, welfare and so on) and collaboration between producers and consumers. The problem is that "organizations fail to respond to requirements for engaging community in planning and development" (Publications and Reports NHS 2007). During the last five years, the politics of the NHS have varied in their intensity and nature, and conflicts have developed around a diversity of issues at different times (Moran 1999).. These have included the possibility of devising planned programs for specific health-care needs; the balance between acute medicine and care of the elderly, mentally ill and mentally handicapped; the organization of acute medical care; the national and regional redistribution of resources to equalize facilities and services; the scope of private medicine in NHS hospitals; the co-ordination of statutory agencies; tiers of administration and types of management; working conditions and pay levels for NHS staff; and cost-containment. Failures in NHS policies are cause by the fact that "NHS bodies on the patch do not have the commitment or the plans in place to ensure financial balance is achieved" (Publications and Reports NHS 2007). Ever since the inception of the NHS there were problems in identifying and measuring costs within hospitals, but by the late 1990s the measurement of costs and efficiency became a major source of concern for government. David Cameroon comments: "His (Gordon Brown's) great experiment in tax and spending has failed. He is an out-of-date politician wedded to state control. The question everyone is asking is, 'Where has the money gone" (Russel 2007). As central government attempted to contain health-service spending, tighter controls were applied to local Health Authorities; special emphasis was given to improvements in efficiency, and healthcare services were required to make 'efficiency savings' in their budgets (Petit-Zeman, 2005). Cost improvements or efficiency savings in the clinical sphere have not, to date, been established, but there have been systematic attempts to devise techniques for measuring and evaluating medical output, and intensive efforts to develop better accounting, budgeting and costing procedures. A major and long-standing difficulty in the NHS, largely due to the absence of market pressures, is that clinical costs were rarely the subject of detailed investigation, and budgets were increased incrementally (Petit-Zeman, 2005; Publications and Reports NHS 2007). These failures in strategy development and strategic planning have led to crisis and dissatisfaction of both medical staff and patients with service quality they receive. Numerous changes in the economic and political context, which led to its modifications, did not help to improve the system of healthcare. There were problems in producing the strategies and operational plans due to inadequate skills, confusion and conflicts between authorities, and mismatches between strategies and operational, budgeted plans. Operational Failures Operational failures are a result of poor planning and lack of strategic vision of NHS. Hawkes (2007) describes the situation as following: The NHS does not change because the incentives are not there. Managers who innovate take risks. If they go wrong, cost money, or produce headlines in the newspapers, the Department of Health can be relied upon to provide no backing. The trick of survival as a NHS manager is to change nothing and balance the books. Managerial and organizational control is thus always contingent and variable. Like the impact of 'structural' interests and exogenous factors on the relative autonomy of participants and institutions, the form and degree of control is an empirical question. Thus, inadequate policies and lack of money force managers do nothing to sustain competitive position and support main operations. The fact that organizational patterns themselves are constantly modified, and apparently adapt to new regimes of capital accumulation, does not weaken the argument for their specificity (Hawkes 2007). Lack of technological innovations and new methods of treatment is another 'failure' of NHS. This influence healthcare quality provided to patients. Health Care quality should first be defined in terms of all aspects of a service delivered to potential customers, all benefits and supporting facilities. The next step is to evaluate all the necessary actions throughout the organization. Today, changing Health Care orientation implies reorientation of the corporate approach to quality, i.e. service orientation (Xanthons, 2006). Move from a traditional 'control' type approach which accepts, implicitly, that mistakes and faults will occur: process orientation. Service quality in Health Care is closely connected with Human Resource Management, technology and clinical settings and. In literature there was a debate concerning the effectiveness of different approaches in Health Care and their impact on service quality improvement (Petit-Zeman 2005). Thus, lack of funding and training programs for healthcare professionals decrease professional skills and knowledge of employees. For instance, "Lord Darzi also correctly identified stroke as a disease where the NHS has failed, miserably. He might have added allergy, liver diseases, osteoporosis or a host of other equally deserving conditions" (Hawkes 2007). Quality management requires that nursing staff and doctors must be ready to cope with difficult situations and patients demands. Effective managers recognize that what they know is very little in comparison to what they still need to learn. Another cause of the operational failures is that the budgeting and provision of health services differs by sector. Most primary care is provided by general practitioners working solo, in partnerships, or in group practices in communities and neighborhoods. Most of them are independent contractors with the NHS, and in England their work (like that of dentists, opticians and pharmacists) is financed and regulated through ninety local Family Health Services Authorities (FHSAs). Only some primary care facilities receive good financial support and regular budgeting (Petit-Zeman, 2005; Russel, 2007). As the pressure on resources has intensified, governments and funding bodies have sought to exercise more control, across the entire apparatus of health-care delivery systems generally, but also more specifically over medical practice. For those agencies wishing to limit or reduce health expenditure, the fundamental problem is that resources are ultimately committed and consumed by clinicians. It is medical and surgical practice, and all the associated paramedical, diagnostic and therapeutic services generated by it, which determine staffing, equipment and pharmaceutical costs. As patient demand has grown, and expectations risen following advances in medical treatments and technology, the production of clinical services has expanded, leading to a continuous rise in expenditure. All of the independent agencies referred to the overwhelming importance of financial problems as the primary concern in their organizations (Xanthons, 2006) They all argued that government under-funding of the NHS together with increased demands had precipitated a situation in which fundamental reassessments of services were necessary. Improvements in efficiency were said to be a continuing requirement, but there was also recognition that rationalization and restructuring were needed. However, this involved the extension of managerial influence over clinicians, which was acknowledged to be difficult. One other basic problem, particularly in hospitals, is that there are several different ways of identifying and classifying costs. As a consequence, it is often hard to ascribe responsibility for expenditure to one discrete sub-unit of the organization, or even to one form of activity (UK Regulatory and Clinical Affairs 2006). Managerial Failure Managerial failures are caused by "lack of effective, integrated workforce planning, Inability to recruit and retain professional staff, inability to develop or implement new roles, lack of training programs" (Publications and Reports NHS 2007). Problems and failures of the government to maintain funding and regular budgeting led to managerial failures. In general, management is a means of motivating staff: responsibility that should be linked with incentives, rewards and sanctions, to promote overall efficiency. Existing consensus management arrangements has led to duplication, excessive meetings and a fragmented and divisive approach to tasks. To remedy the weaknesses of functional specialization, professional functions should be 'effectively geared into the overall objectives of the general management process' (Xanthons 2006, p. 14): a line management system should be established in which the general manager sets the priorities and programs for functional managers. Finally, by business standards, the consultation processes of the NHS were 'labyrinthine' and contributed to 'institutional stagnation': by implication, the introduction of general management would overcome these defects, and speed up decisions. For instance, "the commission called for NHS trusts to appoint a board-level head of dignity improve communication of policy on the issue and make dignity, equality and diversity training 'mandatory and ongoing'. It warned of unannounced inspections in the future" (Healthcare Commission 2007). It is clear from the context of this example, in referring to administrators' goals of maximizing the availability of care, in fact relates this to the growing problem of scarce resources, and disputes about whose decisions should influence expenditure restraint and rationing. It is also obvious that since the date of those comments, pressures to economise have increased significantly. In conditions of economic retrenchment, the delegated discretion represented by clinical freedom is regarded as both the source of ever-increasing claims on resources, and as an obstacle to 'rationalization' in the pattern of service delivery and resource use. Recommendations New strategic approach is the main factor of success and effective healthcare service. It means that all resources should be calculated and all hospitals should be adequately financed. Strict control and resource allocation should be introduced. These are not totally opposed methods of managerial control, and in changed conditions there may be shifts between them. Control is thus rarely absolute or comprehensive; it is precarious, and involves a variety of different strategies and techniques, reflecting external conditions (market pressures) and internal struggles (worker opposition). There may be interpenetrating layers of managerial control, with a cluster of devices and practices. During one period, one form (for example, responsible autonomy) will be attempted, but then, without it being totally replaced, other forms (for example, bureaucratic discipline) may be introduced-the dynamics and outcomes, at all stages, are shaped by group struggles (Xanthons, 2006). Customer relationship management within Health Care quality management emphasizes the use of information technology in managing customer relationships. Advances in database technology have made it possible to know and segment customers in ever more creative ways. Data warehouses can be used to store and search vast amounts of data. Data mining and modeling techniques can reveal otherwise 'invisible' patterns of customer behavior, which can be translated into customer-specific marketing strategies. With its foundations in relationship management, customer relationship management reinforces the view that marketers manage - and businesses win/lose - customer relationships, not customers. Clinical governance and medical staff function are aimed to deliver customer satisfaction and meet changing demands and expectations (Petit-Zeman, 2005). Quality processes help to satisfy requirements of different patients, and help to meet the needs of a particular customer and provide specific personal service for every visitor. The main objective of modern Healthcare system is to maintain the level of service quality and develop strategies to improve their services and service design. Getting this role right, and to a standard of expertise that is superior to that of competitors and sustainable in the longer term, requires an in-depth understanding of the nature and nuance of customer service (Petit-Zeman, 2005). According to Xanthons (2006): there should be clear distinctions between managerial jobs and doctors performance. There are real differences between doctors' and managers' objectives and interests, and that especially in a period of retrenchment, managers will attempt to exert stronger influence over the scope and content of medical practice. Administrators have used management techniques to fix medical workloads and output in accordance with both commercial insurers' and federal welfare agencies' demands for cost-containment. For each level it should be assumed that doctors would be directly involved in the management structure, and that, given the size and organizational complexity of the NHS and its numerous types of staff, it was necessary for there to be an emphasis on multi-disciplinary teams. Xanthons (2006) explains that the distinctive and fundamental principle underlying this arrangement is that policies are to be formulated and implemented through 'consensus management'. Local managers should be enabled to get on with their tasks, and the role of the centre would be restricted to strategic policy rather than detailed intervention. Moreover, at Unit levels, where consensus management had previously led to 'lowest common denominator decisions' and delays, general managers would assume responsibility as final decision-takers, especially in issues crossing professional boundaries and likely to cause disagreement. Urgent management action is necessary at unit level, the team argued, to bring about the real devolution of decision-taking reorganization, and again, doctors would have to accept management responsibility for the effective use of resources (Moran, 1999). In sum, reorganization is the main solution to current problems and failures experienced by NHS. Within the NHS it is difficult to identify all of these strategies precisely, or all aspects of them, but there is sufficient evidence to regard them as real tendencies. For several decades there has been an expansion and diversification in the work undertaken by nursing and paramedical staff, and stratification between senior hospital consultants and junior doctors. More recently there has been a significant increase in hospital patient throughput during a period of rising caseloads and a fall in total beds, and several government campaigns to clear up excessive waiting-lists for hospital treatment. Finally, there have been a series of different measures (performance indicators, clinical budgets and resource management, Diagnostic Related Groups) which have paved the way for managerial evaluation, surveillance and standardization of clinical activity. Bibliography 1. Hawkes, N. 2007, NHS may be sick, but this won't cure it Available at: http://www.timesonline.co.uk/tol/comment/columnists/guest_contributors/article2592071.ece 2. Healthcare Commission exposes failure of NHS trusts to treat elderly patients with dignity they deserve. 2007, Available at: http://www.personneltoday.com/Articles/2007/09/27/42551/healthcare-commission-exposes-failure-of-nhs-trusts-to-treat-elderly-patients-with-dignity-they-dese.html 3. Moran, M. 1999, Governing the Health Care State: A Comparative Study of the United Kingdom, the United States and Germany. Manchester: Manchester UP. 4. Petit-Zeman, S. 2005, Doctor What's Wrong: Making the NHS Human Again. Routledge; 1 edition. 5. Publications and Reports NHS. 2007, Available at: http://www.neynlha.nhs.uk/PublicationsReports/BoardAssuranceFramework.htm 6. Russel, B. Conservative Reaction: Cameron: NHS failure is 'hole in the heart of Budget' The Independent 2007, Available at: http://news.independent.co.uk/uk/politics/article2381097.ece 7. Xanthons, C. 2006, NHS Complaints Managers: A Study of the Conflicts And Tensions in Their Role. Dissertation.com. 8. UK Regulatory and Clinical Affairs. 2006, Available at: http://www.ukresearchanddevelopment.com/10218/en_GB/0.pdf. Read More