15th ISQua
CONFERENCE ON QUALITY IN HEALTH CARE
BUDAPEST, HUNGARY, OCTOBER 7 – 10, 1998
THE
MANAGEMENT OF
HEALTH
CARE ORGANIZATION SYSTEMS
Authors:
Dr Oscar González Morán *
Dr Eduardo Rodas **
Dr Mario Vernengo
Lima ***
Dr Roberto Gallino Fernández ****
Dr Pablo Morici
****
* College
Degree in Public Health – Consultant
** Chief of Medical Informatics at
the Manuel Belgrano Hospital. Province of Buenos Aires
*** Technical Assistant Director at the
San Justo Children’s Hospital .
Province of Buenos Aires
**** Associate
Director at the Manuel Belgrano Hospital. Province of
Buenos Aires
Correspondence to:
e-mail: edurodas@yahoo.com.ar
Informatics
brings about changes in the management of organizations financing and supplying
health services, which we shall proceed to highlight according to our own
experiences in public, private and social health care areas.
The historical transformation of information sources
and systems have accompanied the technological progress of medicine and we
currently feel the need for a profound updating to include users, institutional
and central policies, human resources, software, hardware and humanware in the face of the progress and strong impact
information management is causing on health care organizations.
Informatics systems can therefore interact with
management levels to determine homogeneous groups of health care organizations,
identifying those whose invoicing practices differ significantly from those of
their colleagues; analyzing transactions carried out by organization members in
addition to the broad range of information as regards percentages, averages and
profiles based on mathematical models will enable us to prevent any future
frauds and counteract the impact any control system may have on health
organizations, thus achieving a homeostasis of the system for a balanced
development based on equity, efficacy and efficiency.
Introduction
The process undergone by health care organizations
with the advent of informatics is extremely complex. The impact of implementing
any new technology leads to resistance, which may range from insecurity about
losing one’s job to uncertainty because of lack of knowledge as regards the use
of these new tools. We have noted that health care organizations, as part of
the services sector, did not suffer the mass unemployment caused, for instance,
by the incorporation of robotics in the industrial sector. Lack of knowledge of
new tools has been handled using comprehensive ongoing training plans to
prepare the members of the organization in the use of informatics tools.
When redefining the organizational structure for
health service in an effort to serve the aims of the organization we must
consider the incorporation of the informatics area.
With the help of adequate information about certain
facts, decisions may be made using the deductive / analytical method to replace
estimations and intuitive judgements, which are so
frequent in this area. Transforming data into information involves a cost, and
as such should be considered as important added value.
Information is classified according to the levels at
which it is used:
a) Management
level operation within the production process
b) Management
level tactics within the health care organization
c) Management
level strategy within the health care system
Information should adapt to the level at which it will
be used, which is why it should be increasingly summarized as and when senior
management levels require it.
Incorporating distributed systems contributes to a
participative management. The multidirectional flow of information helps
different members of the organization to have access to the information they
require to make decisions in their corresponding sectors. Distributed
informatics therefore generates and accompanies change dynamics, achieving an
open, participative management.
With the generation of self-managed work groups, new
teams evolve outside traditional health care organization structures, and can
carry forward projects which coincide with the organization’s interests.
On analyzing the medical attention process, with the
understanding that this includes any activity or action carried out on a
person, both to prevent illness and to recover health, we note a permanent
exchange of data between the patient and the person attending to him / her.
Data is understood as the set of unstructured facts
and background material required to achieve exact knowledge of something; the
exactness of this knowledge will enable an efficacious and efficient
performance of the goals of medical attention.
The process of medical attention is essentially a
permanent transfer of data, from the time the patient joins the health service,
when he requires information as to where he must go for attention, when he
first goes to see a doctor and is asked for data in his anamnesis, data
obtained from laboratories, from radiology and scans, data which the doctor
himself compiles with instruments such as a thermometer or a tensiometer, data acquired from his colleagues via
cross-consultations, or from whatever literature he has at his disposal. All
this data is registered in the patient’s case history and is processed by the
doctor on the basis of information he can access, in order to reach a diagnosis
and be able to indicate the course to be followed.
Formerly little importance was given to health care
information. It was only when great epidemics or catastrophes occurred that
their impact was considered and the severity of their side-effects, i.e. death
and illness, was measured.
In our early-century beneficent hospitals, just as in
the rest of the world, medical aid was simple, and made little use of apparatus
and only scarce use of medicinal remedies; health care teams adopted an
attitude of paternalistic protection towards their patients.
Towards the mid 50’s and in the decades following,
modern medicine suffered revolutionary changes with the appearance of
apparatuses and the pharmaceutical industry. It was no longer the doctor who
diagnosed, healed or relieved using his hands or his senses, but rather
technology based on microelectronics with its multiple applications and
advances. Data constitutes the input to an information system and this same
data, organized and analyzed, constitutes the output of the system where the
data is processed.
This multidirectional flow of data which is processed
and transformed into ‘information’ is the basis for the QUALITY of medical
attention.
On analyzing the Health Service management process as
that of a high contact service company, which is what it really is, it may be
noted that data is also fundamental basis for efficient management, especially
as regards making use of resources such as personnel, materials, instruments
and financial resources, among others, which after being processed are
transformed into information.
Given the concept that interaction of the medical care
process and the availability of resources is the basis for the productive
process in this kind of service companies, information management takes on a
central role in Health Services management.
Information is a resource similar to any other (human,
instrumental, building, etc.) in a healthcare system, and as such should be
carefully administered. Second only to human resources, information should be
recognized as the most important resource for whoever is managing a health
service.
Current healthcare systems offer vitally important
information at all levels of healthcare organizations: from the operative level
of the production process, as regards control, to the highest management level
for planning.
Having timely information at hand when required
implies efficient management of available resources.
Computer processing of information is frequently
carried out initially in a somewhat “disorganized” way, that is, it is done
without any prior planning or organization, which will make it difficult to
share it in future, much less integrate it in a single information network.
Information should ideally be precise, reliable,
sufficient and timely. An information system required for managing a health service
is essentially based on storing, organizing and recovering data on a correct
and timely basis. Data constitutes access to an information system and
information is defined as a set of interpreted and organized data which makes
sense and has significance for the user of the system and is the output of this
system.
The person responsible for managing a healthcare
organization and who is unable to recognize that information is the key
material / resource to be used as a basis for adequate decision-making as
regards requirements is undoubtedly doomed to failure.
We can define the management of a healthcare
organization as the process of distributing and making use of resources by way
of planning, organization, management, coordination and control, with the aim
of offering the services patients require and complying with the organization’s
mission.
Information is the basis for planning; it both
determines and defines plans to be drawn up in the short, medium and long term
to achieve the aims of the healthcare service.
The impact caused in areas such as Attention to
Outside Users, Human Resources, Purchasing, Administration, Laboratory,
Pathology, Image Scanning, is such that we would like to mention some of the
benefits achieved.
When informatics was installed in the office where
appointments are given for Out-patient attention, some patients were found to
have up to seven different case history numbers. These numbers are currently
given automatically and a patient data base has been set up. If the patient
already has a case history number the computer will detect it and avoid
duplication.
By filing data from the Out-patient, In-patient and
Emergency departments control is kept on any patient entering or leaving the
establishment.
Secretaries who formerly had to stand up and sit down
over sixty times in one morning to hand out appointments can now work seated at
their computer monitor.
During an interview carried out in the Purchasing
Office, one employee said: “It’s an entire team which has become adapted to
working in a certain way. Our work production in this office has increased.
Purchase requests which formerly took 20 to 30 days to complete when done
manually now take 24 to 48 hours. Learning is made easier for new employees.
They adapt faster. Mistakes jump out at you. Overall work presentation is
better, both in quality and quantity. There are no longer differences between
the estimated budget and the final budget. I’m much less concerned about any
possible mistakes in my work. It’s more difficult to go wrong.”
During the interview in the Human Resources Office we
were told: “The computer improves the quality of our work; it’s neater, the
information it processes is more accurate. Work times have improved notably.”
The high costs involved in healthcare systems, added
to over-utilization of technological resources, excess medication and a lack of
adequate management have made some healthcare organizations frankly unfeasible.
Globalized economy and new paradigms marking behaviors within
companies make it necessary to implement information much faster and more
efficiently.
Many healthcare organizations are suffering losses
because there is no validation for the services they offer, and frequently when
the analysis of this information is prepared it is not done systematically.
Current informatics systems can interact with
management levels and, by making use of these modern tools, can determine
routine behavioral groups, identify organizations whose invoicing practices
differ significantly form those of their colleagues, analyze transactions
carried out by organization members, enable a follow-up of healthcare
organizations and avoid future misapplications. Thus information may be gathered
as regards the average amount of appointments per patient, average number of
patients per family, percentage of house-calls made on public holidays, average
number of diagnosis per patient, percentage of teenage patients attended,
percentage of senior citizens attended, average cost per call, average cost per
patient, average duplicate appointment vouchers, percentage rate of calls vs.
radiology, laboratory, physiotherapy, dentistry studies, etc.
Deviation detection is increased with the creation of
profiles based on mathematical models and interactive tools are available for
analyzing and graphically visualizing information.
Prevention is established by estimating future fraud
and the effect any control system has on organizations offering services.
Application of these management tools will achieve
homeostasis of the system and achieve a balanced development based on equity,
efficacy, efficiency and quality.
It is frequently supposed that having the equipment
(hardware) and a few programs (software) is enough to install informatics at a
healthcare establishment, and that after a time and as the result of experience
the human resource (humanware) will arise, as the
most important resource, accompanied by institutional or centralized policies
as the basis for any informatics development project.
We have observed individual attitudes which seek to
conceal recently acquired know-how, and we feel this goes against the progress
of different projects.
We also believe development should be tailor-made – to
the extent possible – and carried out locally so as to avoid depending on outside
decisions; this should favor growth and continuity of our work.
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