Healtcare Management Course
Lecture 1
What is health?
“A state of complete physical, mental and social well-being and not merely the absence of disease or
infirmity”
“The ability to adapt and to self-manage, in het face of social, mental and physical challenges of life”
Quadruple aim of healthcare
Does management make a difference in HC? Yes!!
Challenges for healthcare management:
- HC managers describe HC organization as unique .. an industry where actions directly impact
patients’ lives.
- Health care is the most difficult, chaotic, and complex industry to manage the hospital is
altogether the most complex human organization ever devised.
How about:
➢ Demographic shift (ageing)
➢ Pace of technological innovations
➢ Changing expectations (patient-centered care, empowerment/ knowledge)
➢ Financial pressures
➢ Workforce shortage
➢ Health crisis
➢ Pandemics
What can healthcare learn from other industries?
Innovative practices have been imported from various industries to health care organizations in …
What can other industries learn from healthcare?
- Creating value that goes beyond short-term gain
- Client relationships based on trust
- Seek the evidence and follow it
- Stimulating working environment (altruism)
- Lifelong learning as a core value
How long has EBHC been going on? Why did it came into existence?
Systematic, evidence-informed practice of management, integrating scientific knowledge with
professional expertise to make organizational decisions (solve organizational problems).
➢ Spin-off of the evidence-based medicine
➢ Translating principles based on best evidence from research
➢ Moving professional decisions away form personal preference & unsystematic experience
Evidence based Management
1. Literature (popular, craft school of thought, self-appointed management gurus)
, 2. Education (mismatch knowledge/ real-world)
3. Practice and Academia
Walshe & Smith offer a framework for the use of evidence in the decision-making process
1. Theoretical evidence: how and why it works
2. Empirical evidence: impact of actual use
3. Experiential evidence: experiences of actors
When thinking of evidence based management we can identify several practical steps:
- Demand evidence
- ….
Some key barriers:
- Not enough good evidence
- Providing solutions is business
- Benchmarking
- Findings do not apply to setting (contextual)
- Psychological factors, we believe what we know; stories are more persuasive
- Organizational factors (access to knowledge )
- Not all managers know the evidence
- Resistance/ pushback to use evidence (threatens personal freedom)
- Simply too much evidence
Risks, downsides, related to evidence based management:
- Delay in the application of new evidence
- Patient vs. population
- Reduced levels of autonomy of the physician
- Values vs. evidence (standardized care vs. peculiar)
Key takeaways:
➢ HC is confronted with challenges, effective management makes a difference
➢ HC is evidence Based Environment
➢ HC management requires understanding of the EBA
➢ HC management decisions require research
Healthcare systems: models
- Beveridge; tax-based, mostly public
- National health insurance; insurance regulated by govt)
- Bismarck; mis of public & private, taxes + insurance funds
- Private; commercial insurers
The Dutch healthcare system in a nutshell
➢ Mandatory bias health insurance package for all citizens
➢ Major players: government, healthcare provider, healthcare insurer, patient
Healthcare tri-lemma
Equity – Efficiency – Quality
,Who health systems six building blocks:
- Service delivery
- Health workforce
- Health information system
- Access to essential medicines
- Financing
- Leadership
Overall goals:
- Improved health
- Responsiveness
- Improved efficiency
Lecture 2
What is healthcare quality?
Different definitions, commonly you will see the use of institute of Medicine.
Here, HC Quality has different dimensions. Care should meet the six dimensions of quality:
- Safe
- Effective
- Patient centered
- Timely
- Efficient
- Equitable
What is improvement?
“The combined and unceasing efforts of everyone healthcare professionals, patients and their
families, researchers, payers, planners and educators – to make the changes that will lead to better
patient outcomes (health), better system performance (care) and better professional development.”
Positioning quality
, Healthcare dilemmas
Improvement, a short story
➢ History of CI lies with incentives to reward employees for improvements (1800s)
➢ Later, more structured approaches such as scientific management (late 1800s, early 1900)
➢ During WWll, implementation of Training within industry is US to improve performance
➢ After WWll, knowledge brought to Japan during rebuild by Deming, Juran, etc.
Healthcare quality: approaches
In practice, all kinds of improvement approaches are used
Which ones do you know?
Which one or ones do you think are the most popular, and why?
➢ Business process reengineering
➢ Lean
➢ SixSigma
➢ Value based healthcare
➢ Total quality management
➢ Statistical process control
➢ Plan do check act
➢ Theory of constraints
Bottom-up Q1 initiatives
Lecture 1
What is health?
“A state of complete physical, mental and social well-being and not merely the absence of disease or
infirmity”
“The ability to adapt and to self-manage, in het face of social, mental and physical challenges of life”
Quadruple aim of healthcare
Does management make a difference in HC? Yes!!
Challenges for healthcare management:
- HC managers describe HC organization as unique .. an industry where actions directly impact
patients’ lives.
- Health care is the most difficult, chaotic, and complex industry to manage the hospital is
altogether the most complex human organization ever devised.
How about:
➢ Demographic shift (ageing)
➢ Pace of technological innovations
➢ Changing expectations (patient-centered care, empowerment/ knowledge)
➢ Financial pressures
➢ Workforce shortage
➢ Health crisis
➢ Pandemics
What can healthcare learn from other industries?
Innovative practices have been imported from various industries to health care organizations in …
What can other industries learn from healthcare?
- Creating value that goes beyond short-term gain
- Client relationships based on trust
- Seek the evidence and follow it
- Stimulating working environment (altruism)
- Lifelong learning as a core value
How long has EBHC been going on? Why did it came into existence?
Systematic, evidence-informed practice of management, integrating scientific knowledge with
professional expertise to make organizational decisions (solve organizational problems).
➢ Spin-off of the evidence-based medicine
➢ Translating principles based on best evidence from research
➢ Moving professional decisions away form personal preference & unsystematic experience
Evidence based Management
1. Literature (popular, craft school of thought, self-appointed management gurus)
, 2. Education (mismatch knowledge/ real-world)
3. Practice and Academia
Walshe & Smith offer a framework for the use of evidence in the decision-making process
1. Theoretical evidence: how and why it works
2. Empirical evidence: impact of actual use
3. Experiential evidence: experiences of actors
When thinking of evidence based management we can identify several practical steps:
- Demand evidence
- ….
Some key barriers:
- Not enough good evidence
- Providing solutions is business
- Benchmarking
- Findings do not apply to setting (contextual)
- Psychological factors, we believe what we know; stories are more persuasive
- Organizational factors (access to knowledge )
- Not all managers know the evidence
- Resistance/ pushback to use evidence (threatens personal freedom)
- Simply too much evidence
Risks, downsides, related to evidence based management:
- Delay in the application of new evidence
- Patient vs. population
- Reduced levels of autonomy of the physician
- Values vs. evidence (standardized care vs. peculiar)
Key takeaways:
➢ HC is confronted with challenges, effective management makes a difference
➢ HC is evidence Based Environment
➢ HC management requires understanding of the EBA
➢ HC management decisions require research
Healthcare systems: models
- Beveridge; tax-based, mostly public
- National health insurance; insurance regulated by govt)
- Bismarck; mis of public & private, taxes + insurance funds
- Private; commercial insurers
The Dutch healthcare system in a nutshell
➢ Mandatory bias health insurance package for all citizens
➢ Major players: government, healthcare provider, healthcare insurer, patient
Healthcare tri-lemma
Equity – Efficiency – Quality
,Who health systems six building blocks:
- Service delivery
- Health workforce
- Health information system
- Access to essential medicines
- Financing
- Leadership
Overall goals:
- Improved health
- Responsiveness
- Improved efficiency
Lecture 2
What is healthcare quality?
Different definitions, commonly you will see the use of institute of Medicine.
Here, HC Quality has different dimensions. Care should meet the six dimensions of quality:
- Safe
- Effective
- Patient centered
- Timely
- Efficient
- Equitable
What is improvement?
“The combined and unceasing efforts of everyone healthcare professionals, patients and their
families, researchers, payers, planners and educators – to make the changes that will lead to better
patient outcomes (health), better system performance (care) and better professional development.”
Positioning quality
, Healthcare dilemmas
Improvement, a short story
➢ History of CI lies with incentives to reward employees for improvements (1800s)
➢ Later, more structured approaches such as scientific management (late 1800s, early 1900)
➢ During WWll, implementation of Training within industry is US to improve performance
➢ After WWll, knowledge brought to Japan during rebuild by Deming, Juran, etc.
Healthcare quality: approaches
In practice, all kinds of improvement approaches are used
Which ones do you know?
Which one or ones do you think are the most popular, and why?
➢ Business process reengineering
➢ Lean
➢ SixSigma
➢ Value based healthcare
➢ Total quality management
➢ Statistical process control
➢ Plan do check act
➢ Theory of constraints
Bottom-up Q1 initiatives
