Summary of the lectures, tutorials, articles, and chapters of the book:
Healthcare Management EBB132A05, Rijksuniversiteit Groningen 2018/2019
Week 1 Healthcare Management Challenges
Hospital management is strongly correlated with health outcomes.
Examples of value in healthcare:
- Website with ranking of health outcomes
- Medical Information Transfer (Electronic Medical Record)
- Interdisciplinary meetings to determine treatment goals
- Rehabilitation (good) vs. send home and emergency again
Healthcare Management is a distinct discipline. However, health care organizations can also learn
from other industries. On safety and complexity for example, there are several similarities with
aviation and automotive. There have been several success stories, but serious questions remain
about the value of these imported practices in improving the performance of health care
organizations.
Other industries can also learn from health care on the following aspects: (1) Create value that goes
beyond short-term gain, (2) create client relationships based on trust, (3) always seek the evidence,
and follow it, (4) create a truly stimulating working environment, and (5) embrace lifelong learning.
Unfortunately, examples of other industries trying to learn from health care organizations are
virtually non-existent.
Healthcare management faces four main challenges:
1. Demographic shift. People live longer and the number of elderly are rising fast. Elderly make
much greater use of the healthcare system. This leads to more demand for healthcare but
there is less supply available, because less people are in their ‘working age’.
2. Pace of technological innovations. The pace by with technological innovation are available is
going faster and faster. This increases the ability to cure illnesses and control chronic
diseases and thus extend life. But managerial decisions on resource allocation needs to be
made, because health care would be unaffordable in +/- 2035 (O. Roemeling, personal
communication, November 12, 2018).
3. Changing expectations. People are better informed and want more from health services,
they are no longer passive recipients. People want to play a more central role in their care
process (public engagement).
4. Financial pressure. In almost every other area of the economy, productivity is rising and
costs are falling through competition and innovation. In healthcare this doesn’t really apply.
Costs are stubbornly high and continue to rise.
, Week 2: The healthcare system and evidence-based management
The Netherlands has the best healthcare system in Europe, but it is not very sustainable because it is
quite expensive.
The main stakeholders in healthcare systems:
- Government, sets the regulations.
- Healthcare providers, such as doctors and nurses.
- Healthcare insurers, sets the prices and reimburse the healthcare services.
- Patients, received the actual care.
Different models for healthcare systems (examples):
Beveridge (United Kingdom, Spain). Healthcare is provided and financed by the government
though tax payments = public.
Bismarck (Germany, The Netherlands). Providers and payers are private, healthcare is usually
financed jointly by employers and employees through payroll deduction, everyone is
covered, no profit, and tight regulations of medical services and fees = private but regulated.
National Health Insurance (Canada). Elements of both the Beveridge and Bismarck model.
Private-sector providers, but payment from a government-run insurance program that every
citizen pays into.
Out of Pocket (poor countries). Countries without a established healthcare system, care is (if
even accessible) paid out of pocket. Result: only rich get care, the poor stay sick.
Private (United States). The US has many separate systems.
o For Americans over the age of 65 on Medicare: like the National Health Insurance,
o For working Americans who get insurance on the job: like the Bismarck model,
o For 15% of the population without health insurance: Out of pocket.
Evidence Based Health Care (EBHC) exist since +/- 1990 and became into existence because of variety
in healthcare outcomes.
Three types of evidence contribute in different ways to decision-making:
- Theoretical evidence, how and why an intervention is meant to work.
- Empirical evidence, what impact the intervention has had.
- Experiential evidence, what people do in response to the intervention.
There are two types of evidence:
1. Broadly applicable general evidence.
2. Evidence gathered in the organization for assisting in local decision making.
Managers mostly do not work evidence-based. Some key barriers/limitations to use evidence:
- Quality of the evidence is limited.
- There is not enough or too much evidence.
- Evidence-based management can threaten managers’ personal freedom.
- Businesses believe that its particulars, practices, and problems are special and unique
(uniqueness paradox).
Healthcare Management EBB132A05, Rijksuniversiteit Groningen 2018/2019
Week 1 Healthcare Management Challenges
Hospital management is strongly correlated with health outcomes.
Examples of value in healthcare:
- Website with ranking of health outcomes
- Medical Information Transfer (Electronic Medical Record)
- Interdisciplinary meetings to determine treatment goals
- Rehabilitation (good) vs. send home and emergency again
Healthcare Management is a distinct discipline. However, health care organizations can also learn
from other industries. On safety and complexity for example, there are several similarities with
aviation and automotive. There have been several success stories, but serious questions remain
about the value of these imported practices in improving the performance of health care
organizations.
Other industries can also learn from health care on the following aspects: (1) Create value that goes
beyond short-term gain, (2) create client relationships based on trust, (3) always seek the evidence,
and follow it, (4) create a truly stimulating working environment, and (5) embrace lifelong learning.
Unfortunately, examples of other industries trying to learn from health care organizations are
virtually non-existent.
Healthcare management faces four main challenges:
1. Demographic shift. People live longer and the number of elderly are rising fast. Elderly make
much greater use of the healthcare system. This leads to more demand for healthcare but
there is less supply available, because less people are in their ‘working age’.
2. Pace of technological innovations. The pace by with technological innovation are available is
going faster and faster. This increases the ability to cure illnesses and control chronic
diseases and thus extend life. But managerial decisions on resource allocation needs to be
made, because health care would be unaffordable in +/- 2035 (O. Roemeling, personal
communication, November 12, 2018).
3. Changing expectations. People are better informed and want more from health services,
they are no longer passive recipients. People want to play a more central role in their care
process (public engagement).
4. Financial pressure. In almost every other area of the economy, productivity is rising and
costs are falling through competition and innovation. In healthcare this doesn’t really apply.
Costs are stubbornly high and continue to rise.
, Week 2: The healthcare system and evidence-based management
The Netherlands has the best healthcare system in Europe, but it is not very sustainable because it is
quite expensive.
The main stakeholders in healthcare systems:
- Government, sets the regulations.
- Healthcare providers, such as doctors and nurses.
- Healthcare insurers, sets the prices and reimburse the healthcare services.
- Patients, received the actual care.
Different models for healthcare systems (examples):
Beveridge (United Kingdom, Spain). Healthcare is provided and financed by the government
though tax payments = public.
Bismarck (Germany, The Netherlands). Providers and payers are private, healthcare is usually
financed jointly by employers and employees through payroll deduction, everyone is
covered, no profit, and tight regulations of medical services and fees = private but regulated.
National Health Insurance (Canada). Elements of both the Beveridge and Bismarck model.
Private-sector providers, but payment from a government-run insurance program that every
citizen pays into.
Out of Pocket (poor countries). Countries without a established healthcare system, care is (if
even accessible) paid out of pocket. Result: only rich get care, the poor stay sick.
Private (United States). The US has many separate systems.
o For Americans over the age of 65 on Medicare: like the National Health Insurance,
o For working Americans who get insurance on the job: like the Bismarck model,
o For 15% of the population without health insurance: Out of pocket.
Evidence Based Health Care (EBHC) exist since +/- 1990 and became into existence because of variety
in healthcare outcomes.
Three types of evidence contribute in different ways to decision-making:
- Theoretical evidence, how and why an intervention is meant to work.
- Empirical evidence, what impact the intervention has had.
- Experiential evidence, what people do in response to the intervention.
There are two types of evidence:
1. Broadly applicable general evidence.
2. Evidence gathered in the organization for assisting in local decision making.
Managers mostly do not work evidence-based. Some key barriers/limitations to use evidence:
- Quality of the evidence is limited.
- There is not enough or too much evidence.
- Evidence-based management can threaten managers’ personal freedom.
- Businesses believe that its particulars, practices, and problems are special and unique
(uniqueness paradox).
