Health management techniques

Contents
• Methods based on behavioural sciences • Quantitative methods
• Organizational design • Cost-benefit analysis

• Personnel management • Cost-effective analysis

• Communication • Cost-accounting

• Information systems • Input-output analysis

• Management by objectives • Model

• Systems analysis

• Planning-programming budgeting system

• Work sampling
Specific learning objectives
 At the end of this session students should be able to ;

• Describe the basic management techniques applicable to health

Introduction
• Management methods and techniques are based on principles of behavioural
sciences and quantitative methods

Health management techniques

Behavioural sciences Quantitative methods

Methods based on behavioural sciences

• The organization of health services designed to meet the health needs and
demands of the people

• Should be reviewed every few years

Methods based on behavioural sciences

Organizational design :
• Poor organization results in waste of resources

• Organization must be suited to its current situation and the needs to be serviced
Methods based on behavioural sciences

Personnel management :
Fundamental techniques of personnel management :

• Proper methods of selection, training and motivation

• Division of responsibility

• Distribution of roles

• Incentive for better work ; opportunities for promotion and professional

advancement ; effective design of "health teams"
Methods based on behavioural sciences

Personnel management :
• Elimination of "square pegs in round holes"
Professional staff not suited to administration, either through training,
selection or natural inclination

• Incentive for better work

• Opportunities for promotion and professional advancement

Methods based on behavioural sciences

Communication :
• Better communication contributes to effective functioning of an organization

• Communication roadblocks exist at various levels :

• Between the doctor and the patient

• Doctor and nurse

• Between the senior officials and juniors

• Between the directorate and the health ministry

• Between the health ministry and other ministries and rest of the government
Methods based on behavioural sciences

Communication :
• Communication barriers are responsible for

• Delays in regular reporting and notification

• Delays in the compilation of statistics

• Delays in the release of supplies and salaries

• Delays in the institution of prompt remedial measures

Methods based on behavioural sciences

Communication :
• Information is needed for day-to-day management of the health system

• Information comes from many sources - formal and informal

• Information system should be tailored according to the management needs of

the individual health services
Methods based on behavioural sciences

Information systems :
• The functions of an information system consist of collection, classification,
transmission, storage retrieval, transformation and display of information

• A good information system provides data for monitoring and evaluation of health
programmes and gives the requisite feed- back
Methods based on behavioural sciences

Management by objectives (MBO)

• Objectives are set forth for different units and subunits

• Each of which prepares its own plan of action - usually on a short-term basis

• Helps in achieving the results more effectively and smoothly

Quantitative methods
Cost-benefit analysis
• Management technique which has attracted the widest
attention for application in the health field

• The economic benefits of any programme are compared with the cost of that
programme
Quantitative methods
Cost-benefit analysis
• The benefits are expressed in monetary terms to determine whether a given
programme is economically sound

• The main drawback is that the benefits cannot always be expressed in monetary
terms

• Generally the benefit is expressed in terms of births or deaths prevented, or

illness avoided or overcome
Quantitative methods
Cost-benefit analysis
Example:

• The cost benefit analysis of the intensified campaign against small pox in India
during the period July 1973 to December 1975 has been shown to give a net
benefit of about Rs.1058 million and eradication of small pox in yearly saving of
about Rs.728 million
Quantitative methods
Cost-effective analysis
• This is a more promising tool for application in the health field than cost-benefit
analysis

• It is similar to cost-benefit analysis except that benefit, instead of being

expressed in monetary terms is expressed in terms of results achieved
Quantitative methods
Cost-effective analysis
• Example :

• Number of lives saved or the number of days free from disease

• In Sikkim, during 1990, it was found that iodized oil injection method is more
cost effective for prevention of irreversible Iodine deficiency disorders than
the iodised salt programme
Quantitative methods
Cost-accounting
• It provides basic data on cost structure of any programme

• Financial records are kept in a manner permitting costs to be associated with the
purpose for which they are incurred
Quantitative methods
Cost-accounting
Example :
• Calculating unit cost- drug consumption per day per inpatient or outpatient,
cost of various lab investigations. It can be used as a tool of comparison
across different hospital, institutions
Quantitative methods
Cost-accounting
• Cost-accounting has three important purposes in health services :

a. Cost control

b. Planning and allocation of people and financial resources

c. Pricing of cost reimbursement

Quantitative methods
Input-output analysis
• Input-output analysis is an economic technique

• In the health field, "input" refers to all health service activities which consume
resources (manpower, money, materials and time)
Quantitative methods
Input-output analysis
• “Output" refers to such useful outcomes as cases treated, lives saved or
inoculations performed

• An input-output table shows how much of each "input" is needed to produce a

unit amount of each "output"

• It enables calculations to be made of the effects of changing the inputs

Quantitative methods
Model
• The model is a basic concept of management science

• It is an aid to understand how the factors in a situation affect one another

• The decision process includes the use of a model

Quantitative methods
Systems analysis
• Systems analysis is essentially finding the cost-effectiveness of the available
alternatives

• The system can be a hospital supply system, an information system, a total

community health service system, an outpatient clinic or any other system with
problems of management

• A system may be made of independent subsystems

Quantitative methods
Network analysis
• A network is a graphic plan of all events and activities to be completed in order to
reach an end objective

• Brings greater discipline in planning

• Two common types of network technique are PERT and CPM

Quantitative methods
Network analysis
PERT (Programme Evaluation and Review Technique)

• Detailed planning and more comprehensive supervision

• The essence of PERT is to construct an Arrow Diagram - represents the logical

sequence in which events must take place

• It is possible with such a diagram to calculate the time by which each activity must
be completed, and to identify those activities that are critical
Network analysis
Network analysis- Measles vaccination programme
Programme Evaluation and Review Technique
Critical path method
• The longest path of the network is called "critical path"

• If any activity along the critical path is delayed, the entire project will be delayed
Planning-programming budgeting system

• To allocate resources so that the available resources of an organization are used

in the most effective way in achieving its objectives

• PPBS does not call for changes in the existing organization

• Budgeting is a link between planning and programming covering it into annual

budget format
Planning-programming budgeting system

• It calls for grouping of activities into programmes related to each objective

• Another approach is known as the 'Zero Budget Approach", i.e., all budgets start
at zero and no one gets any budget that he cannot specifically justify on a year-to-
year basis
Work sampling
• It is systematic observation and recording of activities of one or more individuals,
carried out at predetermined or random intervals

• Provides quantitative measurement of the various activities

• The major parameters that are analysed are the type of activities performed and
the time needed to do specified jobs
Work sampling
• Work sampling studies have been done on doctors, nurses, pharmacists and
laboratory technicians

• Work sampling permits judgments to the appropriateness of current staff, job

description and training

• It helps in standardizing the methods of performing jobs and determining the

manpower needs in any organization
Decision making
• Decisions should not be made with incomplete data

• In the health sector, decisions have to be made about development of resources,

optimum work load for medical and paramedical workers

• Best decision is always made at the top of an organization

Summary
• Methods based on behavioural sciences

• Organizational design

• Personnel management

• Communication

• Information systems

• Management by objectives
Summary
• Quantitative methods
• Model
• Cost-benefit analysis
• Systems analysis
• Cost-effective analysis
• Planning-programming budgeting system
• Cost-accounting
• Work sampling
• Input-output analysis