sungatov

INDUSTRY MANAGEMENT STRATEGY is based on concentration of resources and their more effective utilization
HN1

WITHOUT BIAS, THE HEALTHCARE SYSTEM HAS LONG BEEN IN NEED OF MODERN MANAGEMENT TECHNOLOGIES. ADVANCING COMPLEXITY OF BUSINESS PROCESSES IN MEDICINE, USING EXPENSIVE RESOURCES, DELIVERING INDUSTRIAL VOLUMES OF MEDICAL CARE, PROBLEMS OF QUALITY, AND UNIFICATION OF MEDICAL SERVICES – ALL THESE REQUIRE IMPLEMENTATION OF MODERN TECHNICS WHICH CANNOT BE REALIZED WITHOUT INFORMATION TECHNOLOGIES AND COMMUNICATION MAINTENANCE. THE ADMINISTRATIVE MANAGEMENT SYSTEM EXHAUSTED ITS POTENTIAL. THE INDUSTRY IS WORKING WITH HIGH PRESSURE AND LOW EFFICIENCY.

Obviously, it is impossible to improve demography and reduce the lag from average global indices without innovative solutions.

Despite the serious problems in the Russian economy, it’s worth saying that the experience gained recently has demonstrated the advantages of the market economy. It took up plenty of resources, but, nevertheless, it was implemented within the framework of conceptual ideas and strategic sectors which require standard solutions. Gradually we come to realize that economy should be considered as the subtlest field of human activity, which cannot be reduced to consumer interests. Economics is a social science that studies allocation of scarce resources between competing consumers. It has the centuries-old extremely dramatic history. The tragedy of economics as a certain area of knowledge is related to the fact that it is close to daily needs of people, that’s why often amateurs yield to the temptation to “practice” its management. Unfortunately, one of insufficiently explored fields of economics is the healthcare system economics. For many years it has existed under its own internal laws, which were created as affected by the outside world’s emotional perception and chronic deficit of resources.

Incorrect strategy in the Russian healthcare economics:

1. Extensive resource upgrading without proportionate financing.

2. Excessive specialization оparticularly in the outpatient sector, resulted in well-defined dispatch functions of a district physician’s professional activity and involved distributing referrals to specialists among patients. Consolidation of specialization was accompanied by developing primarily in-patient care. The level of hospitalization reached high figures (22-26%) as opposed to 12-13% in economically well-developed countries.

3. Limitation of information. Upon having analyzed a large number of studies in healthcare economics, one can find out that in some cases authors are not professional economists. Scientific attitude is replaced by an opinion of specialists, whose competence is outside the given specialization and who develop their theory based on their experience and their idea of life. It is a known fact that many achievements of medical facilities are based not on using economic approaches, but on more advantageous work conditions and receiving additional resources. Exceptionality begets many shallow judgments and models which are inapplicable for mainstream use.

Modern managerial decisions need systematic approaches which are applicable for the whole industry. A standard, systematic solution must be based on the statement that medical facilities should be related to standard production units with a check-list of mandatory technological parameters which should be comprehensible, measurable, accessible and acknowledged; work technology must comply with the models accepted all over the world, in the country or the region. High-quality healthcare can hardly be imagined without its compliance with certain standards. If an average life span in Europe is 76-80 years, then 68 years is definitely not a good figure.

If treatment methods in cardiology consist of certain technological sequences which resulted in mortality rate decrease, then discrepancy with these methods must be considered as bad quality or violation of technology discipline which inevitably causes faulty work. In other words, healthcare must use approved models, while consumers have a right to require reliable technologies.

However, as a matter of actual practice, the main problem of healthcare is a huge gap between the idea of what needs to be done and the answer to the question how to do it. Under the conditions of developing market relations, the topic of healthcare economics cannot be the problem of only economists, or only doctors. We can speak about the necessity of creating a new applied discipline across several specialties – a market economics of strictly limited industries.

The global financial crisis influenced the healthcare economy as well. Under such conditions, one of hardening factors is centralization of resources. But the term “centralization” must be interpreted correctly and not confused with total administration. Scientifically founded centralization requires serious economic and systematic decisions based on the process approach, which has nothing to do with hierarchical management.

How can the industry respond to it? First of all, it can conduct an audit of its resources and regroup them from the perspective of satisfying demands of patients, not the industry. Consumer appeal of healthcare must be based on maximal satisfaction of patients’ needs. They must enter a system which would take care of them at all stages of treatment. It is a difficult problem, because healthcare facilities using government resources are preoccupied with consolidating their leadership positions rather than participating in the systematic organization of the technological process where each organization must have its own well-defined place.

In development of high technologies we will inevitably face the necessity of creating an infrastructure or thematic clusters, which improve operation efficiency of expensive medical canters. All medical facilities cannot be centers, as well as centers mustn’t be involved in all processes. Under these circumstances, the government must structure the industry resources keeping in mind interests of citizens. It must be independent from dedication of certain executives. For the government the problem of oncology is not the problem of an oncologic dispensary, it is the problem of the whole cancer care system. The problem of cardiovascular diseases is not the problem of a cardiology center; it is a necessity of creating a system of cardiovascular cases medical care in compliance with high medical standards with the purpose to significantly decrease eliminable causes of mortality. Information technologies play an important part in this complicated situation. They accumulate dynamic processes in economy, management, and give an opportunity to build complex system combinations and monitor fulfillment in the real-time mode. But at the same time we shouldn’t forget that information technologies are not more than just a tool.

We shouldn’t expect miracles from IT-projects. That’s why the important thing is to answer the question – what choice to make? Either to automate the current mess, or to use a basis of process management principles which are applicable for modeling complex business processes regardless of the industry profile? There is no point in automating archaic and inefficient economy. It should be modernized and brought into line with the current domestic economic model.

Approximately 13,000 doctors and 37,000 medical persons work In Tatarstan today; over 2,000 healthcare institutions function; 31,000 beds are available; hundreds of thousands examinations are conducted, etc. According to research of Brigham and Women’s Hospital in Boston, at present there are over 10,000 diseases, 3,000 pharmaceutical drugs, 300 different radiological procedures, and 1,000 laboratory examinations. Obviously, it is impossible to keep such volume of information in head.

There is a need for new principles – not to change, but to teach the system act differently presenting convincing arguments, to make invisible visible, measurable and comprehensible. In fact, the question is about a necessary constituent of any complex business process – dispatching realized on the basis of modern information technologies. Here is one of the most common definitions of the notion «dispatching».

Dispatching is concentration of operating supervision and coordination of managing production processes aimed at maintaining well-coordinated operation of separate parts in order to achieve the highest technical and economic figures. Dispatching aims at providing uniformity of loading at all parts, continuity, eurhythmy, and economical efficiency of executing all the processes of the main production cycle, trouble-free functioning of auxiliary services. Dispatching is also designed for regulating the production process with the purpose of existing proportions or setting up new ones and work mode of an enterprise or an institution. Dispatching includes control and management of technological processes, control and immediate allocation of all kinds of resources, tracking equipment operation. It prevents down-time of equipment and losses of working time and facilitates fulfilling orders in due time. Dispatching makes positive influence on the production economy.

It must be admitted that informatization of the healthcare industry in Tatarstan faces problems that are typical for the whole country; it complicates the process of reforms. They include the following:

- chaotic prehistory of IT-systems development

- using incompatible technical solutions, which require reconsideration of many of them from the perspective of integration processes

- multiple duplication of expenditures when each institution wants to create its own model and infrastructure

- complexity of placing isolated systems into operation and their functioning, resistance on the part of staff.

Despite objective and subjective difficulties, the system approach to innovative reforms of the industry needs development of a new industry management strategy, an integral part of which must be information technologies and, in particular, the Republic of Tatarstan Healthcare Ministry’s Dispatch Center.

The Dispatch Center is a joint project of the Republic of Tatarstan center of Information Technologies, RT Healthcare Ministry, German company Software FG, and Corporative Information Routines company (Kazan). This project was awarded a certificate of the 1st degree as «The Best Medical Information System-2008» in Russia, a winner’s certificate in the nomination «The best solution in informational-analytical maintenance of healthcare services» (2009). It was developed to achieve efficient and proper use of expensive resources of Tatarstan’s high-tech centers and in-patient facilities, increase awareness of the population and accessibility of in-patient care for citizens.

The Dispatch Center is designed for creating an integrated information environment in healthcare, when patients get an opportunity to take part in organization of their treatment and healthcare institutions have an opportunity to deliver medical care in coordination with each other, thus ensuring efficiency increase in work of certain facilities and the system of regional healthcare on the whole. The Dispatch Center is realized as a complex of solutions in the following fields:

- system solutions which provide fulfillment of specific tasks which can be represented as business processes

- information fields containing determinative information (registers, records, references, classifiers)

- management and economic tasks.

The project purposes include enhancing efficiency of management and inter-department cooperation of healthcare resources, increasing information transparency, and optimization of delivering medical services to citizens, which means a customer-oriented system working according to the principle – «It is information that should «run», not people».

PURPOSES:

- to ensure cooperation of all doctors working in the healthcare system of the Republic of Tatarstan.

- to inform the population about opportunities of the Republic of Tatarstan healthcare system.

- to maintain information exchange between all medical facilities of the Republic of Tatarstan.

- to facilitate integration into the united information space of the Republic of Tatarstan Electronic Government and the federal authorities on the basis of officially approved regulations and standard reporting forms of documents.

TASKS:

- organizing interaction between consumers and suppliers of medical services.

- monitoring of using expensive resources.

- forming an integrated data bank of the Republic of Tatarstan healthcare system.

At present organization of medical care is based on participation of several healthcare institutions in the realization of a patient’s treatment protocol. Accordingly, planning an itinerary of a certain patient gives an opportunity to realize stages of the diagnostics and treatment process depending on specialization, a medical facility’s load, and optimal speed of treatment.

The process of planning a diagnostics and treatment process itinerary is closely related to the notion of treatment regulations. Treatment regulations consist of the following components:

- confirmative criteria – the criteria which can confirm the diagnosis made at a medical facility of the first line

- mandatory examinations – the examinations which are necessary for confirming the diagnosis made at the medical facility of the first line

- the list of institutions and regulations which must be fulfilled in order to achieve the result.

Coordinating operation of a medical facility using the Dispatch Center provides means of organizing a treatment process based on the «one window» principle – when a patient has to deal only with the medical facility in his/her district. According to this scheme, the patient doesn’t have to worry about how to get to a high-tech medical care center. His treatment itinerary from an out-patient hospital to a high-tech surgery and follow-up rehabilitation in a spa resort will be well planned by means of the integrated management system. All necessary endorsements and organization of a pre-assessment examination are held by the Dispatch Center and the referring medical facility, the patient’s presence not required. The Dispatch Center provides centralized archiving of data and work with information in accordance with access permissions.

There will be four strategic directions in the Dispatch Center development:

- extending the list of medical business processes managed by means of the Dispatch Center system (processes: delivering high-tech medical care – diagnostics and treatment, provision of medicines, preventive medical examination, etc.);

- creating integrated protected storages of databases of medical and patient-specific information (archive of diagnostic images, archive of a patient’s passports, archive of medical classifiers, register of insured citizens, etc.);

- extending the list of management and economic tasks (monitoring and inspection of institutions, execution of public contracts and quotas, monitoring of pharmaceutical provision, etc.);

- organizing inter-department contacts based on integrating the systems of healthcare management, social services, different ministries and departments (Compulsory Medical Insurance Fund, Civil Registry Office, Ministry of Internal Affairs, etc.).

The first experience of using pilot software and hardware of the Dispatch Center has demostrated its viability and can be recommended as a universal management solution for complex business processes in healthcare.

April 2010

Published in Healthy Nation, №1 2010, issued with support of the Republic of Tatarstan Healthcare Ministry