The role of management in healthcare reform process in Slovenia

One of the most important levers for making the healthcare system in Slovenia more efficient through the implementation of an urgent reform process in the near future is to use a services management approach — management as in a planning, organization, information and controlling system and a decision-making process in the proper choice of leadership for healthcare institutions. The different political options in Slovenia could change the orientations and the solutions concerning relations between public and private sector healthcare. The question of efficient leadership in healthcare institutions remains. Business and managerial functions are basic tools for harmonizing and for overcoming the problems among medical and business sectors in healthcare institutions such as hospitals and clinics.

Keywords: healthcare system, reform process, management.

1. Presentation of some basic problems

Citizens want to have access to a healthcare service whenever and wherever it is needed. Asked what the main weaknesses of Slovenian healthcare are, Slovenes put waiting times on top of the list (MZ, 2000). Bad organization of services comes second, and bad quality third. Slovenes are sensitive to the perceived differences in accessibility and want to know whether accessibility is truly determined solely by different health needs. They want higher quality healthcare services and access to information about good practices, positive models, problems and bottlenecks. They expect more sensitivity on the part of medical staff and greater involvement in decision-making about issues concerning their health and life.
Health workers have their expectations as well. It would be unjust to claim that these expectations solely concern their income. They wish to help their patients. They do not want to bear a responsibility that is not theirs, and they do not want to wonder in fear whether or not their patients will survive until the future date of an operation. They would like to offer citizens the best medical care that science and technology can provide. They want a stimulating working environment, opportunities for personal professional development and participation in decision-making while maintaining the autonomy of their profession. They want fair competition in their profession, and they want us to find a systematic way to eliminate the levelling of wages and to reward the quantity and quality of the work performed. They expect outdated hierarchies to be supplemented by teamwork.
The state is aware that it must be a good steward of the healthcare system, which was entrusted to the state by its real owners — the citizens. Stewardship means commitment and responsibility to the needs of citizens being met in the most efficient and high-quality manner. The aim of the state is better health for all citizens and a stable healthcare system. The state is aware that health must be preserved and strengthened not only as a fundamental human right, but also as support for the development of human potential.
Slovenia is distinctive among the transitional economies to the extent that it largely retained its basic values concerning health care in the first decade of its independence — that it did not allow money rather than health needs to open the door to the healthcare system. Its Constitution states that the right to social security includes a guarantee of access to health services for all without distinction in relation to personal circumstances including wealth. However, with the reform of the health system in 1993, we withdrew from some values, especially in terms of solidarity in healthcare financing. Some other values, which we would otherwise wish to strengthen, have not yet reached the levels of a just, social and effective state.
Administration and management of public healthcare institutions will more closely approximate those in public enterprises. Councils of healthcare institutions will be transformed into supervisory councils. In addition to supervision, they will also have a guiding role in strategy preparation. A management body will be established, whose members will be individually and collectively responsible to the supervisory council. Management on all levels will be evaluated on the basis of professional and financial results. Public healthcare institutions will be responsible for the overall treatment of patients from entry into the system because of a specific problem to the completion of treatment.

2. State stewardship of the healthcare system

Because of their close ties with people, their needs and expectations, healthcare systems are in most cases public systems. Health is the most important ingredient of national and individual well-being. In a way, it is ‘owned’ by individuals, as are the resources (financial as well as material and informational) intended for health. As people have difficulty in managing these resources individually, they have entrusted the state with the stewardship of the entire healthcare system. As stated above, stewardship of the healthcare system means commitment and the responsibility to the needs of citizens being met in the most efficient and high-quality manner. Primary responsibility for this stewardship, of course, lies with the Ministry of Health.
Growing demands for increased efficiency, quality and responsibility for the economic management of resources in the public sector in the last decade have, in European countries, given rise to a transfer of entrepreneurial methods, tools and activities into the public and non-profit sectors. Where the state used to participate in direct management of healthcare institutions, it withdrew from that form of management and retained only a regulative role — that of steering and directing the healthcare system. In the new spirit of stewardship, the state retained and strengthened its obligation to steer the healthcare system with the highest regard for ethics, quality and effectiveness. In this sense, state regulation can be understood as a kind of compromise between the rigid system of direct control and management of institutions by the state on the one hand, and the system of market competitiveness on the other.

Miroslav Končina: director, University Psychiatric Hospital, Ljubljana

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