EUROPEAN PAPERS ON THE NEW WELFARE

12. Proposal

The primary objective of reforming the administration and regulation of the healthcare system is to create incentives for service providers to make their organization and management more efficient. The vision is of a modern user-friendly healthcare system that will retain the positive traditional and cultural features of the previous system and secure a high level of equality of access to healthcare benefits and health by means of an efficient healthcare system founded on the best examples of good healthcare practice in the world.
This will be strategically achieved by giving a greater role to the modern regulation rather than administration of healthcare organizations, recognizing the part that private ownership and private funding can play within healthcare and in developing competition, which will force public institutes and companies to adopt standard and efficient forms of organization and management.
Areas of standardization for service providers are efficiency and effectiveness indicators for healthcare management. These indicators are being prepared within the Ministry of Health’s healthcare system management project, which was finished in 2004. The indicators will enable direct comparisons between healthcare institutes, determine their level of efficiency and effectiveness and with that management performance. These standards will assist healthcare institute councils in their administrative role, and assist the founders when making decisions within their function as the general meeting point.
The next area to be standardized, which incorporates the preceding pair while being a precondition, or necessary tool, for their implementation, is the creation and regulation of IT standards. The purpose of standardizing healthcare IT is to create a standard healthcare information system, and to operate and maintain it. The emphasis in the field of data will be on preparing a national data dictionary with definitions and descriptions of all the terms used in the standardized healthcare information system. In such an information-based environment there will also be the need to publish recommendations on the software and hardware requirements.
The changes to be ushered in by the reform will more clearly define the powers and responsibilities of participants involved in administrating or managing the healthcare system at every level. By analogy with companies, the principle of a management board, consisting of one member or more, will be applied at the management level. Larger service providers will have separate business and medical management. Members of the management board will have to have management qualifications and experience. The supervisory council will appoint the management board, whose members will be individually and jointly responsible to the supervisory council for achieving objectives and performing their functions. Instead of conflicts between the functions of the medical and business management being resolved within the management board to the detriment of one function or the other, they will be resolved by the supervisory council. The main functions of the management board in public healthcare providers of course must be planning, organizing, managing and supervision.
The development of the managerial function will be based on the efficient use of resources (financial, human, material and information), on standardizing and developing healthcare management quality and efficiency indicators, introducing the concept of best management practice to the strategic and operational levels and introducing effective tools such as business planning models, organizational efficiency models, management efficiency models and management information systems. There will be an emphasis on result-oriented management meaning that results will be an essential element for assessing healthcare managers. The Ministry of Health will apply a range of management performance indicators such as economy indicators (cost/investment ratio), efficiency (investment/results ratio) and effectiveness in achieving set objectives, quality of services, human resource management and rationalizing processes.
As the predominant current organizational form for public healthcare institutes is an extremely linear structure based on a strict hierarchy, the reform has to bring in organizational forms based on more efficient organization and employee participation — primarily by means of incentives for senior management. The management board will have to assume more responsibility for implementing the basic tasks of healthcare providers, attaining objectives set by the founder, the more efficient use of resources and above all achieving customer satisfaction. Middle management (heads of departments, units and processes) will have to be included in achieving an institute’s financial and other objectives. The powers and responsibilities of middle management will be determined according to the same principles as those for the most senior management ranks, as will the assessment of their results. Priority will also be given at the middle management level to employees with management qualifications.
One of the more common methods of solving the problems described above that are encountered in modern health services is to make the transition to a process-based organization. The advantage of process-based organization over traditional organizational functions is demonstrated in the transfer of full supervision and responsibility for process implementation to the management of a business process, known as a profit centre, which is responsible for business performance.
A ‘process’ in healthcare is the entire procedure of treating the patient from first entry to the system to the conclusion of treatment.
In some sectors the basic process-based organization can be supplemented by a project-based organization. The ability to efficiently implement projects using project management skills will be crucial in implementing the institutional changes envisaged by the reform. A project-based organization differs from a process-based organization in that it focuses on implementing complex, one-off tasks. Special attention will be paid to linking up different service providers and attaining clearly set objectives within limited budgets and set deadlines. Project management studies will be part of management training at every level.
Work is already underway within the reform of healthcare management on the formulation of a postgraduate education programme. Three priority areas, or healthcare management levels, have already been formulated. The first is the umbrella or state level — strategic level management. This includes: the Ministry of Health, HIIS, Institute of Public Health, the University Medical Centre Ljubljana and other large hospitals, national institutes and tertiary institutions. The next level covers managers of individual healthcare services, directors of small hospitals and clinics and health centre directors. This is a primary decision-making level and is crucial to individual institutions. Finally there is the third level — middle management — which includes section heads, owners or administrators of private health institutions or private practitioners. Alongside these three levels there is an additional parallel group, covering people involved in defining the network of public healthcare services and planning at the primary healthcare level. These are officials working in social service departments of urban and other municipalities.

13. Conclusion

The basic political, economic and social question of healthcare reform in Slovenia is at the moment and will be in future the question of the relationship between public and private sectors and their part in national healthcare, based on the definition of ‘social state’. Irrespective of these basic national questions, the organization, information, controlling systems and leadership as managerial functions in the healthcare system and process define and will define the realization of the basic functional principles of legality, transparency and effectiveness of the healthcare system on macro and micro levels. All three principles in public and private healthcare sectors governed by state healthcare policy can be realized only through the implementation of effective healthcare management and through effective use of business and managerial functions.

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