dr.jabbari-ph.d. objectives : by the end of the session participants should be able to: discuss the...

Dr.Jabbari-Ph.dDr.Jabbari-Ph.d


ObjectivesObjectives: :

• By the end of the session participants should be able to:

• Discuss the nature of a hospital

• Describe the roles and responsibilities of a hospital manager

• Evaluate the sources of power and manager's work


مدیریت • فراروی های چالش و مشکالت مهمتریننمایند لیست را بیمارستان

بین • تجارب و بیمارستان سازمان تحوالت کلیات باشوند آشنا زمینه این در موجود المللی

در • بیمارستان جایگاه اصالح برای مختلف های گزینهدهند قرار بحث مورد را سالمت نظام

نمایند • بحث را مربوطه المللی بین و کشوری تجاربداخل • ساختار اصالح برای مختلف های گزینه

دهند قرار بحث مورد را بیمارستان


INTRODUCTION

TO

HOSPITAL

MANAGEMENT


What is a hospitalWhat is a hospital??

• OXFORD DICTIONARY (2001): an institution providing medical treatment and nursing care for sick or injured people.

• WHO: It represents the main concentration of health resources, professional skills and medical equipment.


What are the functions of a What are the functions of a hospitalhospital??

• Patient Care :Diagnosis and Treatment , Care and Rehabilitation

• Teaching : Patient Education , Training for medical, nursing and other disciplines ,Continuing education

• Research : Clinical , Nursing , Health Systems , Educational


What are the functions of a hospital?What are the functions of a hospital?ContiConti……

• Health system support : Referrals , Community health service , Outreach to other health units and communities , Supervision of primary care services

• Employment : Employer of health professionals , Employer of locally recruited staff , Purchaser of local goods / services


What are the functions of a hospital? ContiWhat are the functions of a hospital? Conti……

• Market place : Selling of goods, e.g. drugs to patients , Charging fees and determining exemptions , Providing space for commercial enterprises , Contracting out of services

• Societal role : Symbol of local community identity , Community asset , Provider of social care (non-medical cases) a , Medical power base


How are hospitals classifiedHow are hospitals classified??

بيمارستانها • بندي :طبقهجغرافيا : • ، برحسب شهرداري ، استاني ، ايالتي ، فدرال ، مركزي

غيره و اجتماعي ، اي ناحيهمالكيت : • نظر انتفاعي از و ,بيمارستان خيريه بيمارستانهاي

انتفاعي غير خصوصيكاري • معدن ، زرع و كشت ، ارتش جمله از صنعتي بيمارستانهايدولتي • بيمارستانهايدانشگاهي • بيمارستانهاي

فني : • غيره براساسظرفيت و كليه ، كودكان بيمارستان مثلخدمات : • سطح براساسنوع ، اول سطح ارجاعي بيمارستانهاي

سوم سطح ، دوم• ، رواني بيمارستانهاي مثل اورژانس غير ارجاعي بيمارستانهاي

توانبخشي ، نهائي بيمارستانهاي ، نظر تحت بيمارستان


What is the role of a hospital within What is the role of a hospital within other systemsother systems??

هستند . • كشورها اغلب در سالمت نظام كليدي اجزاء بيمارستانهامورد سالمت نظام پيشرونده اصالحات در بيمارستانها اينحال با

شوند . مي واقع توجهي كمسازمان • هاي دستورالعمل ، گذشته سال پنجاه طول های در

بهداشتي مراقبتهاي روي بر سالمت خدمات توسعه براي جهانياند . شده متمركز خانواده پزشكي و اوليه

از • وضوح به بايستي بيمارستانها در شده ارائه مراقبتهايكاركردهاي روي بر ، كنند حمايت اوليه بهداشتي مراقبتهاياوليه بهداشتي مراقبتهاي جايگاه در كه درماني و تشخيصي

شود . متمركز ، نيستند پذير امكان


What is the role of a hospital within other systemsWhat is the role of a hospital within other systems??

و • خريد مسئوليت اوليه بهداشتي مراقبتهاي كشورها برخي دراند . كرده دريافت نيز را دوم سطح مراقتبهاي مالي تامين

تعادل • نقطه كه است اين مانده باقي سئوالحمايت و مردم عالئق و بيمارستاني مراقبتهاي

؟ كجاست عمومي بهداشت از


What is the role of a hospital within other systemsWhat is the role of a hospital within other systems??

بيمارستانهاي • بدون اوليه بهداشتي مراقبتهايموفق تواند نمي ارجاع راسسيستم در قوي

در . مهمي بسيار نقش بيمارستانها بعالوه شوددارند . انساني نيروي آموزش

براي • سمبوليك ارزشهاي با قوي نهاد بيمارستانگذاران سياست و سالمت متخصصين ، مردم

است .بيمارستان • در اي حرفه هاي گروه غالب بعالوه

دارند زيادي عالئق آن قدرت تداوم براي


What are some of the environmental What are some of the environmental influences facing hospitalsinfluences facing hospitals??

• Political forces and donor influence

• · Separating hospitals from the national Civil Service under titles such as autonomy, corporatization

• · Increasing use of preventative and elective procedures over emergency ones.

• · Sums of money allocated to hospitals is a political rather than an economic question


• Conti…

• Health sector reforms, hospital autonomy, decentralized or devolved management,

• local integration of services more contractual relationships, public / private

• Access to clinical information via the Internet

• Changes in perceptions and an increased awareness of possibilities and rights are

• also reforming longstanding patterns of needs and demands


• Conti…• Economic pressures• · Increase in needs and demands• · Changes in length of stay• · Greater health knowledge and higher

expectations for improved quality of services• · Increase reliance on user fees and income

generation• · Fewer external donors• · Impoverished populations increasingly unable

to pay fees


• · Essential care packages

• · Growing interest in Quality Assurance

• · The concept of “hospital” is changing. Policies of decentralization and autonomy

• Demographic changes

• · Population migration

• · Epidemiological transition resulting in changes in profiles and patterns of morbidity

• and mortality, increased life expectancies


• Conti…

• Health policy develops:

• · Change in views of governments and populations on health status and medical and hospital care

• · New social policies toward medical care and hospitals

• · Financing health care and medical technology

• · Management methods for improvement through quality assurance


• Trends of hospital• · Minimally invasive surgery and day surgery concepts• · New pharmaceuticals ,may reduce the need for

hospitalization• · Shorter course treatments (DOTs – TB)• · Changes in secondary and tertiary care facilities.

Growth of accountability and quality assurance of services

• · Decentralized management and flexible employee contracts

• · Staffing – emphasis on competence rather than on credentials

• · Hospitals without walls• · Telemedicine


What is ManagementWhat is Management??• · Getting things done – maintaining momentum

and making things happen• · Finding out what is going on• · Reacting to new situations and problems• · Responding to demands and requests• · Deciding what to do and then getting it done

through the effective use of resources

• ·


• A process which exists to get results by making the best use of the human, financial, and material resources available to the organization and to individual managers

• · Ability to organize complex technology, bring together different people form different professions to deliver service as a team.


How does the work of a hospital manager differ from that How does the work of a hospital manager differ from that

of a manager of some other enterpriseof a manager of some other enterprise??

• Multiple stakeholders

• Complex process

• Organizational culture


The hospital manager's roleThe hospital manager's role

• Lack of control over much of the (technical and professional) work of the organization

• · Lack of clarity about objectives and outcome measures• · Co-ordination of articulate and independent-minded

professionals within the institution, with a primary loyalty to their profession rather than the individual hospital

• · Constant exposure to public scrutiny and comment• · Unlimited demands of users• · Balancing unreliable and insufficient resources with

unrealistic political and public expectations (for government hospitals especially)


• Constant exposure to public scrutiny and comment

• · Unlimited demands of users

• · Balancing unreliable and insufficient resources with unrealistic political and public expectations (for government hospitals especially)

• …..


The hospital manager’s sources of The hospital manager’s sources of available poweravailable power

• · Resource power - access to money, staff time, stationery, transport, senior people

• · Expert power - the one who understands finance, organizational dynamics, law

• · Personal power - influence through charisma, popularity or connections

• · Position power - by virtue of being "the boss"• · Veto power - may be available but is not

recommended


شماره گروهی شماره کار گروهی 11کار

و • بهداشتی سیستمهای برخی شکست دالیل: نمائید لیست را جهان در درمانی

برنامه • طراحی مامور شما کاری گروه چنانکهعنوان به گردد کشور بیمارستانی بخش اصالحات

این فراروی های چالش مهمترین اقدام اولیننمائید مشخص گروهی کار انجام با را بخش


سیستمهای • برخی شکست دالیل: درمانی و بهداشتی

گیر • پا و دست و سخت قوانین و مقرراتخالقیت • برابر در مقاومتساالری • پدر فرهنگپزشکان • مشارکت عدمای • حرفه مدیران وجود عدمفرماندهی • تعدد


مدیران • شغلی ثبات عدماهداف • و سیاستها وضوح عدمبیماران، • های خواهش و نیازها درک عدمکارکنان ”“““““““““““““““““““““““““““““•مستقل • ارزشیابی سازمان وجود عدمو ....•


اصالحاتاصالحات

کسب • راستای در بیمارستان جایگاه اصالحبازار با ومواجهه بیشتر استقالل

بیمارستان • داخل سازمان اصالحو ...•

dr.jabbari-ph.d. objectives : by the end of the session participants should be able to: discuss the...

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