Human Resource Management in

practice

Ass. Prof. Danguole Jankauskiene

Mykolas Romeris University

Lithuania

Structure of the presentation

Global challenges for human resources management Public health challenges Market changes Changing roles Health reform

HR Management problems National level Local level

Benchmarking example – NGO’s “Project HOPE” experience in CEEC

Social exclusion

Marginalized groups Aging of the population Percent of population over 65 years will

continue to rise

Aging population will create additional health costs. Almost 30 % of population will be > 65 years by 2025.

How to manage those related costs?Broad Age Groups, Trends and Projections

-10

0

10

20

30

40

50

60

70

80

1995 2000 2005 2010 2015 2020 2025

Pop<15 Pop 15-64 Pop>60

Health Challenges

Increase in noncommunicable diseases, injuries, and violence

In particular cardiovascular diseases, depression - are major cause of death and Disability Adjusted Life Years (DALYs)

Unfinished agenda of communicable diseases

Health challenges

0

200

400

600

800

1000

1200C

zech

Rep

ublic

Esto

nia

Hun

gary

Latv

ia

Lith

uani

a

Pola

nd

Slov

akia

Slov

enia

EU-1

5av

erag

e

SDR

per

100

,000

All Causes Circulatory System Cerebro-vascular

CEEC population health status remains poor

Changing role of the State

Fast pace of privatization Creation of market incentives Less involvement of State in delivery of

services

Number of PHC institutions during 1998-2007 in Lithuania

160

8

152177

13

164

214

16

198

283

85

198

306

108

198

322

124

198

370

172198

383

197198

398

211

187

404

203201

0

50

100

150

200

250

300

350

400

450

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Total Private State

Health expenditure in CEEC (2007)

Responsibilities of governments

Financing and allocation of resources so as to maximize the health impact

Attention to ethical issues involved in the new biotechnologies and genetics

Application of new knowledge and technologies based on scientific evidence and cost effectiveness considerations: demonstrable contribution to health gains

Responsibilities of governments

Correct inequity in access to health and health care

Access for the poor and vulnerable

Health is a basic need and a primary good that enables people to be productive and contribute to society

Decentralization

Trends to have responsibilities for implementation at local level

Central functions to emphasize more coordination between central policy direction, monitoring - as well as shared responsibility for implementation at the local level

Citizens’ empowerment

Patients‘ rights

Empowerment in patient choice and participation in decision making

This is a continuing theme in health care reform

New public management and modern public health

OIP (organization, innovation, personnel) model

Recognition, that demand for services may be controlled by health promotion measures that improve environment, lifestyles

Emphasis on intersectoral action for health (private sector, civil society, media)

Shift to Primary Health care

Recognizes the importance of integration of a variety of services at the local level

Provision of efficient services as first line of care Coordination of health promotion, environmental

activities at the local level Engagement of citizens and communities in the

needs assessment and in the planning and evaluation of services

Human resources at the heart of health care reforms Costs of health care personnel rising fast in

Europe

Spending for personnel has followed the general pattern of public spending for health

Deployment mix of human resources varies widely

- Example: the nurse to doctor ratio is 3 to 1 in the UK and Ireland, but 1 to 1 in Southern Europe

Salaries (in percent) have increased very rapidly in Lithuania

Changing roles: Nurses

Lithuania: 1.8 nurse per physician. A ratio of 2:1 is considered a minimum

and 4:1 is more satisfactory for cost effective and quality care

OECD - 3:1 on average

Changing roles: Physicians Number of physicians per

capita is 60% higher than new EU members’ average

23% of physicians have some private practice, of which 8% are mainly private

25% in primary care (France 50% )

Promotion of multidisciplinary health care teams

Key new roles of nurses and medical practitioners

Need to learn new skills, in prevention, health promotion, management of health services

Globalization

Need for global solutions Free movement of personnel and patients

Example: to control tobacco use there is a need to harmonize policies and legislation to deal with market forces

Gap from theory and practice

Fundamental changes in new public management and new public health

Restructuring of the systemStructural changesTrainingPlanning of numbersMentality

Problems in National level

Inequities Migration Planning Doctors/nurses ratio and allied health

personnel Management training

Level of poverty level in Lithuania (2006 data)

Residence place Poverty level %

Total 20

Urban 13,1

Big cities 8,6

Other cities 19,4

Rural 34

Social welfare system provides enough coverage in EU countries (by opinion of respondents in percent)

Source: EC Special Eurobarometr 2007 “European Social Reality”

7574

7268

666464

6159

5551

5049

4745

393636

3230

232222

2019

18

8

48

10

0 20 40 60 80 100

LuxemburgFrance

BelgiumFinland

DenmarkAustria

UKSpain

The Netherlands Germany

EUIreland

SloveniaMalta

SwedenCzech rep

HungaryItalyItaly

GreeceSlovakiaEstonia

RomaniaLithuania

CyprusPolandLatvia

PortugalBulgaria

Social welfare system as an example for other countries in EU (by opinion of respondents in percent) Source: EC Special Eurobarometr 2007 “European Social Reality”

7974

7370

6463

6258

5347

4032

30

2823

1513

1111

1010

88

76

52

30

0 20 40 60 80 100

FinlandDenmank

FranceBelgium

LuxemburgNetherland

Sweden Austria

UKSpain

GermanyIreland

MaltaMalta

ItalySlovenia

Czech repLithuania

CyprusHungaryEstonia

Slovakia PolandGreece

RomaniaLatvia

PortugalBulgaria

2,5 % POSTRAGUATES AND 3,8% PHYSICIANS RESOLVED

TO EMIGRATE

RIGHTS TO MOVE, RESIDE AND EXERCISE PROFESSIONS

Migration of specialistsMigration of specialists

Willingness of Lithuanian medical specialists to work abroad in percent 2005

Source: KMU survey, 2005

26

60,7

26,5

3,8 2,5 2,30

10

20

30

40

50

60

70

Willing towork abroad

Emigrated

Doctors

Resident doctors

Pharmacists

Planning of human resources “Is a neglected topic in the most countries Significant methodological weaknesses which have been discussed for decades but

not resolved. Workforce planning policies, where they exist, tend to assume that existing healthcare

delivery systems are efficient, and the forecasts made are rarely costed systematically.

In most healthcare systems, workforce planning is driven by healthcare expenditure, with resources dictating volume of provision.

Typical workforce planning systems ignore variations in practice and the possibility of changing productivity, skill mix and substitution.

Healthcare policy makers increasingly recognize the need for more integrated planning of human resources in healthcare, in particular making the management of human resources responsive to system needs and design, instead of vice versa”. (Karen Bloor, Alan Maynard. Planning human resources in health care: Towards an economic approach. An international comparative review. University of York March 2003).

In Lithuania we do have national strategic HR planning program since 2003

Comparison of effectiveness and efficiency

Indicator Lithuania

2006

EU

2006

Inequity

1. Physicians per 100 000 inhabitants 398 315 Moderate

2. Family doctors per 100 000 inhabitants 76,6 97,7 (2005) Moderate

3. Hospitals per 100 000 inhabitants 5,13

(acute 2,5)

3 Big

4. PHC institutions per 100 000inhabitants 29,37 66,22 Big

5. Hospital beds per 10 000 inhabitants 79,9 57,6 Big

6. Private beds % out of all beds 0,39 20,9 Big

7. Hospitalization rate per 100 inhabitants 23,23 18,06 (2005) Big

8. Average outpatients Visits for 1 inhabitant 6,56 6,8 (2005) Small

10. Average length of stay in the hospital/ days

10 9,17 (2005) Moderate

11. Bed occupancy rate in percent. 76 76 None

Hospital beds (2007) Despite downsizing, there

remains plenty of room for rationalization

Hospitals below 200 beds too small to provide full range of general hospital services

Distances are not an issue, patient safety is.

Hospital productivity

Too many admissions ALOS in smaller

hospitals is twice as long and is larger ones (and not all are nursing)

Efforts to develop day-surgery need to be sustained.

Hospital productivity (2007)

Bed Occupancy Average Length of Stay

Shift to Primary care in Lithuania

0500

100015002000250030003500

Family medicine Family doctor (GP) and Team of doctors (internist,

pediatrician, gynecologist, surgeon)

The Need For Balance

Effective Care

Efficient CareAppropriate

Care

Equity

STATUS QUO BIG BANG

RESTRUCTURING APPROACHES

Health care quality

Positive evaluation of inpatient care in EU countries (by opinion of respondents in percent)

Source: EC special Eurobarometr 2007 “Health and long term care in EU”

9392

9088

8785

8483

8282

8079

77

7169

6764

6362

5857

5548

4343

42

76

42

0 20 40 60 80 100

BelgiumAustria

SwedenFinland

The NertherlandsDenmark

MaltaFrance

SpainLuxemburgCzech rep

GermanyUK

SloveniaEU

CyprusEstoniaIreland

ItalySlovakiaPortugal

LithuaniaLatvia

GreeceHungaryBulgaria

PolandRomania

Positive evaluation of specialist ambulatory care in EU countries (by opinion of respondents in percent)

Source: EC special Eurobarometr 2007 “Health and long term care in EU”

938787

8685

848383

8180

7877

75

7574

7171

7068

6662

615959

5857

75

53

0 20 40 60 80 100

BelgiumFranceAustria

Czech repFinlandCyprus

The NetherlandsMalta

EstoniaLuxemburg

SlovakiaGermanyDenmark

ItalySlovenia

EUSweden

UKGreeceEstoniaIreland

LithuaniaLatvia

PortugalRomaniaBulgaria

PolandHungary

Positive evaluation of GP practice in EU countries (by opinion of respondents in percent)

Source: EC special Eurobarometr 2007 “Health and long term care in EU”

9695

9393

9291

9090

8989

8888

84

8382

8181

787777

7373

7271

6968

84

62

0 20 40 60 80 100

MaltaBelgium

FranceAustriaCyprus

DenmarkIreland

LuxembuSpain

TheGermany

UKEU

SloveniaHungary

CzechFinland

SlovakiaEstonia

ItalyLithuania

GreecePolandLatvia

RomaniaBulgariaSwedenPortugal

Institutional level

Shortage of doctors Salaries Organizational behavior and conflicts Management of health care quality Knowledge in management

MRU Study: What are the organization’s current management practices

What does the organization currently do with respect to managing people:How does it recruit?How does it select?How does it pay people?What training is provided?How does it evaluate performance?What organization structure is used to organize work?

Problems of HR in the HC institution 23 percent of respondents feel respected and

evaluated well by their manager, 20 percent feel evaluated badly

20 percent of respondents feel that their salary correlates with the qualification, 40 percent - don’t

“….Job is too demanding and stressful” in EU countries (by opinion of respondents in percent) Source: EC Special Eurobarometr 2007 “European Social Reality”

717070

6762

5554

5352

4747

4645

414141

403939

3736

3534

3332

25

43

24

0 20 40 60 80 100

LithuaniaGreece

BulgariaMalta

CyprusPortugalSweden

LatviaItaly

SlovakiaRomania

AustriaLuxemburg

PolandEU

SpainHungarySloveniaGermany

EstoniaFranceIreland

DenmarkUK

Czech repBelgiumFinland

Netherland

Modern health policy and management technologies

1. Team work and team training

2. Program supervision

3. Evaluation of individual needs

4. Socialization in the community

5. Case management

“5 star” health care specialist

Service provider Decision maker Communicator Community leader Manager

Training of health care managers

Biomedical approach should be changed into

Biopsichosocial

Knowledge and skills requirements

Project HOPE Health Care Management Training Program

Program Goals: 1) increase management skills, 2) improve the effectiveness and

efficiency of health care facilities through better management,

Program Structure four weeks of off-site training, each day comprised of the following

sequence: concept lecture, exercise, case study, project work.

Program Participants Multidisciplinary teams; Multisectoral health care

institutions.

Program lecturers International academic

staff Local academic staff Local case studies

Program Curriculum

Module I: Health policy, Role of Management, Strategy and Implementation.

Module II: Operations Management/Quality Improvement Module III: Human Resources Module IV: Finance/Budgeting

4 ECTS credits - 120 hours ,

360 participants in Lithuania

Evaluation of good practice A comprehensive management training initiative in Lithuania,

together with international partners such as Project HOPE’s Executive Health Care Management Program, offers a highly leveraged evidence-based strategy to improve patient care from a total quality perspective.

The opinion of participants is favorable towards the program. Projects selected by participants have the potential to improve the organizational systems in which care is delivered, setting the stage for a broad base of improvement in clinical processes.

The partnering strategy used to administer the program and the networking that occurs from bringing together managers from diverse organizations promotes the emergence of new ideas and opportunities for sharing and leveraging existing resources.

SUSTAINABILITY

4 MASTER STUDY PROGRAMS IN THE COUNTRY with 80 creditsHealth policy and managementHealth lawHealth economisManagement of health care institutions

In Summary . . . .

Human resources is a key issue in transitional EU countries facing a lot of global and national challenges

Human resources practices are often inconsistent with its strategies.

In Summary . . . .

Global actions for HR migration focusing on legal requirements should be taken

Exchange of information and benchmarking of good examples and problems should be more active

In summary. . . .

Health care system recognize the need to plan health human resources better EU

Joint projects from EU funds on human resources training, information exchange and new strategies should be initiated

“The problem is the system and the system belongs to

MANAGEMENT”

Edward Deming