Why we need training in international health

management & leadershipDr. Janet Harris

University of Sheffield School of Health & Related Research

In 2012, Harvard University held a symposium "Twenty-first Century Health Care Management Education: Confronting Challenges for Innovation with a Modern Curriculum."

It brought together 114 global faculty from schools of medicine, health care administration, public health, and business; leaders of the US professional societies; and HBS alums active in health care investing , leadership, entrepreneurship, and policy making.

http://hbswk.hbs.edu/item/6933.html

What Health Care Managers Need to Know--and How to Teach Them

Academics generally cited a shortage of faculty who understood health care and could teach business skills; were familiar with case method teaching knew how to involve the local entrepreneurial health

care community Academics need to avoid ‘silo teaching’ and provide

a more holistic approach to linking across topics such as accounting, finance, analysis of the cost effectiveness of various health care models at different points in time, in response to changes in policy and systems

Conclusions from CEOs of the world’s most innovative health

care organisations

Academics tend to focus on organisational theory, systems, policy analysis

CEOs think in terms of innovation, leadership, management of change

Academics teach a static and theoretical understanding

CEOs need to develop lifelong learning skills that enable them to access and critically review health care trends, using a global perspective and drawing upon a range of management skills to coordinate a response

Academics or entrepreneurs?

Hospital dominance over primary care Labour market imbalances Gender stratification Lack of acknowledgement of the importance

of community health workers (who are often low status and unpaid)

Teaching competencies Teamwork Leadership Change management

Shifting to a focus on lifelong learning e.g. the skills to keep updated in a rapidly evolving environments Political Economic Social Technological/informational Legal Ethical

Another perspective on what’s missing when educating health workers

Caught between a rock and a hard place

Taught to health care workers

Needed by users of the health care market

Competencies

A global rise in chronic and long term conditions Global recession disrupting government

systems, increasing unemployment and poverty, increase in ill health, reduced access to health services

Limited human resources for health in low and middle income countries

A ‘know-do’ gap where knowledge and skills are unevenly distributed

Drivers for different approaches to learning health management

A global rise in chronic and long term conditions has triggered a shift from acute care to health promotion, prevention and self-care

Managers are expected to respond to this transition using a range of strategies for transforming acute and primary care sectors including re-training to foster better links between primary, acute

and community care re-organisation of pathways of care while building

capacity in the community sector to address self-management of long term conditions

The shift to chronic and long term conditions

Global recession has highlighted limited access to health care in many countries

The recession has also exacerbated international and within-country differences in the social gradient and inequalities in health.

As the implications of unfair access to health care become increasingly apparent, health managers are challenged to identify effective strategies for equitable access, often requiring cross-sectoral working and collaboration with other sectors.

Global recession and fragile states

Limited human resources for health

“We know the problem, but we don't do anything to solve that problem.” (Margaret Chan, statement on Launch of the final report of the Commission on Social Determinants of Health)

How can health management training solve the problem?

The “know and do gap”

A story about global continuing medical education

• How can we address the ‘know-do’ gap through the establishment of global programmes for continuing medical education?

• How can we transfer effective CME programmes to the countries that need them?

Abi Sriharan Health Partners for

PeaceAbi Sriharan, Oxford Vice-Chancellor’s Civic Award

Combining experience with postgraduate work

Abi's work, Championing Peace Through Health Initiatives, brings Palestinian, Israeli, Jordanian and Canadian medical students and health professionals together to build trust, understanding and cooperation between Arabs and Israelis in conflict regions.

The first success: universal screening for hearing deficiency in children

The ‘know-do’ gap

n Oldenburg Beer, 2013)

Over 50% of medical equipment and technology is not used in LMICs because health workers are not trained to use it. (Howitt et al, 2012)

In Pakistan four in every ten general practitioners used tranquilizers to patients with hypertension (Jafar et al., 2005).

8 in every 10 caregivers in developing countries are not competent to identify two key symptoms of childhood pneumonia and only 20% of the children identified with pneumonia received antibiotic treatment (Wardlaw, Tess, Johansson, Emily White, & Hodge, Matthew, 2006) 

The real know-do gap: from knowledge to practical application

Transferring facts about evidence based practice and how to use the latest technology is easy

Establishing programmes where this information can be modified so that it is relevant for local health systems is not

The important ingredient is partnerships

Health needs and health systems should drive curriculum development

Frenk (2011) http://siteresources.worldbank.org

Global implementation of diabetes guidelines

http://gamapserver.who.int/gho/interactive_charts/ncd/health_systems/management_ncd/atlas.html?indicator=i0

Management of post-partum haemorrhage using (some) WHO

guidelines in Uganda

http://globalhealth.unc.edu/blog/2011/08/motherhood-in-uganda-students-of-the-world/

Health workers are knowledge brokers

Teaching health workers to become knowledge brokers

Norwegian Development Agency NOMA Project

Faculty trainingCapacity building

Internationalisation of the curriculum

What do we need to be doing?

Access up to date information Critically assess quality of information Set agendas and priorities for health improvement Lead on implementing policy Evaluate implementation Diagnose problems with quality and consistency and

develop feasible local solutions Manage change and transition

Using real life scenarios and partnership teaching

Training health managers how to

"The teaching of health care administration needs to be more imbued with holistic, real-world issues and teaching approaches: more case-based teaching and efforts to help students focus on strategic insights and business models; an enhanced focus on organizational innovation and implementation; and increased field-based learning."

http://hbswk.hbs.edu/item/6933.html

Teaching real-world issues