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Human Resource Management in practice

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

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Human Resource Management in practice

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  1. Human Resource Management in practice Ass. Prof. Danguole Jankauskiene Mykolas Romeris University Lithuania

  2. 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

  3. Challengies for Human resource management

  4. Social exclusion • Marginalized groups • Aging of the population • Percent of population over 65 years will continue to rise

  5. Aging population will create additional health costs. Almost 30 % of population will be > 65 years by 2025.How to manage those related costs?

  6. Health Challenges • Increase in noncommunicable diseases, injuries, and violence • In particular cardiovascular diseases, depression - are major causeof death and Disability Adjusted Life Years (DALYs) • Unfinished agenda of communicable diseases

  7. Health challenges

  8. CEEC population health status remains poor

  9. Changing role of the State • Fast pace of privatization • Creation of market incentives • Less involvement of State in delivery of services

  10. Number of PHC institutions during 1998-2007 in Lithuania

  11. Health expenditure in CEEC (2007)

  12. Responsibilities of governments • Financing and allocation of resources so as to maximize the healthimpact • Attention to ethical issues involved in the new biotechnologies andgenetics • Application of new knowledge and technologies based on scientificevidence and cost effectiveness considerations: demonstrable contribution tohealth gains

  13. 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 beproductive and contribute to society

  14. Decentralization • Trends to have responsibilities for implementation at local level • Central functions to emphasize more coordination between centralpolicy direction, monitoring - as well as shared responsibility forimplementation at the local level

  15. Citizens’ empowerment • Patients‘rights • Empowerment in patient choice and participation in decision making • This is a continuing theme in health care reform

  16. New public management and modern public health • OIP (organization, innovation, personnel) model • Recognition, that demand for services may be controlled by healthpromotion measures that improve environment, lifestyles • Emphasis on intersectoral action for health (private sector, civilsociety, media)

  17. Shift to Primary Health care • Recognizes the importance of integration of a variety of services atthe local level • Provision of efficient services as first line of care • Coordination of health promotion, environmental activities at thelocal level • Engagement of citizens and communities in the needs assessment andin the planning and evaluation of services

  18. 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 publicspending for health • Deployment mix of human resources varies widely - Example: the nurse to doctor ratio is 3 to 1 in the UK andIreland, but 1 to 1 in Southern Europe

  19. Salaries (in percent) have increased very rapidly in Lithuania

  20. 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

  21. 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% )

  22. 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

  23. 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

  24. Management problems in CEEC

  25. Gap from theory and practice • Fundamental changes in new public management and new public health • Restructuring of the system • Structural changes • Training • Planning of numbers • Mentality

  26. Problems in National level • Inequities • Migration • Planning • Doctors/nurses ratio and allied health personnel • Management training

  27. Level of poverty level in Lithuania (2006 data)

  28. Social welfare system provides enough coverage in EU countries (by opinion of respondents in percent) Source:EC Special Eurobarometr 2007 “European Social Reality”

  29. 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”

  30. Migration of specialists RIGHTS TO MOVE, RESIDE AND EXERCISE PROFESSIONS 2,5 %POSTRAGUATES AND 3,8%PHYSICIANSRESOLVED TO EMIGRATE

  31. Willingness of Lithuanian medical specialists to work abroad in percent 2005Source: KMU survey, 2005

  32. 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

  33. Comparison of effectiveness and efficiency

  34. 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.

  35. 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.

  36. Hospital productivity (2007) Bed Occupancy Average Length of Stay

  37. Shift to Primary care in Lithuania • Family medicine • Family doctor (GP) and Team of doctors (internist, pediatrician, gynecologist, surgeon)

  38. The Need For Balance Effective Care Appropriate Care Efficient Care Equity

  39. RESTRUCTURING APPROACHES STATUS QUO BIG BANG

  40. Health care quality

  41. 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”

  42. 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”

  43. 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”

  44. Institutional level • Shortage of doctors • Salaries • Organizational behavior and conflicts • Management of health care quality • Knowledge in management

  45. 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?

  46. 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

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

  48. Modern health policy and management technologies • Team work and team training • Program supervision • Evaluation of individual needs • Socialization in the community • Case management

  49. “5 star” health care specialist • Service provider • Decision maker • Communicator • Community leader • Manager

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