Management of Health Care Practice - Essay Example

?Management of health care practice Introduction The practice manager’s role in a hospital in running GP practice in a multicultural diverse area like Newham, a London borough involves understanding of the responsibilities related to whole host of activities in an organization such as finance, HRD, housekeeping, front office management apart from the support services relating to GP. This needs leadership qualities, motivational abilities and team management capabilities with tact and empathy on the part of the practice manager. Development and delivering of new services, programs for orientation, training and development of staff for ensuring right mix in skills and staffing are essential. Organization of staff, logistics, supplies and services in providing efficient health care with minimum waiting time and discomfort to the patients need to be achieved by reducing inequalities under safe and clean environmental conditions for enhancing the level of patient experience. The role of practice manager has become more crucial under the major healthcare reforms come into force effective April 2013 in enhancing health and well-being of the population (GOV.UK, 2013) Operational management Operational management involves organization of the team, management of the staff and undertaking strategic activities with leadership to achieve the organizational objectives. According to Handy (1994, p. 17) “A proper understanding of the relevant concepts of organization theory has brought much comfort to individuals in tension as well as allowing them to carry out the analytical task of the manager, which is: To identify the key variables in any situation; To predict the probable outcomes of any changes in the variables; To select the ones he can and should influence.” Operational management in a hospital setup is no different from the other industries, though the nature of responsibilities of a manager varies from industry to industry. Practice Organisation Attributes that are essential in practice include leadership, ability to communicate, motivating skills, ability to use discretion and judgement, innovation and interpersonal skills. These attributes are essential at various levels of the organization in varying degrees. According to the King’s Fund (2011, p. viii) “the health service does need a national focus on leadership and management...” Training and development to the staff plays an important role in cultivating these attributes in the workforce in an organization and the practice manager needs to organize programs for this purpose. GP practice managers ensure GPs are provided with necessary support services which involve organizing of human resources that include nursing, technical and administrative staff and other facilities. Management of front office, establishing appropriate system for appointments and maintenance of records for easy retrieval when they are required later are the important administrative functions related to the job. Depending upon the single or multi surgery units and other linked practices operational in the organization, change management or introduction of new services based on the developments in the field of medical technology and efficient co-ordination with the government agencies and social service organizations are essential for sustainability in the long run. In the dynamic field of healthcare management, creating an atmosphere for collection of data, analysis and research and reporting is fundamental for growth and development of the health care system. Crisis management calls for preparedness at all times to meet the challenges that may include major accidents, epidemics and natural disasters like typhoons and floods. Handling of such situations with confidence efficiency enhances reputation of the organization. Management of Staff In management of the staff, the important factors are effective communication at all levels, establishing standards for performance, evaluation of performance on regular basis for taking corrective measures to improve the performance and skills of the employees and establishing efficient reporting system in place. Tarrant et al. (2003, p. 1) stated “human communication, individualised treatment or management and whole person care are the features of personal care.” Thorough understanding and application of QOF system that measure the services provided against specified criteria enhance the quality level in the organization. Therefore, management of staff should aim at compliance with the standards, practice protocols and guidelines. The Practice Manager needs to review the practice protocols on a regular basis to upgrade them, if necessary and remove them if they are obsolete to avoid ambiguities in adopting the procedures. Strategic Activities The responsibilities of a practice manager are multifarious which include managing the business side of the health centre, budgeting, development of business strategy and maintaining healthy and safety environment in compliance with the statutory regulations. Coordination with various agencies including family doctors is prerequisite for efficiency in management. The nature of duties of a practice manager calls for fair knowledge of accounting and experience in planning, HRM and public relations. “New clinical commissioning groups (CCGs) have been developed which place family doctors in the driving seat of delivering the NHS reforms...They are made up of member GP practices which, through their constitution, establish a governing body to oversee the way they carry out their responsibilities” (NHS Airedale, Wharfedale and Craven Clinical Commissioning, 2013). Apart from the above activities, the practice manager has to look after several other areas which include inventory control, procurement of supplies and services, quality control, maintenance of all sorts (civil, mechanical and electrical), marketing and public relations. Diversity in workplace is very important since the hospital has to cater to the needs of people from diverse cultural, social and religious backgrounds speaking a variety of languages. Mead and Roland (2009, p. 1) found “Important differences in assessments of care exist in different ethnic minority groups. Some negative evaluations may reflect communication issues.” Recruitment, training and placement of employees in various departments have to be planned and reviewed on a continuous basis. While diversity in workplace enhances the ability provide superior service to patients in a multicultural diverse area, the employees need to be trained to understand and appreciate each other’s cultural and social values for working under a harmonious atmosphere in the organization. Newham is cosmopolitan in nature and “has over 400 independent shops representing cultures from around the world... The profile of our residents is young and diverse, with around 40% of Newham’s people being under 25 years-of-age, and more than 100 languages spoken locally, from Albanian to Zhuang.” (London Borough of Newham, Annual Report, 2009-10, p. 4 &5) Therefore, diversity in work place is an important factor in practice. Patient welfare, health and safety First Practice Management (2013) states “The National Patient Safety Agency (NPSA) is a Special Health Authority created to co-ordinate the efforts of all those involved in healthcare and to learn from patient incidents occurring in the NHS.” Patient welfare is the national priority and it is co-ordinated at various levels. “The Patient Safety Division works closely with royal colleges, frontline staff and organisations, patient groups, strategic health authorities, other NHS bodies, academic centres and sectors beyond healthcare to promote patient safety” (National Patient Safety Agency, 2013). Feedback from the patients is very important in introducing changes for improving the quality of service. The concept of user involvement in health care is gaining ground. Fudge et al. (2007, p. 1) stated “Healthcare professionals and service users understand and practise user involvement in different ways according to individual ideologies, circumstances, and needs”. A proper system should be in place for making surveys, receiving complaints, making exit interviews to register patients’ grievances if any and record their suggestions for improvement. “The survey provides us with a picture of what works well and what needs improving” (BMA, 2013). Analysis of these inputs would be useful in strengthening the efficacy of practice and improving the culture of the organization at all levels. Interactions between practice managers and medical professionals will increase cooperation in providing healthcare. Wise (2010) stated that “junior doctors and senior managers have put together draft recommendations on how to collaborate to improve the quality of care.” Health and safety regulations “By April 2013 it is expected that NHS primary care medical services will join all dental providers, independent ambulance services, the NHS Trusts, adult social care and independent healthcare providers in being registered and regulated with the aim that everyone using healthcare services (independent or NHS) in England will have a positive experience that can be measured against a single regulatory framework” (CQCC Consultancy, 2013). Therefore, the practice manager has to integrate the activities of the organization with NHS for compliance with the requirements and for enhancing the level of efficiency in providing healthcare services. A hospital has to comply with several regulations relating to environment mainly in the area of bi-medical waste management which covers, generation, segregation and storage of bio-medical waste and its treatment, transportation and proper disposal in addition to regulations made under Health and Safety at Work and other acts and the practice manager role is very crucial in compliance of these regulations. Financial management Efficiency in utilization of resources calls for making strategic planning in respect of cost management. For example, usage of ED facilities by prioritizing the patients based on triage scales will be useful in effectively utilizing the ED facilities. This will not only improve patient flow, but also results in cost savings to the management and satisfaction of the patients. Similarly, efficiency in registration process and effectively using telephone triage will reduce waiting time of the patients in hospitals. Proper scheduling of nursing and medical professionals will improve patients’ flow in the hospitals and reduce cost on overall basis. Regular maintenance of equipment, instruments and ambulances will enhance the level of quality of service and avoid breakdown in services. Budgeting of various operations during the year is essential to identify the areas where further capital investment is necessary to avoid bottlenecks in the operations or increase the staff strength for achieving the optimum balance in the facilities in tune with the patients’ flow. This will also enable the management to compare the actual performance with the budgets for taking remedial actions to improve efficiency. “Bringing the private sector into health has led to the development of a series of vibrant social enterprise services” (Medical Protection Society, 2013).  Financial viability of the organization depends upon efficiency in administration (policy making and determination of objectives) and management (execution of plans and policies). According to Mullet (2013) GP needs to be managed in more business minded way. The overall performance is reflected in keeping the costs under control and efficient use of resources. However, non-financial factors such as quality of health care, patients experience in hospitals, reduced waiting time of the patients in hospitals are the fundamental factors involved in translating the objectives and plans into financial viability. Optimisation of the service configuration In health care delivery process, inter alia practice manager needs to focus on reducing overcrowding in ED, enhancing OR scheduling, optimizing schedules of nursing and medical professionals, improving triage process for reducing waiting time and efficiency in allocation of the ED facilities, reducing laboratory turnaround time and increasing competitiveness in providing health care services by improving cost efficiency. For example, according to Magerlein and Martin (1978, p. 426), “A vast majority of scheduling systems either ignore surgical patients, schedule a fixed number per day, or schedule patients until an OR time constraint is reached.” Optimization in health care services involves contribution at various levels. For example, Swinglehurst et al. (2011, p. 8) stated “reception and administrative staff make important “hidden” contributions to repeat prescribing in general practice.” Developments taking place in IT should be integrated into the system for improving the service level. Greenhalgh et al. (2010, p. 9) stated, “It is significant that many general practice record systems in the United Kingdom already include functionality for secure email communication with patients...” Premises management The hospitals have to primarily focus their attention on cleanliness, hygiene and healthy environment at all levels. Safety should be ensured for free movement of men, equipment and material. Accessibility to the hospital from outside as well as good lighting and free flow of air within the hospital with good system for sanitation, ventilation and waste disposal are important. The premises should be maintained to ensure safety and security of the disabled people by providing necessary facilities to them. Emergency systems should be in place and maintained properly. Performance measurement It could be observed from the model performance appraisal form given in Annexure-I that systematic performance can reveal the satisfaction level of the employees, strengths and weaknesses of the organization, the areas where an employee needs training, steps to be taken for improving the performance and the view of the appraiser for taking corrective measures wherever required. Budgeting is another important tool in evaluation of performances by various departments of the organization. In this process, actual performance is measured against the budgeted performance that reveals pitfalls in performance. The management can either take measures to improve efficiency or revise the budgets to be realistic for measuring future performance. Conclusion The importance of practice manager has phenomenally increased over the recent years due to sevaral factors. Though the need for increasing financial viability of the organizations and improving quality of health care services are the important factors under competitive environment, the other factors include expectations of the patients that increased due to awareness among the patients about their needs and rights in the backdrop of convergence of technology and statutory requirements with regard to provision of healthcare and environmental regulations. According to Medical Group Management Association (MGMA) data indicate "a potential trend of the need for exemplary practice management in practices of all sizes" (Beaulieu, 2012). The industry needs superior talent for effective management. Talented people with diverse experience in general management in other sectors will also get attracted to this industry to fulfil the needs of the hospital industry. References Beaulieu, D., 2012. Practice Managers start to see modest raises. 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[online] Available at: [Accessed 24 April 2013]. London Borough of Newham, 2010. Annual Report, 2009-10. [online] Available at: < http://www.newham.gov.uk/NR/rdonlyres/C71C3ED7-7809-4573-859C-B1DAA6DA578A/0/LBNAnnualReport200910.pdf> [Accessed 28 April 2013]. NHS Airedale, Wharfedale and Craven Clinical Commissioning, 2013. Major health service reforms come into effect in April 2013. [online] Available at: [Accessed 22 April 2013]. Royal College of General Practitioners, 2013. Sample Performance Appraisal Form. [online] Available at: [Accessed 23 April 2013]. Swinglehurst, D., Greenhalgh, T., Russel, J. and Myall, M., 2011. Receptionist input to quality and safety in repeat prescribing in UK general practice: ethnographic case study. BMJ 2011; 343:d6788, pp.1-11. Tarrant, C., Windridge, K., Boulton, M., Baker, R. and Freeman, G., 2003. Qualitative study of the meaning of personal care in general practice. BMJ Volume 326 14 June 2003, pp. 1-8. The King’s Fund, 2011. The Future of Leadership and Management in the NHS. [online] Available at: [Accessed 23 April 2013]. Wise, J., 2010. Junior doctors and senior managers make plans to collaborate to improve care.  BMJ 2010; 341: c6485. Read More