Professionalizing Healthcare Management: A Descriptive Case Study

Document Type: Hypothesis

Authors

1 Yale School of Public Health, Yale University, New Haven, CT, USA

2 Yale Global Health Leadership Institute, Yale University, New Haven, CT, USA

Abstract

Despite international recognition of the importance of healthcare management in the development of high-performing systems, the path by which countries may develop and sustain a professional healthcare management workforce has not been articulated. Accordingly, we sought to identify a set of common themes in the establishment of a professional workforce of healthcare managers in low- and middle-income country (LMIC) settings using a descriptive case study approach. We draw on a historical analysis of the development of this profession in the United States and Ethiopia to identify five common themes in the professionalization of healthcare management: (1) a country context in which healthcare management is demanded; (2) a national framework that elevates a professional management role; (3) standards for healthcare management, and a monitoring function to promote adherence to standards; (4) a graduatelevel educational path to ensure a pipeline of well-prepared healthcare managers; and (5) professional associations to sustain and advance the field. These five components can to inform the creation of a long-term national strategy for the development of a professional cadre of heathcare managers in LMIC settings.

Keywords

Main Subjects


"Watch the Video Summary"

 

  1. Bradley EH, Taylor LA, Cuellar CJ. Management matters: a leverage point for health systems strengthening in global health. Int J Health Policy Manag. 2015;4(7):411-415. doi:10.15171/ijhpm.2015.101
  2. World Health ORganization. The WHO Health Systems Framework.  http://www.wpro.who.int/health_services/health_systems_framework/en/.  Accessed March 24, 2015.
  3. World Health Organization. The World Health Report 2000 - Health systems: improving performance. http://www.who.int/whr/2000/en/.  Accessed March 24, 2015. Published 2000.
  4. Fetene N, Linnander E, Fekadu B, et al. The Ethiopian health extension program and variation in health systems performance: what matters? PLoS One. 2016;11(5):e0156438. doi:10.1371/journal.pone.0156438
  5. Bradley EH, Byam P, Alpern R, et al. A Systems Approach to Improving Rural Care in Ethiopia. PLoS One. 2012;7(4):e35042. doi:10.1371/journal.pone.0035042
  6. Conn CP, Jenkins P, Touray SO. Strengthening health management: experience of district teams in The Gambia. Health Policy Plan. 1996;11(1):64-71. doi:10.1093/heapol/11.1.64
  7. Kebede S, Mantopoulos J, Ramanadhan S, et al. Educating leaders in hospital management: A pre-post study in Ethiopian hospitals. Glob Public Health. 2012;7(2):164-174. doi:10.1080/17441692.2010.542171
  8. Kwamie A, Dijk Hv, Agyepong I. Advancing the application of systems thinking in health: realist evaluation of the Leadership Development Programme for district manager decision-making in Ghana. Health Res Policy Syst. 2014;12:29. doi:10.1186/1478-4505-12-29
  9. Mutale W, Stringer J, Chintu N, et al. Application of balanced scorecard in the evaluation of a complex health system intervention: 12 months post intervention findings from the BHOMA intervention: a cluster randomised trial in Zambia. PLoS One. 2014;9(4):e93977. doi:10.1371/journal.pone.0093977
  10. Sucaldito NL, Tayag EA, Roces MC, Malison MD, Robie BD, Howze EH. The Philippines Field Management Training Program (FMTP): strengthening management capacity in a decentralized public health system. Int J Public Health. 2014;59(6):897-903. doi:10.1007/s00038-014-0603-5
  11. Umble KE, Brooks J, Lowman A, et al. Management training in Vietnam's National Tuberculosis Program: an impact evaluation. Int J Tuberc Lung Dis. 2009;13(2):238-246.
  12. Egger D, Travis P, Dovlo D, Hawken L. Strengthening management in low-income countries. Making health systems work. Working paper No. 1. Geneva: World Health Organization; 2005. http://www.who.int/management/general/overall/Strengthening%20Management%20in%20Low-Income%20Countries.pdf.  Accessed November 15, 2016.
  13. Banaszak-Holl J, Nembhard IME, Taylor L, Bradley EH. Leadership and Management: A Framework for Action. Shortell and Kaluzny's Healthcare Management: Organization Design and Behavior. Cengage Learning; 2011.
  14. Buchbinder SB, Shanks NH. Introduction To Health Care Management. 2nd ed. Burlington, MA: Jones & Bartlett Learning; 2012.
  15. Dwyer J, Paskavitz M, Vriesendorp S, Johnson S. Occasional Paper No. 4. An urgent call to professionalize leadership and management in health care worldwide. https://www.k4health.org/sites/default/files/An-Urgent-Call-to-Professionalize-Leadership-and-Management-in-Health-Care-Worldwide.pdf.  Accessed November 15, 2016. Published 2006.
  16. Starr P. The Social Transformation of American Medicine. New York: Basic Books; 1982.
  17. Willis-Shattuck M, Bidwell P, Thomas S, Wyness L, Blaauw D, Ditlopo P. Motivation and retention of health workers in developing countries: a systematic review. BMC Health Serv Res. 2008;8:247. doi:10.1186/1472-6963-8-247
  18. Franco LM, Bennett S, Kanfer R. Health sector reform and public sector health worker motivation: a conceptual framework. Soc Sci Med. 2002;54(8):1255-1266.
  19. Schwarcz SK, Rutherford GW, Horvath H. Training for better management: avante Zambezia, PEPFAR and improving the quality of administrative services: Comment on "Implementation of a health management mentoring program: year-1 evaluation of its impact on health system strengthening in Zambezia province, Mozambique." Int J Health Policy Manag. 2015;4(11):773-775. doi:10.15171/ijhpm.2015.136
  20. Edwards LJ, Moises A, Nzaramba M, et al. Implementation of a health management mentoring program: year-1 evaluation of its impact on health system strengthening in Zambezia Province, Mozambique. Int J Health Policy Manag. 2015;4(6):353-361. doi:10.15171/ijhpm.2015.58
  21. Matovu JK, Wanyenze RK, Mawemuko S, Okui O, Bazeyo W, Serwadda D. Strengthening health workforce capacity through work-based training. BMC Int Health Hum Rights. 2013;13:8. doi:10.1186/1472-698X-13-8
  22. Special Issue: Improving Rwandan hospital management capacity. On the Horizon. 2016;24 (Issue 4).
  23. Aryankhesal A. Strategic Faults in Implementation of Hospital Accreditation Programs in Developing Countries: Reflections on the Iranian Experience. Int J Health Policy Manag. 2016;5(9):515-517. doi:10.15171/ijhpm.2016.70
  24. Kassebaum NJ, Bertozzi-Villa A, Coggeshall MS, et al. Global, regional, and national levels and causes of maternal mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384(9947):980-1004. doi:10.1016/S0140-6736(14)60696-6
  25. Wang H, Liddell CA, Coates MM, et al. Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384(9947):957-979. doi:10.1016/S0140-6736(14)60497-9
  26. Hartwig K, Pashman J, Cherlin E, et al. Hospital management in the context of health sector reform: a planning model in Ethiopia. Int J Health Plann Manage. 2008;23(3):203-218. doi:10.1002/hpm.915
  27. Dogan M, Pelassy D. How to Compare Nations : Strategies in Comparative Politics. 2nd ed. Chatham, UK: Chatham House; 1990.
  28. Stake RE. The Art of Case Study Research. Thousand Oaks: Sage Publications; 1995.
  29. Flyvbjerg B. Five misunderstandings about case-study research. Qual Inq. 2006;12(2):219-245. doi:10.1177/1077800405284363
  30. Bradley E, Hartwig KA, Rowe LA, et al. Hospital quality improvement in Ethiopia: a partnership-mentoring model. Int J Qual Health Care. 2008;20(6):392-399. doi:10.1093/intqhc/mzn042
  31. Linnander E, McNatt Z, Sipsma H, et al. Use of a national collaborative to improve hospital quality in a low-income setting. Int Health. 2016;8(2):148-153. doi:10.1093/inthealth/ihv074
  32. McNatt Z, Thompson JW, Mengistu A, et al. Implementation of hospital governing boards: views from the field. BMC Health Serv Res. 2014;14:178. doi:10.1186/1472-6963-14-178
  33. Rosner D. A brief history of healthcare management. In: Haddock CC, McLean RA, Chapman RC, eds. Careers in Healthcare Management: How to Find Your Path and Follow It. Chicago: Health Administration Press; 2002:1-7.
  34. Rosner D. Doing well or doing good: the ambivalent focus of hospital administration. In: Long D, Golden J, eds. The American General Hospital: Communities and Social Contexts. Ithica, New York: Cornell University Press; 1989:157-169.
  35. Chart of US Population, 1790-2000. http://www.census-charts.com/Population/pop-us-1790-2000.html.   Accessed March 10, 2017.
  36. MacEachern MT. Some economic problems affecting hospitals today and suggestions for their solution. Bulletin of the American Hospital Association. 1932;6(7):58-67.
  37. El-Saharty S, Kebede S, Dubusho PO, Siadat B. Ethiopia: Improving health service delivery. http://siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Resources/281627-1095698140167/EthiopiaHealthSystemDelivery.pdf.   Accessed March 13, 2017. Published 2009.
  38. Federal Ministry of Health (FMOH). Health Sector Development Programme IV, 2010/11 - 2014/15. Addis Ababa, Ethiopia; 2011.
  39. Kebede S, Abebe Y, Wolde M, Bekele B, Mantopoulos J, Bradley EH. Educating leaders in hospital management: a new model in Sub-Saharan Africa. Int J Qual Health Care. 2010;22(1):39-43. doi:10.1093/intqhc/mzp051
  40. Ambelie YA, Demssie AF, Gebregziabher MG. Patients' satisfaction and associated factors among private wing patients at Bahirdar Felege Hiwot Referral Hospital, North West Ethiopia. Sci J Public Health. 2014;2(5):417-423.
  41. Zewdie BB. The role of private wing set up in public hospitals in reducing medical professionals' turnover. Journal of Studies in Management and Planning. 2015;1(11):14-23.
  42. Dhaba S, Abdulahi S, Waqijira A, et al. Innovation and performance improvement: sharing experiences from four hospitals in Oromia region. Quarterly Health Bulletin. 2010;3(2):40-53.
  43. Ageze L, Abt Associates Inc. Revenue retention for quality in health care in Ethiopia. Global Health Council, 35th Annual International Conference; May 27-31, 2008; Washington, DC.
  44. Sarto F, Veronesi G. Clinical leadership and hospital performance: assessing the evidence base. BMC Health Serv Res. 2016;16 Suppl 2:169. doi:10.1186/s12913-016-1395-5
  45. Larson MS. The Rise of Professionalism: A Sociological Analysis. Berkeley, CA: University of California Press; 1978.
  46. The Joint Commission. The Joint Commission: over a century of quality and safety. https://www.jointcommission.org/assets/1/6/TJC_history_timeline_through_2015.pdf.   Accessed November 15, 2016. Published 2015.
  47. Brauer CM, Joint commission on Accreditation of Healthcare Organizations. Champions of quality in health care: a history of the joint commission on accreditation of healthcare organizations. Lyme, Conn: Greenwich Publishing Group; 2001.
  48. Smits HL, Leatherman S, Berwick DM. Quality improvement in the developing world. Int J Qual Health Care. 2002;14(6):439-440. doi:10.1093/intqhc/14.6.439
  49. Borem P, Valle EA, De Castro MSM, et al. Pay for performance in Brazil: UNIMED-Belo Horizonte Physician Cooperative. Health Systems 20/20 project. https://www.hfgproject.org/pay-performance-brazil-unimed-belo-horizonte-physician-cooperation/.  Accessed November 15, 2016. Published 2010.
  50. Bashir H, Kasmi S, Eichler R, Beith A, Brown E. Pay for performance: imprroving maternal health services in Pakistan. Health Systems  20/20 project. https://www.hfgproject.org/wp-content/uploads/2015/02/Pay-for-Performance-Improving-Maternal-Health-Services-in-Pakistan.pdf.  Accessed November 15. 2016.
  51. Dimovska D, Sealy S, Bergkvist S, Pernefeldt H. Innovative pro-poor healthcare financing and delivery models. Washington, DC: Results for the Development Institute; 2009.
  52. Gonzalez G, Eichler R, Beith A. Pay for performance for women's health teams and pregnant women in the Philippines. Health Systems 20/20. https://www.scribd.com/document/42589748/P4P-Women-s-Health-Team-and-Pregnant-Women-in-the-Philippines.  Accessed November 15, 2016. Published 2010.
  53. Kilonzo M, Senauer K, Switlick-Prose K, Eischler R. Paying for performance: The Reproductive Output Based Aid Program in Kenya. Healthy Systems 20/20 Project. http://www.gpoba.org/sites/gpoba/files/Kenya_MSK_Brief_Format_7.9.10.pdf.  Accessed November 15, 2016. Published 2010.
  54. Warren C, Abuya T, Obare F, et al. Evaluation of the impact of the voucher and accreditation approach on improving reproductive health behaviors and status in Kenya. BMC Public Health. 2011;11:177. doi:10.1186/1471-2458-11-177
  55. McNatt Z, Linnander E, Endeshaw A, Tatek D, Conteh D, Bradley EH. A national system for monitoring the performance of hospitals in Ethiopia. Bull World Health Organ. 2015;93(10):719-726. doi:10.2471/BLT.14.151399
  56. Cleveland EC, Dahn BT, Lincoln TM, Safer M, Podesta M, Bradley E. Introducing health facility accreditation in Liberia. Glob Public Health. 2011;6(3):271-282. doi:10.1080/17441692.2010.489052
  57. Rowe LA, Brillant SB, Cleveland E, et al. Building capacity in health facility management: guiding principles for skills transfer in Liberia. Hum Resour Health. 2010;8:5. doi:10.1186/1478-4491-8-5
  58. Stevens R. In sickness and in wealth: American hospitals in the twentieth century. Baltimore: The Johns Hopkins University Press; 1999.
  59. Commisson on Accreditation of Healthcare Management Education. CAHME Update. AUPHA Annual Meeting June, 2016; Kansas Citi, MO.
  60. Ijsselmuiden CB, Nchinda TC, Duale S, Tumwesigye NM, Serwadda D. Mapping Africa's advanced public health education capacity: the AfriHealth project. Bull World Health Organ. 2007;85(12):914-922.
  61. Finley FR, Ivanitskaya LV, Kennedy MH. Mentoring junior healthcare administrators: a description of mentoring practices in 127 U.S. hospitals. J Healthc Manag. 2007;52(4):260-269.
  62. Rabbani F, Shipton L, White F, et al. Schools of public health in low and middle-income countries: an imperative investment for improving the health of populations? BMC Public Health. 2016;16:941. doi:10.1186/s12889-016-3616-6
  63. Freund PES, McGuire MB. Health, Illness, and the Social Body: A Critical Sociology. 2nd ed. Englewood Cliffs, NJ: Prentice Hall; 1995.
  64. Johnson TJ. Professions and Power. London: Macmillan; 1972.
  65. Pool J. Hospital management: integrating the dual hierarchy? Int J Health Plann Manage. 1991;6(3):193-207.
  66. Perks RW. Accounting and Society. London: Chapman & Hall; 1993.
  67. Freidson E. Profession of Medicine; A Study of the Sociology of Applied Knowledge. New York: Dodd, Mead; 1970.
  68. Freidson E. Professionalism Reborn: Theory, Prophecy, and Policy. Chicago: University of Chicago Press; 1994.
  69. Ayeleke RO, North N, Wallis KA, Liang Z, Dunham A. Outcomes and impact of training and development in health management and leadership in relation to competence in role: a mixed-methods systematic review protocol. Int J Health Plann Manage. 2016;5(12):715-720.