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Management Techniques in Healthcare - 3

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Management Techniques in Health Care Can Be Classified as Given Below

(Qualitative) Those based on organizational behavior (behavioral sciences)
1. Organizational design
2. Personnel management
3. Communication
4. Information systems
5. Management by objectives
(Quantitative) Health Economics based
1. Cost benefit analysis
2. Cost effective analysis
3. Cost accounting
4. Input – output analysis
(Quantitative) Those based on budgeting and operational research
1. Model
2. System analysis
3. Network analysis- PERT and CPM
4. Planning programming budgeting system
5. Work sampling
6. Decision taking

Following techniques have been included in part 3 (this part)
1. Model
2. Systems Analysis
3. Network Analysis
5. Work Sampling
6. Decision Making

• A mathematical model of the program or activity is constructed by studying the effects of different inputs on the outcome.
• The model shows the relationship among various inputs and the output which may be the
– number of lives saved,
– number of vaccinations given,
– number of patients cured,
– Number of health personnel trained etc.
• This model or equation is constructed using the long term historical data showing the impact of various risk factors and interventions
• These observations are used to construct the mathematical equation
• If we don’t have the above observations already, we cannot construct the model
• These are extensive equations, built into a software
• These software can be installed in the computer and the effect of altering one or more of the inputs like
– increasing the number of trainers to double the present
– Adding 500 sites for cancer screening across the state etc.
– The software will predict the increase in the number of lives saved from Ca Cervix for each of the above.

Systems Analysis
• The technique is used mainly for increasing the cost - effectiveness of a
– program,
– healthcare institution or
– any system (e.g. the entire healthcare of the State)
• The basis of the technique is that any system is made up of a number of sub-systems
• If each sub-system is analyzed using a number of strategies and
• The most cost-effective strategy is adopted for each sub-system, then
• The whole system automatically becomes optimally cost-effective

Network Analysis
• Is useful in a new Project
• Examples of Public Health Projects
– A rural health center decides to create a nutrition counselling clinic for under 5 children
– A hospital develops a program to reduce cross infection rates by Improving infection control measures in the hospital
– The health ministry is to launch a maternal and child health program

• Characteristics of a new Project
– Unique purpose
– Temporary (once completed and running regularly, it becomes a clinic, program etc.)
– Requires resources
– Involves uncertainty
• A project requires a large no. of interrelated activities for
• The orderly accomplishment of a large number of tasks of diverse nature becomes necessary.
• ‘Network Analysis’ refers to
– breaking down a complex project into its component parts (activities, events, durations etc.) and
– Plotting them to show their interdependencies and inter-relationships
– The lines connecting the events are called ‘paths’
• The basic principle is to show diagrammatically, the logical sequence in which different events between the start and the end of a project need to take place
• ‘Network model’ consists of a set of points (shown as circles or squares) which are joined by lines
– The points represent the accomplishment of a task and
– The connecting lines represent the activities necessary for this achievement
– Any delay across the network can then be detected or anticipated
– and corrective action can be planned

Two variations of Network Analysis are mostly used in healthcare
1. Program Evaluation and Review Technique (PERT)
• Used mainly for new projects mostly without precedence.
• Without previous experience, the likely time needed for each activity needs to be estimated
2. Critical Path Method (CPM)
• Used mainly in projects which have been repeated enough, at different places, hence the likely time required for each activity is already known from previous experience
• Purpose is to identify the longest path and apply methods to shorten this path to finish the project at the earliest possible

Project Management and Review Technique
– Useful mainly for new projects which have no precedence
• Allows
– an estimation of the time and resources needed to complete the project
– Prediction of likely delays and hurdles
– These delays can be addressed beforehand by taking appropriate administrative actions in anticipation
• PERT is a scheduling tool, and does not help in finding the best or the shortest way to complete a project
• An example has already been discussed as the project to eradicate disease x

Critical Path Method (CPM)
• CPM diagrams
– (1) all activities,
– (2) time required for their completion,
– (3) and how each activity is related to the previous and next activity
– The probable time needed for completion of each activity is already known
• A sequence of activities is called a 'path,' and the longest-path in the diagram is the critical path.
• The critical path determines the total time required for the project
• It is 'critical' because all activities on it must be completed in the designated time, otherwise the whole project will be delayed.
• If activities outside the critical path speed up or slow down (within limits), the total project time does not change
• If the ‘critical path’ is shortened, the efficiency of the total project can be improved. The resources and personnel needed for this can be withdrawn from non-critical paths and used in the critical path.

Differences between PERT and CPM
Useful mainly for new projects which have no precedence Useful for projects which have precedence
PERT is a scheduling tool, and does not help in finding the best or the shortest way to complete a project CPM helps in finding the shortest way to complete the project
Time required for each activity can be an estimation only Time required for each step is almost precisely known from previous experience
Main objective is to complete the project in a time bound manner Main objective is to complete the project in the shortest possible time

Similarities between PERT and CPM
1. Both are used for accomplishing new projects
2. Both consists of graphic representation of the events (as squares or circles) and activities (as lines or arrows)
• In other words, both are types of ‘Network Analysis’
3. Both help in optimal utilization of time and resources

Planning - Programming Budgeting System
For achieving a goal:
• First planning is done, followed by
• Programming and implementation i.e. the plan which was made and approved on paper is now being run.
The budget for all steps of implementation is specified for one year only in the plan.
Once the program is running, the budget for each step and component is reassessed each year
Further allocation of the budget would depend upon the performance and utility of each component of the program.
So, Planning Programming Budgeting for subsequent years

‘Zero Budget Approach’
• Zero Budget Approach’ is a type of PPBS.
• The budget for each component is zero at the beginning of each year unless the amount is justified by the workers and
• only that amount which has been satisfactorily justified, will be released
• Hence the activities under the program need to be justified on a year – to – year basis

Work Sampling
• It is a method of sampling used for estimation of the utilization of
– Equipment
– Machines
– Vehicles
– Time by the health personnel
– It involves observation of the workers for activities carried out by them during the course of work
• The observations should be many and not just a few times
– A large no. of observations are required for valid estimates
• The day and time chosen for the observations must be random
• Each observation should be for a sufficient length of time
• Finally these observations are subjected to statistical methods to obtain valid estimates of:
– Idle time of machines, equipment etc.
– Utilization of time by the health personnel for various activities
• Appropriate modifications can then be made for better utilization of the equipment and time

Decision Making
• Decision making is required when there are more than one ways for achieving the goal
• Each option is given a value and the possible consequences of each options are also given values
• Probability of each consequence is assessed and the best possible action is decided according to the final score
Preconditions for Decision Making
• The decision maker should be informed of ALL the possible options
• Probability of all the consequences after undertaking each option must have been calculated by the analyst. Decision should not be made with incomplete data
• Decisions must be made at the appropriate level (not necessarily the top level each time)
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