Health care institution is very active and complex.  All activities and business goals can be focused on the patients /clients, and/or at the same time to the business results or capacity.

Making the decision to go in the process of changes is always very brave, it needs a mastering a lot of challenges and barriers. In this process have to use a leadership approach. Authors Srića and Kaufman suggest using catalysator management, which can influence the team members, support each team member and through the coaching process help each to utilize the maximum of own value. Using catalysator management each leader by the own example leads to the best practice. Catalysator management is the most damaging kind of leading and including cognitive, technical and interpersonal skills and knowledge. (Srića & Kaufman, 2019)

Management needs and perspective in healthcare

Elementary needments healthcare institution is to achieving goals and results in financial efficacy and goals for quality control. For realization efficacy, it needs to achieve effectiveness. Wisdom and strategy planning are the only correct way and perspective process management processes in medicine. (Svetic Cisic, 2019)

Definition and finding aims for achievement efficacy and efficient results

The orientation of the efficacy is on the time and process of conduction, measure and definition time which is planned for activities. To do activities in a very short time has to try, with minimum budget, persons and equipment.

Efficacy has to focus on achievement planned aims, without measuring efficacy, only focused on time and money. (Goleš, 2018)

Internal and external activities

Managements activities in health care system is differentiated regarding to intern and extern shape. (Holder, 2019)

Internal activities

• Planning and definition aims with very clear efficient and efficacy results
• Coaching each team member in professional development, yearly peer review performance, measure index fluctuation, strategy plan to achievement aims and tactics to hiring the best professionals (Svetic Cisic R., 2016)
• In the modern health care institution, the organizing principle is a matrix, less pyramid hierarchy
• Implementation quality assurance with definition aims qualities through medicine’s relevant aims
• Leadership approach, with using motivation, development, emotional intelligence and excellent communication skills
• Making effective and efficient decisions (Goldsmith, 2012)

• External activities

• Supporting and focusing on demographic needs
• Following legislative and guidelines
• Implementing accreditation’s activities
• Collaborating with insurance companies
• Representing the institution in the best way and lobbing (Goldsmith, 2012)

Management position in healthcare institution

High management commitment and leadership skills in a healthcare organization are important. Sharing the same values through high, middle and low-level management.

All managers from each level are important and have an own rule in all processes od decision making, achievement business aims and implementation of quality assurance and using resources. Sharing information and open two ways communication is the basis for final success, efficacy, and prosperity.

Efficacy in a healthcare institution

Basic activity is to define the business process and to definition intervention, responsible person, documentation, medical equipment and time. (Infographic1) Using Paretto’s law and definition 80% of intervention can be helpful for harmony and efficacy through the business process. The rule is that only 20% of activities can be improvised and can be adapt according to the current situation. (Infographic1) Investing 20% of your time in strategic planning will yield 80% of results and lead to success. In such an organized system, employee satisfaction and thus customer satisfaction are achieved.

Successful set goals

Establishing quality management requires defining goals, monitoring, and an annual report. It is necessary to define and implement goals in the field of medicine and monitor their success. Each field of medicine has specific indicators that should be defined at the level of senior and middle management, with the support of high management.

In nursing, one of the disciplines of management in the healthcare system, some of the quality indicators such as are:

• Monitoring high risk for fall and correlation with fall incidents
• Monitoring of decubitus occurring at the institution or occurring during previous hospitalizations
• Continuous education and active or passive participation
• Hand hygiene and monitoring 200 moments hand hygiene according to WHO recommendation (WHO, 2009)
• Monitoring patient’s/client’s satisfaction with nurses, physicians or other multidisciplinary team members
• Monitoring patient’s pain and definition of acceptable postoperative physiology pain

Planning strategy

Competitive atmosphere in healthcare service requires a high level of motivation, development of management skills, continue education and continue extensive knowledge. This is basic for managers in low, middle or high management. Developed leadership skills, along with catalytic management implementation processes, a positive example of own practice can influence associates, team members and encourage them to be engaged, proactive, create a positive atmosphere of acceptance and support. Only in such conditions is growth and development possible. A carefully crafted strategy carefully planned with the use of SWOT analysis is a roadmap to be pursued in order to achieve efficiency and effectiveness. (Svetic Cisic, 2019)

Managers competences

Each successfully leading and implementation management principle is depending on the management/leadership skills of the director. Competences are defined by Lotich and are including skills, knowledge, qualification, and abilities to lead. (Lotich, 2015)

Twelve keys leadership competences

1. Supervision – professional feedback and supervision employees, using management instruments (for example peer review –
2. Conflict resolution – establishing an organizational supporting culture which doesn’t tolerate any kind of violence or conflict
3. Emotional intelligence- understanding and control emotion, other and own emotions, implementation ei and influence ei on the final success
4. Communication skills in verbal and written communication. They require a structured communication process and defined modes of communication. Thinking about activities and channels of communication with employees, team members, and answering questions: when, how often, and by what means to communicate.
5. Effective management – clear and open expectations from employees, job description, feedback about work efficacy, mentoring and supporting and public praise.
6. Interviewing skills with prospective new hires – introducing yourself to a CV, structured questions, and conducting a documented assessment during the interview.
7. Team building – using basic skills to work in a team.
8. Delegation – the ability to delegate jobs and show confidence in team members.
9. Consulting services – the use of the services of professionals from other industries for growth and advancement and for the achievement of strategic goals.
10. Coaching – Assisting associates to develop and utilize their best potential and thus achieve their own professional goals and contribute to the institution in achieving its goals.
11. Problem Solving – Challenges and problems are part of everyday life and the ability to find optimal successful ways to overcome and effective solutions.
12. Motivation – Every leader should know how to motivate and inspire employees and become aware of the needs of these activities. As there is no unique formula for all, it is successful and worthwhile to apply the motivation and inspiration applied to each individual. (Lotich, 2015)

Conclusion:

The complexity of health care organization, there dynamic, complex workflow process and financial specific requirement demand from management personal knowledge, skills, leadership. Work process with clear definition activities, responsible persons and documentation enable efficacy, monitoring work process in the time, achievement financial aims and quality control goals. Wisdom strategy, monitoring efficacy and efficiency leading to successful management in the healthcare system.

Keywords

Efficacy, efficiency, competence, management, leadership, strategyA good practice is really important

Literatura

Goleš, D. (03. 02 2018). bizpro.hr/efikasnost-i-ili-ucinkovitost-isto/. Dohvaćeno iz https://www.bizpro.hr: https://www.bizpro.hr/efikasnost-i-ili-ucinkovitost-isto/

Holder, H. (05 2019). Jones and Bartlett Publishers, LLC. Dohvaćeno iz Managing the hospital and social care interface – The Nuffield Trust: https://samples.jbpub.com/9780763759643/59643_CH02_5289.pdf

Srića, V., & Kaufman, I. (12. 04 2019). The World is Broken We Need to Fix It. Dohvaćeno iz https://skopemag.com: https://skopemag.com/2019/04/12/ira-kaufman-velimir-srica-presents-the-world-is-broken-we-need-to-fix-it-path-to-strategic-harmony

Svetic Cisic, R. (03. 04 2019). Mudra strategija za uvođenje promjena u zdravstvenim ustanovama – Consultecca. Dohvaćeno iz Consultecca.org: https://www.consultecca.org/mudra-strategija-za-uvodenje-promjena-u-zdravstvenim-ustanovama/

Lotich, P. (01. 07 2015). thethrivingsmallbusiness.com/manager-competencies/. Dohvaćeno iz thethrivingsmallbusiness.com: https://thethrivingsmallbusiness.com/manager-competencies/

Svetic Cisic R., F. S. (2016). Using Nursing Peer Review for Quality Improvement and Professional Development with Focus on Standards of Professional Performance. Nursing and Health, Vol. 3(5), pp. 103 – 109.

WHO. (2009). Save lives, Clean your hands. Dohvaćeno iz World Health Organization : https://apps.who.int/iris/bitstream/handle/10665/44196/9789241598606_eng.pdf?sequence=1

Goldsmith, S. B. (2012). Understanding Healthcare management. U S. B. Goldsmith, Understanding Health Care Management: A Case Study Approach 1st Edition (str. 17-31). Massachusetts: Jones & Bartlett Learning;

Objava A good practice is really important pojavila se prvi puta na Consultecca.

Socrates

Supporting clients in implementation of valuable and efficient changes in health care system.

Every day we are witnessing the increasing speed of change management, especially in medicine. However, sometimes it seems that is not the same speed of the change management in the hospital organisation vs the speed of medicine progress. The wisdom of change management is a fundamental competency for managers and supervisors, employees and leaders and include special knowledge and skills. The base of change management is strategy. Strategy can be separated to the two different parts: strategy planning and strategy managing. The both part are very close in the practice and they both really depend on each other. The questions are: what is wisdom and why needs wisdom for strategy?

Wisdom

Wisdom is combination of knowledge and also rational intellectual practice and mental process.¹ Humans are trying to make sense to the world around them with limited knowledge. (McKenna and David, 2005). In classical times, wisdom was listed among the four principal virtues: justice, moderation or self- control, courage and wisdom.  (Rowley, 2006; Rowley  and  Slack, 2008)¹ However, the focus is on the wisdom in leadership. Leadership´s wisdom have four attitudes. Wise leader must be capable in complex environments of cognitive complexity and coping with complex events.The leader must deeply and rational think, understand questions and situation. He/she should be capable for creative thinking, to discover and to use logic, make decision rely to instinct, non-rational process in judgment. Finally, the leader have to have capacity for a long-term vision, long-term prosperity for humanity. (McKenna, 2009)¹

Change Management

Change Management is the term that is used to refer to the change or transitioning people, groups, companies and projects from one status to another.  For success, it is important to have strategy plan, which includes suitable plan of action. Change management is process and takes time, needs expertise, dedication and a lot of effort in implementation. It requires the involvement professional expert, commitment management, executive staff and enthusiastic staff, which can being affected by changes too. The important thing is that organisation and people must figure out why it needs the change management approach and how will the changes benefit it.^2,3 Organisational change management are divided into three smaller stages: unfreeze, change and refreeze according to Lewin’s model. Management and organization must unfreeze current situation, be aware that change needs and make decision to go forward in new process.  The teamwork approach is necessary, because with these can be avoided some obstacle or challenges. Time to implement changes is next step. Effective change requires clear and constant communication across all affected channels and organisational level. Finally step is refreeze. After continues evaluation and modification some steps in the change process and achievement strategic goals. Teams and organizations need to move away from an old to new one organisational model or process. ^2,3

Lewin’s Change Management Model

It is very simple to understanding Kurt Lewin’s Change Management Model: Unfreeze – Change – Refreeze (Lewin, 1940). If you have a large cube of ice (figure organization model/process) it must to make amenable to change (unfreeze). The iced water you must mold to shape you want (change). The last stage is to solidify the new shape (refreeze). ^4,5  

Figure 1.Lewin’s Change Model⁵ 

Strategy

Strategy includes two part, strategic planningand strategic management. Each effective change management have to include the strategy planning process.

Strategy planning

Strategy planning includes vision and mission, goals and objectives.

For develop new strategy must have SWAT analyse of the old process. The SWAT analyse should use for new planning and new goals. To help in process strategy planning is important to have answer on the questions below:

• Where are we?
  – Situation analysing of strategic assessment including internal and external analysis
• Where should we be?
  – Possible future situation
• Where do we want to go?
  – Future vision 2 to 5 years. Consider SMART goals
• How do we get there?
  – Strategies
• How do we get there?
  – Implementation and tactics
• Are we getting there?
  – Assessment and metrics

Strategy management 

To accept the strategy management helps to plan strategy and new organisation future. There are three parts: organising, leading and controlling.

Organising 

The organising engaged by strategic management includes incorporative organisation design, organisational culture and networking, effective communication.

Organisational culture

From some recent research we can find different definition of organisational culture. Organisational culture includes an organisation’s expectations, experiences, philosophy, as well as the values that guide member behaviour, and is expressed in member self-image, inner workings, interactions with the outside world, and future expectations. ^6,7  Culture is based on shared attitudes, beliefs, customs, and written and unwritten rules that have been developed over time and are considered valid (The Business Dictionary).^6,7   Culture also includes the organization’s vision, values, norms, systems, symbols, language, assumptions, beliefs, and habits (Needle, 2004).^6,7  To summarize important of this part is to be aware of the facts that organisational culture can influence on the outcomes such as productivity, employee engagement and commitment. To care and to establish corporative culture is essence of effective change management process.^6,7 

Leading

Implementing and using leadership methods for leading change process are predict of success. To lead, to be a part of teamwork, to respect other partners in evolution process can result with positive outcome. Clearly and open communication and behaviour that encourages different opinion and innovation predict a healthy culture at the workplace. Using organizational culture to inspire and to motivate employees can be very effective in the whole process of change management. ^8,9 

Controlling

Continuous evaluation and annual SWOT analysing process is Condicio sine qua non¹⁰ for success. Evaluation and modification some actions if the results of SWOT analysis is needed  to achieve  goals. Measuring and analysing all process lead to valid results and achieving strategic goals.This is controlling and the last part of strategic management.

If you need help to identify exactly what the problem is, and to prescribe strategy to solve the problem, help in the process of strategy change management, not theoretical solution, but solution based on the experience and practical skills and knowledge, contact us.

Key words:

Wisdom, Change management, Lewin, Strategy, Strategy planning, Management Strategy , Organizational culture

Reference:

1. Aslı Küçü kaslan Ekmekçi et al. (2014) Wisdom and management: a conceptual study on wisdom management, Procedia – Social and Behavioral Sciences150:1199 – 1204

2. Lucidchart Content Team (2018), 4 Fundamental Change Management Models https://www.lucidchart.com/blog/four-fundamental-change-management-models

3. Cleverism, Anastasia (2015), Major Approaches & Models of Change Management https://www.cleverism.com/major-approaches-models-of-change-management/

4. Lewin’s Change Management Model, Understanding the Three Stages of Change https://www.mindtools.com/pages/article/newPPM_94.htm

5. Lewin’s Change Model PowerPoint Template https://slidemodel.com/templates/lewins-change-model-powerpoint-template/

6. What is Organizational Culture? Organizational Culture Definition and Characteristics, https://gothamculture.com/what-is-organizational-culture-definition/

7. Martins E.C. (2013) Building organisational culture that stimulates creativity and innovation https://www.emeraldinsight.com/doi/abs/10.1108/14601060310456337

8. Prachi Juneja, MSG Content (2019) Role of Communication and Relationship for a Healthy Organization Culture, https://www.managementstudyguide.com/setbacks-of-organization-culture.htm

9. Alex Malouf A. (2017) Why Organizational Culture (And Employee Communications) Should Matter To You https://www.entrepreneur.com/article/294820

10. Cambridge University Press https://dictionary.cambridge.org/dictionary/english/sine-qua-non

Objava The Wisdom of Change Management Strategy in Health Care Organisation pojavila se prvi puta na Consultecca.