HEALTH CARE OPERATIONS MANAGEMENT

Health Care Operations Management

Health Care Operations Management

Introduction

Developing countries are initiating various system improvement projects in health institutions based on the continuous quality improvement (CQI) and total quality assurance (TQA) programmes (Counte and Meurer, 2001). Hospitals of developing countries have significant limitation of resources. Shortage of funds, lack of priority setting on quality of service, inadequacy of training on hospital management and low public awareness on quality of hospital service are the obstacles to performance improvement of the public health sector (Ovretveit, 2002). The productivity of the hospitals is, therefore, not satisfactory and the implementation of performance improvement programmes often encounters resistance from the management and employees, including labour unions, which remain conservative in attitude to any changes to the existing system. (Wijesinha, 2003).

Sri Lanka has achieved a demographic transition from a situation of high mortality and fertility rates to a low mortality and low fertility situation (Department of Health Services, 2002). However, the total national health expenditure is maintained at a level of less than US$8 per capita per annum. This was considerably below the estimated US$13 per capita that it would cost to provide the World Bank's cost effective package of basic preventive and curative health service (Hsiao, 2000). Government health expenditure is estimated to be only 1.1-1.2 per cent of GDP from 2000 to the current year 2003 (Pacific Consultants International et al., 2003). It provides finances for 50 percent of national health expenditure (Health Development and Research Programme, 2002).

Thus, Sri Lanka's health sector is at a position where the financing of government hospitals is stagnant or declining relative to the number of patients seeking treatment. In addition, public approval for user fees only ranges from 12 to 20 per cent, depending on what the fees were to be charged for. Public disapproval of fees is greatest in the case of inpatient treatment (Rannan-Eliya, 1996).

Master plan study for strengthening health system in Sri Lanka, interim report October 2002, proposes among other things to lay down standards and criteria for hospital infrastructure and have them regularly reviewed by an expert committee and more emphasis and resources be given to health manpower development, including training and quality assurance monitoring, to meet the increasing technical and managerial demands of the public health system (Pacific Consultants International et al., 2002).

Shortage of financial resources was indicated as the most serious constraint to improve performance by 90 per cent of hospital managers in Sri Lankan government sector health service delivery system, according to a survey by Institute of Policy Study of Sri Lanka (Somanathan et al., 2000). It was also highlighted by this report that suitable systematic management training can be one effective solution, which is feasible under the given circumstances to improve the efficiency in a climate of resource constraints (Somanathan et al., 2000).

Considering the resource constraints, the Sri Lanka Government declared 1996 as the productivity year and declared 1996-2005 a productivity decade. With an objective of improving employee motivation, performance and productivity in the health sector, productivity programmes were introduced ...