12 - The Impact of Management Training and Education on the Performance of Health Care Providers: What Do We Know?

Summary

INTRODUCTION

What Is the Need for Management Training and Education of Doctors in Health Care?

Health care systems around the world are faced with a large array of challenges that include: a call for greater accountability, better results, improved performance, greater efficiency, and improved access to services. To meet these challenges, countries are engaged in health sector reform — which often entails fundamental and systematic changes in financing, decentralized governance and organization, and capacity building. To meet the continuing and growing pressures of increasing costs associated with disease profiles (both communicable and non-communicable), ageing populations, technology growth, and consumer and provider expectations, there is widespread emphasis on the improvement of management and leadership in health care. At all levels of the health care system, competent managers are required to address the challenges. Health care managers and doctors are, for the most part, held responsible for implementing changes, and coping with organizational crises, and expected to be accountable for performance, without receiving appropriate institutional support or recognition of their role as potential change agents.

A review of the World Health Organization online database of poverty reduction strategy papers indicates that a number of countries specifically identify management issues as a part of their strategies to improve health and health care. Bosnia and Herzegovina have established management centres offering postgraduate training on various aspects of health care management. Cambodia is in the process of strengthening the management of cost-effective interventions and improving the human resources and development system through the improvement of management skills and decentralization and rationalization of management systems. As a means of strengthening management, a number of multilateral and bilateral donors are assisting countries in their health sector reform initiatives by providing technical support for the strengthening of management. As an example, the Kazakhstan Health Technology Transfer and Institutional Reform Project, which is to be implemented until 2013, has a component targeted at improving health management capacity (World Bank 2009). A second example is the recently introduced master degree in health management, in the Republic of Serbia, which is funded by the European Union (Republic of Serbia Ministry of Health 2010). There are many other bilateral and multilaterally funded health reform programmes that include health care management as a major component/building block.