Nederlandse Tropen Cursus NTC & Core Course MIH Daily management and training

1. Nederlandse Tropen Cursus NTC & Core Course MIHDaily management and training Daily management of a health facility Pieter van den Hombergh IQhealthcare Working party On Q of Care Research LHV Dutch Association of GPs

2. Program Wednesday 12-5-2010 Morning 9.00 - 10.00 Introduction 10.00 - 11.00 Analysis of Kilgoris, a LIC health facility Coffee 11.00 –12.00 Practicing management skills Lunch 13.00 – 13.30 Making plans 13.30 – 14.00 ABC-drill 14.00 – 15.00 Practicing ABC 15.00 – 15.30 Evaluation & Final slides

3. Management of the organisation is quality of care patient Physician A Surgeon B Matron Nurse A Midwife B Tutor

4. Organizing your work = fun & magic

5. What is management? To enable people to perform jointly creating the required conditions Conditions: • Joint goals and values, • Training and guidelines • Structure • Leadership: Pusher, Puller, Player, Pleaser

6. The professional • Shows creative and independant thinking • Has experience, craftmanship & knowledge • Sticks to professional values and guidelines But is a hopelessly unguided missile.

7. QUALITY IMPROVEMENT Why practice management? Improvement of practice management = 80% of all possible improvement in health care

8. I Infrastructure II Team III Communication IV Finance V Quality of care/ Safety Premises, equipment Service, Accessibility Doctor’s bag, First Aid Delegation, job mix Workload, Jobstress Patiënt records, staff Network of care givers, ICT Year-report Certification, Innovation QI, protocols etc. Management Field descriptionMain categories in a health facility

9. Organisation Analysis

10. Organisation Analysis

11. Organisation analysis Urgency & Cohesion

12. Urgency Choose from your heart = The fuel for performance Elastic band Creativity Stress What I want? Reality

13. Negative if: Goal is sky high Goal is not realistic Time is short Urgency depends on someone else (boss) Negative urgency causes stress, is tiresome Positive if: Goal is tickling Goal is realistic Well planned in time Is well perceived by you, comes from your heart Positive urgency is inspiring, creative & gives energy Urgency

14. Bureaucratic Formal, values + guidelines Supervision by superiors Standardisation of tasks Authority based on social order Fit for e.g. passport Professional Autonomous, creative Supervision by colleagues Standardisation is a problem based on knowledge and skills Fit for advertisement bureau Different organisations

15. Model of Mintzberg Structure = the way the organisation has divided work in tasks and the way it coordinates these tasks.

16. Professional organisation • Professional burocracy • Too many professionals • Too little support • Difficulty in standardisation • Small top

17. Without MISSION & VISION is each question, each daily problem, each situation a confrontation with the lack of common purpose

18. Setting goals / objectives The importance of an explicit, clear and transparant GOAL

19. Importance of setting goals • Powerful management-instrument • Noses in the same direction • Clarifies the problems • Can be evaluated • Can be split in parts • Is communicable • Motivates

20. SMART Objectives Specific Measurable Achievable - Aantoonbaar Relevant Time-limited- Tijdgebonden

21. CARE What is optimal? • Tb • Smoking • AIDS • Blindness Patient demand True needs Demand optimum Supply Doctors, Hospitals, Local healers

22. Reflection Clinical effectiveness TransparancyAccountability Reward

23. From goal to strategy data year-report policy- advice SWOT-ANALYSIS GOAL STRATEGY THE ENVIRONMENT

24. Threats & opportunities analysis Demographic, political & economic developments Dispensaries Hospital Community District health authority Health facility Church Drugs supply Colleagues Training centre Referral hospital Social, technological & communication developments

25. To motivate To analyse To communicate To delegate To negotiate To direct, guide To think, make an inventory To inform To plan To use power MANAGEMENT SKILLS

26. IN THE PURSUIT OF QUALITY OF CARE every defect is a treasure

27. Ability to manage versuswillingness to manage

28. Ability to manage versuswillingness to manage

29. Long term planning versuspractical daily management

30. Long term planning versuspractical daily management

31. Long term planning versuspractical daily management

32. Managing = • Choose • Commit yourself • Be reliable, trustworthy, true to yourself consistent, not letting people down. • Know your strengths and weaknesses This how you show integrity and respect for yourself!

33. Managing = not manipulating • Think in win – win (not I win you loose) • Don’t give up on integrity • Check intentions and consult your conscience • A goal never justifies the means • Only want, what can be done

34. Good Clinical Governance = Sum of Quality Improvement & Accountibility

35. Analyse Thinking in problems MANAGEMENT SKILLS

36. Analyse Communicate Thinking in problems MANAGEMENT SKILLS openness

37. OPEN COMMUNICATION • Systematic approach in the consultation • Don’t think in solutions, avoid jumping to • Listen open, don’t judge • Try to get the whole picture first • Encourage with ‘hmm’, ‘o yes’ • Check

38. Analyse Communicate Motivate Delegate Leadership Plan MANAGEMENT SKILLS

39. Motivating people People do not get tired of working hard, but they do get tired of lack of purpose and lack of power.

40. TO MOTIVATE Motivating elements • Their own tasks with • Responsibility • Time for consultation • Consultation at an early stage • Passing on knowledge and skills • Appreciation and positive feedback

41. TO DEMOTIVATE Demotivating elements • Working place is awful or not available • Too little responsibility • Too litle time for consultation • Vague tasks & agreements • Starting late • Finishing late

42. TO DELEGATE CONDITIONS FOR PROPER DELEGATION • Motivation of the staff • Competence of the staff • Supervision • Presence of the supervisor • Space for the delegated tasks • Informed consent of the patient

43. TO DELEGATE ACCEPTANCE BY THE PATIENT Better acceptance, when • staff is licensed • staff is supervised • staff has experience • staff does other tasks as well • Staff has autonomy and professional charter

44. GIVING FEEDBACK • Start with the good things • Be factual, descriptive • Be specific • Discuss behaviour that can be changed • Offer alternatives • Be owner of the feedback • Feedback discloses your motives

45. RECEIVING FEEDBACK • Listen first, don’t reject, don’t argue, let it sink in • Ask for clarification, when necessary • Check the feedback with others • Ask for the feedback you want • Determine beforehand what you want to do with the feedback

46. Analyse Communicate Motivate Delegate Organise prepare MANAGEMENT SKILLS

47. Analyse Communicate Motivate Delegate Organise MANAGEMENT SKILLS Evaluate = Check

48. THE MANAGEMENTCIRCLE Setting goals Observe Analyse Think Ask Plan Evaluate Organize Implement Coordinate, motivate

49. PLANTREATMENT cq ADMISSION ROOM • Problems • Insufficientlight • Parentsfill the room • Admission room givesalsoaccess to treatment room • Nurses are alwayspresent doingothertasks • Concentration of staffsuckspatients; That was whereithappened. • At the end of a daypeople are more grumpy. • Treatment room toosmall in times of Malaria/meningitis • Admission room toosmallwithtoomanypurposes. • Advantages • "Relatives" were in treatment room behind the "slab", withchild • Staffkeptaneyeonseriouslyillchildrenduringadmissioon • Equipment present duringadmissionfortreatment (LP, IV, O2) • The treatment room had sufficientlight

50. PLAN Doing the right things Doing the right things right PLAN