| Peer-Reviewed

Health Management Challenges: The Case of Hospital from Behind-os-Montes and Alto Douro and East Kent Hospitals University NHS Foundation Trust

Received: 27 May 2022     Accepted: 20 June 2022     Published: 9 January 2023
Views:       Downloads:
Abstract

It is imperative that healthcare systems, regardless of their source of funding, are sustainable, provide quality care and develop towards their customers’ expectations. This study aims at a comparative analysis between two hospital centres, one belonging to the Portuguese National Health Service and the other to the British National Health Service, in order to identify which strategies have been adopted by their hospital management to reduce health costs without prejudice to the quality of the services provided. To this end, semi-structure interviews were conducted with the financial directors of both hospitals. The questions presented focus on changes in terms of financing, the relationship between costs and quality, improving efficiency by cutting costs, strategies for reducing waste and operating vectors for improving efficiency. In the Portuguese case, his perspective focuses on the management and organisation of services from a perspective intrinsic to the organisation, characterised by restructuring and innovation, based on close and cooperative interrelations between sectors and hierarchies. In the British testimony, we verify a perspective more focused on the outside of the organisation, placing its focus on an inter-relational triangulation between population, organisations and professionals. The focus on health professionals, technology, reorganisation of services and waste stands out as being four fundamental pillars of action for an efficient cost reduction, without impairing quality, considered as areas of intervention relevant to the development of future studies. We also highlight the managers’ concern in cost reduction without prejudice to quality and in promoting services adjusted to the needs of the users.

Published in International Journal of Health Economics and Policy (Volume 8, Issue 1)
DOI 10.11648/j.hep.20230801.11
Page(s) 1-9
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2023. Published by Science Publishing Group

Keywords

Health Management, Expenditure Management, Health Sector, Quality, Efficiency

References
[1] Antunes, M. J. (2001). A Doença da Saúde – Serviço Nacional de Saúde: Ineficiência e Desperdício. Lisboa, Portugal: Quetzal Editores.
[2] Alexander, J. A., Hearld, L. R., Jiang, H. J., & Fraser, I. (2007). Increasing the relevance of research to health care managers: Hospital CEO imperatives for improving quality and lowering costs. Health Care Management Review, 32 (2), 150-159. DOI: 10.1097/01.HMR.0000267792.09686.e3.
[3] Baptista, C., Magalhães, T., Chaves, I. (2015). A Identificação de Desperdício de Medicamentos Em Ambiente Hospitalar, Gestão Hospitalar, 6, 4-11 ISSN: 0871-0767.
[4] Barros, P. P. (2013). Pela Sua Saúde. Lisboa, Portugal: Fundação Francisco Manuel dos Santos. ISBN 9789898424785.
[5] Bernardino, M. (2017). Gestão em Saúde: Organização Interna dos Serviços. Coimbra, Portugal: Almedina. ISBN: 978-972-40-7121-3.
[6] Berwick, D. M., Hackbarth, A. D. (2012). Eliminating Waste in US Health Care. JAMA, 307 (14), 1513-1516. DOI: 10.1001/jama.2012.362. Retirado de: https://jamanetwork.com/journals/jama/article-abstract/1148376
[7] Brown, E. C. F. (2018). Health Reforms and Theories of Cost Control. The Journal of Law, Medicine & Ethics, 46, 846-856. DOI: 10.1177/1073110518821978.
[8] Carvalho, M. T. G. (2009). Nova Gestão Pública e Reformas da Saúde – O Profissionalismo numa Encruzilhada. Lisboa, Portugal: Edições Sílabo. ISBN: 978-972-618-546-8.
[9] Cociorva, A., Saraiva, M., Ferreira, O., Novas, J. C. (2009). Planeamento e Controlo dos Custos da Qualidade nas Empresas Portuguesas Certificadas. In. J. A. C. Santos (eds.), Turismo e Gestão: Inovação e Empreendedorismo no Contexto da Economia Empresarial (344-354). Faro, Portugal: Fundação para o Desenvolvimento da Universidade do Algarve ISBN: 978-972-9341-89-2.
[10] Colombo, F. (2018). “Healthcare systems: Tackling waste to boost resources”. OECD Observer, 7, 1-4 DOI: https://doi.org/10.1787/f5719ebb-en
[11] Correia, E. (2019, Maio). Custos da Qualidade nas Pequenas e Médias Empresas Industriais Portuguesas. XII Jornadas Luso-Espanholas de Gestão Científica, Covilhã, Portugal. Retirado de: https://www.researchgate.net/publication/333039824_CUSTOS_DA_QUALIDADE_NAS_PEQUENAS_E_MEDIAS_EMPRESAS_INDUSTRIAIS_PORTUGUESAS
[12] CQI. (2020). Portal do Chartered Quality Institute. Retirado de: https://www.quality.org/what-quality
[13] Donabedian, A. (1990). The Seven Pillars of Quality. Archives of Pathology & Laboratory Medicine. 114 (11), 1115-1118 Retirado de: https://pubmed.ncbi.nlm.nih.gov/2241519/
[14] Ferrinho, P., Simões, J., Miguel, J. P., Beja, A., Cortes, M., Hartz Z. (2013). Da Gestão Estratégica do Sistema de Saúde Português à Avaliação do seu Desempenho – Um Percurso em Construção, Anais do IHMT, 12, 76-87. DOI: https://doi.org/10.25761/anaisihmt.195
[15] Ganhão, F. (1993). Ignorar é mais caro do que formar. Revista Exame, 49.
[16] Garvin, D. A. (1984). What does “Product Quality” Really Means. Sloan Management Review, 26 (1), 23-43. Retirado de: http://www.oqrm.org/English/What_does_product_quality_really_means.pdf
[17] Gronroos, C. (1990). Serviçe Management and Marketing: Managing the Moments of Truth in Service Competition. Lexington, EUA: Lexington Books. ISBN: 978-066-9200-35-5.
[18] Howard, J. A. (1977). Consumer Behavior: Application of Theory. New York, EUA: McGraw-Hill. ISBN: 978-007-030-5205.
[19] Hvenegaard, A., Arendt, J. N., Street, A., Gyrd-Hansen, D. (2011). Exploring the relationship between costs and quality – Does the joint evaluation of costs and quality alter the ranking of Danish hospital departments? The European Journal of Health Economics 12 (6), 541-551 DOI: 10.1007/s10198-010-0268-9.
[20] Infopédia. (2020). Portal Infopédia: Dicionários Porto Editora Disponível em: https://www.infopedia.pt/dicionarios/linguaportuguesa/desperd%C3%ADcio
[21] Lopes, A., Capricho, L. (2007). Gestão da Qualidade. Lisboa, Portugal: Editora RH.
[22] Lewandowski, R. (2014). Cost Control of Medical Care in Public Hospitals: a Comparative Analysis. International Journal of Contemporary Management, 13 (1), 125-136. Disponível em: https://www.researchgate.net/publication/265207468_COST_CONTROL_OF_MEDICAL_CARE_IN_PUBLIC_HOSPITALS_A_COMPARATIVE_ANALYSIS
[23] Mezomo, J. C. (2001). Gestão da Qualidade na Saúde: Princípios Básicos. São Paulo, Brasil: Manole. ISBN: 9788520412633.
[24] Melo, J. Q. (2015). Sustentabilidade em Saúde – Um Novo Paradigma de Cuidados. Que Caminhos para o Futuro?. Gestão Hospitalar, 5, 30-33. ISSN: 0871-0767.
[25] Miller, G., Rhyan, C., Beaudin-Seiler, B., Hughes-Cromwick, P. (2017). A Framework for Measuring Low-Value Care. Value In Health, 21 (4), 375-379. DOI: https://doi.org/10.1016/j.jval.2017.10.017.
[26] New England Healthcare Institute (2008). Waste and Inefficiency in the U.S. Health Care System – Clinical Care: A Comprehensive Analysis in Support of System-Wide Improvements. Disponível em: https://www.nehi.net/writable/publication_files/file/waste_clinical_care_report_final.pdf
[27] Northcote, D., Llewellyn, S. (2002), Challenges in costing health care services. International Journal of Public Sector Management, 15 (3), 188 – 203. Disponível em: https://www.emerald.com/insight/content/doi/10.1108/09513550210423361/full/html
[28] Nyakala, K. S., Munyal, T., Vermeulen, A. (2017). Evaluation of quality management practices in the public hospitals: a questionnaire survey. International Business Conference, South Africa, 94-105. Disponível em: https://www.researchgate.net/publication/322385714_Evaluation_of_quality_management_practices_in_the_public_hospitals_a_questionnaire_survey
[29] Patel, G. (2009). Total Quality Management in Healthcare. The MIDAS Journal – medical Imaging and Computing. Consultado em 16 maio. 2020. Disponível em: http://hdl.handle.net/10380/3062
[30] Pinho, M. (2010). O Racionamento dos Recursos da Saúde através do estabelecimento de prioridades: Uma perspetiva Social. Lisboa, Portugal: Universidade Lusíada Editora.
[31] Righi, A. W., Schmidt, A. S., Venturini, J. C. (2010). Qualidade em Serviços Públicos de Saúde: Uma avaliação da Estratégia Saúde da Família. Revista Produção Online, 10 (3), 649-669. ISSN: 1676-1901.
[32] Shrank, W. H., Rogstad, T. L., Parekh, N. (2019). Waste in the US Health Care System: Estimated Costs and Potential for Savings. JAMA, 322 (15), 1501-1509. DOI: 10.1001/jama.2019.13978.
[33] Smith, S., Newhouse, J. P., Freeland, M. S. (2009). Income, Insurance, And Technology: Why Does Health Spending Outpace Economic Growth?. HEALTH AFFAIRS, 28 (5) DOI: https://doi.org/10.1377/hlthaff.28.5.1276.
[34] Song, Z., Rose, S., Safran, D. G., Landon, B. E., Day, M. P., Chernew, M. E. (2014). Changes in Health Care Spending and Quality 4 years into Global Payment. New England Journal of Medicine, 371, 1704-1714. DOI: 10.1056/NEJMsa1404026.
[35] Stadhouders, N., Kruse, F., Tanke, M., Koolman, X., Jeurissen, P. (2019). Effective Healthcare Cost-containment Policies: A Systematic Review. Health Policy, 123, 71-79. Disponível em: https://www.sciencedirect.com/science/article/pii/S0168851018306341
[36] Urdan, A. T. (2001). A Qualidade de Serviços Médicos na Perspetiva do Cliente. RAE- Revista de Administração de Empresas, 41 (4), 44-55. ISSN: 0034-7590.
[37] Vaz, S. (2015). Sistemas de Avaliação de Qualidade em Saúde em Portugal: Que caminho seguir? Gestão Hospitalar, 6, 12-19. ISSN: 0871-0767.
Cite This Article
  • APA Style

    Antonio Ferreira, Sara Andre. (2023). Health Management Challenges: The Case of Hospital from Behind-os-Montes and Alto Douro and East Kent Hospitals University NHS Foundation Trust. International Journal of Health Economics and Policy, 8(1), 1-9. https://doi.org/10.11648/j.hep.20230801.11

    Copy | Download

    ACS Style

    Antonio Ferreira; Sara Andre. Health Management Challenges: The Case of Hospital from Behind-os-Montes and Alto Douro and East Kent Hospitals University NHS Foundation Trust. Int. J. Health Econ. Policy 2023, 8(1), 1-9. doi: 10.11648/j.hep.20230801.11

    Copy | Download

    AMA Style

    Antonio Ferreira, Sara Andre. Health Management Challenges: The Case of Hospital from Behind-os-Montes and Alto Douro and East Kent Hospitals University NHS Foundation Trust. Int J Health Econ Policy. 2023;8(1):1-9. doi: 10.11648/j.hep.20230801.11

    Copy | Download

  • @article{10.11648/j.hep.20230801.11,
      author = {Antonio Ferreira and Sara Andre},
      title = {Health Management Challenges: The Case of Hospital from Behind-os-Montes and Alto Douro and East Kent Hospitals University NHS Foundation Trust},
      journal = {International Journal of Health Economics and Policy},
      volume = {8},
      number = {1},
      pages = {1-9},
      doi = {10.11648/j.hep.20230801.11},
      url = {https://doi.org/10.11648/j.hep.20230801.11},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.hep.20230801.11},
      abstract = {It is imperative that healthcare systems, regardless of their source of funding, are sustainable, provide quality care and develop towards their customers’ expectations. This study aims at a comparative analysis between two hospital centres, one belonging to the Portuguese National Health Service and the other to the British National Health Service, in order to identify which strategies have been adopted by their hospital management to reduce health costs without prejudice to the quality of the services provided. To this end, semi-structure interviews were conducted with the financial directors of both hospitals. The questions presented focus on changes in terms of financing, the relationship between costs and quality, improving efficiency by cutting costs, strategies for reducing waste and operating vectors for improving efficiency. In the Portuguese case, his perspective focuses on the management and organisation of services from a perspective intrinsic to the organisation, characterised by restructuring and innovation, based on close and cooperative interrelations between sectors and hierarchies. In the British testimony, we verify a perspective more focused on the outside of the organisation, placing its focus on an inter-relational triangulation between population, organisations and professionals. The focus on health professionals, technology, reorganisation of services and waste stands out as being four fundamental pillars of action for an efficient cost reduction, without impairing quality, considered as areas of intervention relevant to the development of future studies. We also highlight the managers’ concern in cost reduction without prejudice to quality and in promoting services adjusted to the needs of the users.},
     year = {2023}
    }
    

    Copy | Download

  • TY  - JOUR
    T1  - Health Management Challenges: The Case of Hospital from Behind-os-Montes and Alto Douro and East Kent Hospitals University NHS Foundation Trust
    AU  - Antonio Ferreira
    AU  - Sara Andre
    Y1  - 2023/01/09
    PY  - 2023
    N1  - https://doi.org/10.11648/j.hep.20230801.11
    DO  - 10.11648/j.hep.20230801.11
    T2  - International Journal of Health Economics and Policy
    JF  - International Journal of Health Economics and Policy
    JO  - International Journal of Health Economics and Policy
    SP  - 1
    EP  - 9
    PB  - Science Publishing Group
    SN  - 2578-9309
    UR  - https://doi.org/10.11648/j.hep.20230801.11
    AB  - It is imperative that healthcare systems, regardless of their source of funding, are sustainable, provide quality care and develop towards their customers’ expectations. This study aims at a comparative analysis between two hospital centres, one belonging to the Portuguese National Health Service and the other to the British National Health Service, in order to identify which strategies have been adopted by their hospital management to reduce health costs without prejudice to the quality of the services provided. To this end, semi-structure interviews were conducted with the financial directors of both hospitals. The questions presented focus on changes in terms of financing, the relationship between costs and quality, improving efficiency by cutting costs, strategies for reducing waste and operating vectors for improving efficiency. In the Portuguese case, his perspective focuses on the management and organisation of services from a perspective intrinsic to the organisation, characterised by restructuring and innovation, based on close and cooperative interrelations between sectors and hierarchies. In the British testimony, we verify a perspective more focused on the outside of the organisation, placing its focus on an inter-relational triangulation between population, organisations and professionals. The focus on health professionals, technology, reorganisation of services and waste stands out as being four fundamental pillars of action for an efficient cost reduction, without impairing quality, considered as areas of intervention relevant to the development of future studies. We also highlight the managers’ concern in cost reduction without prejudice to quality and in promoting services adjusted to the needs of the users.
    VL  - 8
    IS  - 1
    ER  - 

    Copy | Download

Author Information
  • Institute of Management and Organizations of Health, Portuguese Catholic University, Viseu, Portugal

  • Institute of Management and Organizations of Health, Portuguese Catholic University, Viseu, Portugal

  • Sections