Conclusion

This post is an automatic translation from a text written in Slovenian. Translation is generated with use of DeepL Pro tool. Original text is postaed and available here: https://paradim.si/category/slovensko-zdravstvo-2022-23/

The Slovenian healthcare system operates as a state-run healthcare system. Working conditions are shaped in different parts of the whole system. Relevant are questions about financing, about the main ideas or model on which the system is based and operates. In addition to management (the relationship between manager and providers), governance and the relationship between owners and management are also important. However, in keeping with the theme, this website is primarily concerned with the elements within an institution, i.e. the elements of governance and management.

If we are talking about problems or inadequacies in an organisation, these occur in healthcare both at systemic and at the level of the individual institution. What is the system level? In the public debates on RTVSLO, we have seen several calls for a change in the roles of certain entities within the system. Among the specific wishes expressed was, for example, the transfer of administrative work from family medicine to the ZZZS, as well as to occupational, transport and sports medicine. Defining or changing the roles of the different entities in the system is part of the organisation at system level.

Calls for the professionalisation of managerial roles target (at least as a priority) action at the level of individual healthcare institutions. This is a solution that is probably necessary if we are to make real progress and, above all, if we are to set up a system that (in the future) will itself professionally resolve (at least a significant proportion of) problematic situations.

Professionalisation of leadership roles

In theory, the definition of the skills required for a given role is clear. It starts with an analysis and description of the role, which tells what the person in the role has to do or provide (as a contribution to the department, team or the organisation). What the person has to do, he or she has to have the knowledge to do; and the next step is to define the knowledge and skills needed, both the areas and the level of these skills. The skills needed by managers can therefore be identified through careful analysis, and this becomes the clear basis for professionalisation.

In the process, there may be different views on what activities a leader needs to do and what a leader needs to provide for a community. There are several philosophies and approaches in the field of leadership, so there are some variations in the definition of the role, but in any case the leadership role (in a given chosen way) must fulfil its basis, which is solid. The manager has to design the systems, the leader has to motivate and guide or, through the relationship with the people, ensure that they are implemented.

The organisational challenge for the pay system

I do not want to introduce myself, to write about the public sector pay system, as this is not my field. But I do want to raise some of the themes that are raised by the discussion of the topics presented in the previous notes.

After the initial intervention in the health pay system, we are now hearing accusations of a broken balance; that is to say, that the difference between staff earnings within the system is now inadequate. Pay should be linked to the complexity (in all aspects of performance) of the role. Research on organisation and organisational culture highlights inadequacies in the very definition of roles. They highlight the (unjustified) subordination of certain roles in the system and the distinctly hierarchical culture. They also highlight the individualistic identity or the absence of a group identity.

The pay or reward system gives feedback information on the work done. When such a system is justified, it (successfully) reinforces the existing working arrangements. If the current working arrangements is problematic, then it would be logical that a new pay system should should be redesigned and reorganised. The absence of a group identity brings the result of less cooperation, exchange, more burden on the individual and so on. The absence of a culture of flexibility (as opposed to a culture of hierarchy) negatively has a negative impact on the involvement of team members and departments and on the implementation of change. I want to offer a reflection that it (may) be right to “break down” relationships, roles should be redefined … and the new pay system should follow these changes.

So: professionalisation?

After the closure of the Polje Health Centre, the participants in the programme Tarča “Slovenian Patient”, which was broadcast on 12 January 2023, mainly discussed who was responsible for the situation. At the end of the programme, Dr Brigita Skele Savič called for the necessary education and training of the management staff. What about the main representatives of the current policy? I have not yet seen any concrete action in this area in my monitoring of public communications, but I am certainly watching developments in anticipation.

However, the following content may give us some answers. For example, a quick search (using Google search with the keyword ‘healthcare management’) of existing educational programmes in the field of healthcare management will reveal:

• Management in Health and Social Care Programme. Implemented by: the Faculty of Organisational Sciences and the Faculty of Health Sciences (University of Maribor) in cooperation.
• Programme Management and Economics in Health Care. Implemented by: Faculty of Economics (University of Ljubljana).
• Programme Management in Health Care and Health Law. Faculty of Health Sciences (University of Primorska).

As an additional interesting content, I would like to mention the publication of the book Management in Healthcare Organisations. The book is co-authored by Dr Rudi Rozman (management), Dr Jure Kovač (management), Dr Bojana Filej (nursing) and Dr Andrej Robida (medicine). The book is published by GV Publishing in 2019.