managing the family medicine practice

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MANAGING THE FAMILYMEDICINE PRACTICE

dr. Merry Tiyas A.

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THE FIVE STAR DOCTOR

C ARE PROVIDER

DECISION MAKER

COMMUNIC ATOR

COMMUNITY LEADER

MANAGER OF HEALTH C ARE

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MANAGING THE FAMILY MEDICINEPRACTICE

Managing People and Resources

Managing Facilities and Utilities

Managing Information

Managing Finance and Managed Care

Managing Quality

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MANAGING PEOPLE ANDRESOURCES

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Input 3M : manpower, money and

materials. Process operational work,

developmental work, and

organizational work.

Output technical care and patient

satisfaction

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BASIC FUNCTION OF A MANAGER

Planning

Process of setting objectives andformulating the steps which will be

necessary to attain these objectives.

Long term strategic planning

Short term operational planning

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Organizing

Process of getting activities, people,materials structured to meet organizational

objectives. It includes :

 ± setting of job description

 ±  Authority to act

 ± departmentalization

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Leading

 ± process of influencing staff to meetpredetermined objectives.

 ± The skills to be an effective leader:

communication and feedback skills

motivation of staff 

use appropriate leadership style.

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SKILL SET OF THE MANAGER

Conceptual skills skills of perceiving how

the part of the organization link together instructure and processes.

Human skills skills involved in working

with people.

Technical skills skills in managing things

rather than people and are often learned

through on the job training programs.

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MANAGING PEOPLE

From entry to exit of staff, there are many aspects in managingpeople :

 ± Recruitment ± Selection

 ± Induction training

 ± Motivation

 ± People handling

 ± Structure

 ± Leadership ± Personal effectiveness

 ± Change management

 ± Staff development delegation, appraisal, courses

 ± Separation

 ± promotion

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STRATEGIC MANAGEMENT

Basic of strategic planning five steps:

 ± Identification of current objectives and strategy ±  Analysis of the external environment

 ±  Analysis ot the organization¶s strengths and

weakness

 ± Strategic decision making to decide on services tointroduce, services to scale down

 ± Strategic implementation at functional levels.

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SWOT Analysis

     Strengths, weaknesses, opportunities andthreats.

     Opportunities and threats exist in the externalenvironment.

     Opportunities are prospect to fill existing or newservice needs.

     Threats come from competitors, policies andeconomic outlook,and changes in public.

     Strengths, weaknesses are state of theorganization to sustain itself.

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MANAGING FACILITIES ANDUTILITIES

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SUPPLIES AND STORES

MANAGEMENT PRINCIPLES

Deals with ordering; receipt; maintenance;

and issue when required. The supplies can range from drugs and

pharmaceuticals to syringes and needles aswell as general use items like stationery.

Stocks of pharmaceuticals and medicalrequire close monitoring to ensure they donot deteriorate or reach expiry dates.

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MAINTENANCE AND STORAGE

Some rules are needed in the issue of drugs

and pharmaceuticals: ± Proper accounting of items issued

 ± Restriction of number of people having acces to

stores

 ± Regular inventory taking and action taken toexplain discrepancies.

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DRUGS.

The operations management principles are: ± Use principle of first in, first out (FIFO) its

important to avoid running of date.

 ± Circulate information on maintaining shelf life

through proper storage. ± Do spot checks and regular inventory taking

reduce wastage from date expiry, poor storage

and pilferage.

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VACCINES.

The operations management principles are : ± Maintain the ³ cold chain´. Transport to outlying

places must be carefully planned.

 ± Keep every one knowledgeable of the ³cold

chain´, down the driver. ± Review the ³cold chain´ regularly to ensure that

the ³cold chain´ works.

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MANAGING DISCREPANCIES

Discrepancies the differences between

recorded and actual quantity of money or inventory.

Reasons : ± Human error 

 ± Machine counting error  ± Incomplete recording

 ± Pilferage

 ± Fraud

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 Action to be taken for all discrepancies

     Take immediate action     Parties involved to explain what they know of the

matter 

     Conduct the necessary investigation

     Take uniform decision as has been laid down asstandard operating instructions.

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MANAGING INFORMATION

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MEDICAL RECORDS

Documentation of clinical details.

Properly kept and used, allow us to see the problemsolving process form which we can deliver better 

care.

 An effective record keeping system contributes to

the standard of care.

 Attention paid to how medical records are organized,

filed and maintained is integral to effective practice.

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System of filling records :

Numeric  Alphabetical

 Address or company

Color coding

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MANAGING FINANCE ANDMANAGED CARE

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FINANCIAL MANAGEMENT

Keeping proper records of income, expenditure and

profit.

Preparing financial statements at the end of accounting

period.

 Analyzing financial statements and taking the

necessary actions.

Implementing inventory and stock control processes.

 Acting on discrepancies.

Ensuring that financial records are audited.

Developing financial plans.

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Income :

 ± Consultation

 ± Sale of medicine

 ± Fee for service

 ± House calls

 ± Investment from surplus revenue

Expenses : ± Staff cost as salary, bonus etc.

 ± Occupancy cost such as rents, repair, telephone, utilities.

Profit : difference between income and expenses.

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Financial Audit

The purpose of financial audits is to ensure

accountability in the use of financial andmaterial resources.

External audit

Internal audit

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MANAGED CARE

Refers to a variety of techniques for 

influencing the clinical behavior of healthcare provider and/or patients, often byintegrating the payment and delivery of health care.

Aim : to place administrative control over cost, quality, or access to health careservices in a specific population coveredenrollees.

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Managed Care Systems

The prototype managed care system is the

Health Maintenance Organization (HMO). Capitation system of payment is key feature.

Capitation involves paying physicians a fixed,

prospective amount for each patient

regardless of the cost of caring for thepatient.

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Capitation is one example of managed care

practices that seek to control costs of healthcare.

Some managed care practices seek to

impact the quality of care.

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Managed care is structured around a variety

of incentives to encourage the practice of cost-effective medicine, and to minimize

variation in clinical practice pattern.

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In its ideal state, money is saved through

several mechanisms: ± Standardization of fees

 ± Reduced variations of care

 ± Cheaper alternatives without undue sacrifice of 

quality or convenience ± Exclusion of non effective treatment

 ± Reduction of unnecessary tests and treatments

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MANAGING QUALITY

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QUALITY AND QUALITY ASSURANCE

QUALITY : care that meets or exceeds expectations.

Two aspects : ± technical

 ± patient satisfaction.

Evaluated by structure, process and outcome

indicators.

Based on the result of these indicators implement

improvement programs to close the quality gaps.

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QUALITY ASSURANCE is an attempt to

protect and enhance quality. Concerned with patient care that is high in

professional quality, and satisfying to the

patient.

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Quality holds the promise of being able to :

Deliver the most appropriate and up to datemedical care.

Reduce the chance of unsuitable treatment andcare, and an appropriate variation in carebetween doctors.

Encourage accountability between providers,consumers and founders of health care.

Save unnecessary costs by reducing waste,duplication and increasing efficiency.

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