On 14 January, the first day of Gaidar Forum, the expert discussion, entitled Competences for Efficient Management in Healthcare, was held in RANEPA. This discussion was organized as part of the Viable Healthcare platform. Its participants discussed what the profile of professional competences for efficient management in healthcare should be, what is needed for professional training of managers in this area, and shared best practices of business participation in education for public healthcare. Andrey Sharonov, Rector of Skolkovo Moscow School of Management, moderated the discussion.
Veronika Skvortsova, Minister of Public Healthcare of the Russian Federation, opened the discussion. “In the current period of development of our country, raising quality of administration in public healthcare is assuming prominence. This is conditioned by, among other things, the processes currently occurring and developing in healthcare system. Firstly, an increasing number of state financial resources that are assigned for implementation of the program of state guarantees. 2015 is the first year when insurance contributions are actually paid in full for the unemployed, meaning we have reached the planned value, that is, 1.5 billion rubles. Secondly, the necessity to increase efficiency of public spending. Thirdly, restructuring financial flows and shaping of preeminently single-channel financing,” Minister Skvortsova said. She also noted some new trends in healthcare for 2015, specifically, all types of medical assistance are immersed into compulsory medical insurance including emergency aid. It is for the first time the system is transforming into a single-tariff system for the whole country and unified methods of payment of medical assistance.
Currently, senior executives program that has been there since the Soviet Union times is still in force. In parallel, managers are trained based on non-medical education. A project of the unified standard for professional training in public healthcare is also being drafted now. Federal RANEPA program helped in its development, and it enabled determining the essential components for training of a future specialist. Unified professional community of healthcare executives was formed in a year: In May, a meeting with the participation of heads of departments of medical and non-medical higher education institutions was held. In October, the conference, entitled Senior Executives, was held. As a result, a special-purpose discussion platform for key problems in management was established in I.M. Sechenov First Moscow State Medical University.
Minister Skvortsova emphasized that the process of professional training of managers who will administer the field of medicine needs to be reviewed. She also emphasized the importance of establishing the nationals, not state system of public healthcare.
Tatyana Averyanova, Head of the Department of Economics at Novosibirsk Medical Institute, talked about the professional standard for managers in all three degrees, namely, bachelor, specialist, and master, being developed now. She said that it is extremely important to understand what qualification and job description of every manager should be and what jobs future graduates of universities will have. This issue is being studied also on the social level, specifically, chief medical officers are questioned, and they talk about their expectations.
Examples of participation of business in raising the quality of professional education for the medical field were presented by Liz Fowler, Vice-President and Global Head of Health Policy in Johnson & Johnson. This company has developed and is currently implementing a program for professional training of managers in healthcare in INSEAD business school (France), with Russian professionals participating. Talking about the participation and the role of business, she said that public healthcare gives a lot of opportunities for public/private partnership, and the company has a lot of examples of successful cooperation, including those in Russia. During the discussion, the Advanced Medical Technology Education Center launched by Johnson & Johnson in Kazan in the partnership with the Ministry of Healthcare of Tatarstan was mentioned several times. Together with a German foundation for healthcare, Johnson & Johnson established the Institut für Innovation und Integration im Gesundheitswesen Integrierte Versorgung Schizophrenie der AOK Niedersachsen for schizophrenia treatment. The objective of the program is to completely change management of this disease from the moment it is diagnosed until its social adaptation. A manager is appointed to every group of patients, and these patients are mainly watched at their homes. The results of this work have exceeded any expectations. For instance, the number of suicide attempts among these patients has had a twelve-fold decrease.
“We are willing to implement this program in Russia if it is going to be called for. On the model of this program, we can introduce some other programs which are of more interest in Russia,” Ms. Fowler said. Eric Cornut, Chief Ethics, Compliance and Policy Officer of Novartis, talked about global trends in administration of the healthcare system and approaches to decision making related to healthcare. In many countries, efficiency is still measured with the amount of investments into certain activities, whereas achieving and evaluating final results of these activities are of principal importance. Experience shows that healthcare systems which utilize a result-centric approach achieve better results in terms of the health of population in a long term with similar or smaller investments. “We are glad to be a partner of the state in discussing the approaches to increasing the efficiency of the healthcare systems in Russia for the good of patients and society as a whole,” Mr. Cornut said.
When discussing the importance of public and private partnership in healthcare, Alberto Colzi, Vice President for EEMEA Operations in AbbVie, emphasized the importance of maintaining current amount of investments against the background of the complicated economic situation. “In Russia, this is investment for remote future, for a long term,” he said, adding that not only national health depends on them, but also the opportunity to diversify the economy. Mr. Colzi also said that redirecting investment to early disease detection and their prevention is essential. Getting back to the competences required from managers, Elena Yashina, Deputy Head of RANEPA Center for Information Technologies in Administration, emphasized proficiency in law, current regulations and bylaws. “We need to train not only chief medical officers, but also cynical economists. It should be clear that investment into public healthcare is literally an investment,” Larissa Popovich, Director of Higher School of Economics Institute of Healthcare Economics, talked about financial ‘literacy’ of managers.
“Unfortunately, we will not avoid charging chief medical officers with a significant amount of competences that they are unaware of yet,” she said, explaining her point with the quickly advancing technical progress. Ms. Popovich indicated strategic thinking among key skills that managers need to possess. Many competences occur at the interface of medicine and other fields like mathematics, physics, chemistry, and biology. Managers should understand what people they will need in the short term for the healthcare system to be provided with physicists able to develop new equipment and mathematicians able to precisely calculate a drug dose.
Dmitry Khalilov, Partner in EY and Head for Services for Medical and Biological Industry Group in Russia and CIS, talked about a research into critical competences for administrators of different levels in healthcare. He mentioned that now around 26 key competences are singled out. They are split into three groups, namely, ‘transformation’ (includes everything related to innovations, finance, and economy), ‘administration’ and ‘people’. “Competences are in a permanent expansion, and they number is growing, too. Probably, chief medical officers need a designated deputy, an administrator, who will be able to take this area of responsibility,” Mr. Khalilov said.
Sergey Shishkin, Director of Healthcare Policy Center in National Research University – Higher School of Economics, proposed to develop distance-learning programs. “Key advantage of the private sector is the service offered,” Professor Shishkin emphasized. He said that the mass sector infrastructure needs to be developed, too. The second important issue is job arrangement. Managers have to re-arrange jobs as wage increase raises the status of a given doctor, but not the quality of his or her work.
“In management, the most important thing is goal setting. We say that there is no goal in administering, but in medicine, a goal-based approach is important as the question is life or death” Abel Aganbegian, RAS Academician and Head of the Department of Economic Theory and Politics in RANEPA, said.
Dmitry Butashin, Vice-Rector in RANEPA, responsible for professional training of civil servants and the program for training of management personnel (the so called Presidential Program), talked about the joint project of RANEPA, Ministry of Healthcare of the Russian Federation, and Ministry of Economy of the Russian Federation. Since 2011, RANEPA has trained more than 6.5 thousand deputy chief medical officers and chief medical officers from 85 Russian regions including two regions in Crimea as part of the program for professional training of management personnel in healthcare and education. “At the launch of the program, there was an understanding that the deficit of management competences of healthcare institutions’ directors is very high. We tried to include at least some key dimensions of activities that chief medical officers have into the program,” he said. Mr. Butashin explained that the most charged issues for managers in healthcare were administration of finance and economy as well as quality management as expected. “There are two more things that the program showed, namely, teambuilding––an ability to form a team to achieve certain results––and project management, that is, an ability to organize activities, to implement them, and to evaluate their result,” he said.
Summarizing the discussion, Minister Skvortsova expressed her confidence in the concept that a person who has been trained in all complications related to financing should perform administration of a medical institution. She also talked about some medical and paramedical criteria related to service rendering and the necessity to have a person responsible for the list of medications and introduction of innovative ones among such managers. Minister Skvortsova invited the participants of the discussion to submit their proposals for improving the work of the respective Ministry and to participate in shaping the education concept in the medical industry.