CC BY
7IRSNI 76.75.29 УДК 614.23
FEATURES OF TRAINING OF HEALTH CARE ORGANIZERS IN
INTERNATIONAL PRACTICE
1112
F. Bimurzayeva , Zh. Buribayeva , A. Saparaliyeva , S. Tuktibayeva
1National Medical University named after S.D. Asfendiyarov, Kazakhstan 050012 Almaty, Tole bi, 94
2Akhmet Yassawi International Kazakh-Turkish University, Kazakhstan 161200 B. Sattarkhanov, 29
To highlight current trends and approaches in health management training systems, a review of literature data in international databases PubMed, Science Direct, Google Scholar, Cochrane Library.
Key words: health care; healthcare management specialists; public health.
ОСОБЕННОСТИ ПОДГОТОВКИ ОРГАНИЗАТОРОВ ЗДРАВООХРАНЕНИЯ В
МЕЖДУНАРОДНОЙ ПРАКТИКЕ
1 1 1 2
Ф.А. Бимурзаева , Ж.К. Бурибаева , А.М. Сапаралиева , С.А. Туктибаева
Национальный медицинский университет имени С.Д. Асфендиярова, Казахстан 050012 Алматы, Толе би, 94
Международный казахско-турецкий университет имени Ходжа Ахмета Ясави, Казахстан 161200 Туркестан, Б. Саттарханов, 29
Для выделения современных тенденций и подходов в системах подготовки кадров управления здравоохранением проведен обзор литературных данных в международных базах данных PubMed, Science Direct, Google Scholar, Cochrane Library.
Ключевые слова: здравоохранение; специалисты в области управления здравоохранением; общественное здравоохранение.
ХАЛЬЩАРАЛЬЩ ТЭЖ1РИБЕДЕ ДЕНСАУЛЬЩ САЦТАУ
УЙЫМДАСТЫРУШЫЛАРЫН ДАЯРЛАУДЬЩ ЕРЕКШЕЛ1КТЕР1
1 1 1 2
Ф.А. Бимурзаева , Ж.К. Бурибаева , А.М. Сапаралиева , С.А. Туктибаева
1С.Д. Асфендияров атындагы Улттьщ медициналык университет, ^азакстан 050012 Алматы, Теле би, 94
^ожа Ахмет Ясауи атындагы Халыкаралык казак--тур^ университету ^азакстан 161200 ТYркiстан, Б. Саттарханов, 29
Денсаулык сактауды баскару кадрларын даярлау жYЙелерiндегi казiргi замангы урд^тер мен кезкарастарды белш керсету ушш PubMed, Science Direct, Google Scholar, Cochrane Library халыкаралык деректер базаларындагы эдебиеттерге шолу жасалынды.
Кшттш сездер: денсаулык сактау; денсаулык сактауды баскару мамандары; когамдык денсаулык сактау.
Corresponding author: Tuktibayeva Saule Aktleuovna PhD Head of the Department of the Akhmet Yassawi International Kazakh-Turkish University, Kazakhstan 161200 B.Sattarkhanov 29 +77026512379 saule79s@mail.ru
Recieved: 18.05.2021
Accepted: 25.05.2021
Trained personnel are an important component of the infrastructure needed to effectively perform basic functions and basic public health services, as well as to improve health outcomes [1,2]. However, most public health officials have little or no formal training in public health [3]. This situation may have contributed to the Institute of Medicine's characterization of the public health infrastructure as being in disarray[4] . Although public health institutions recognized the need to train public health personnel, training was a low priority and presented a huge challenge [5].
Thus, according to the authors, in modern socio-economic conditions, including health care system reforms, it is very difficult to overcome the crisis phenomena in the industry without the development of
professional management personnel. Today, in Kazakhstan, as in many foreign countries, medical institutions are turning into complex and interconnected systems, for the successful management of which skilled managers are needed. At the same time, it is noted that quite often medical managers do not have sufficient special knowledge and skills for professional management. In this regard, there is a need to train the heads of medical organizations and health management specialists according to comprehensive programs of public health organizers, which requires changes in the existing system of training and advanced training of public health specialists, health management personnel with reference to international standards [6].
The term "public health specialist" refers to persons directly responsible for the organization and quality of medical care to the population, as well as to employees of state health management bodies. At the same time, this circle of specialists does not include heads of departments of medical organizations, who are actually first-level specialists in healthcare management [7].
In the electronic databases PubMed, Google Scholar, ScienceDirect and Cochrane Library, a comprehensive literature search was conducted on research on the model of training of health care organizers published in peer-reviewed journals.
The data of foreign countries shows that new trends are becoming more and more clearly evident in the issues of improving the training of personnel in the field of health management, which are of considerable interest for the domestic health care [8]. There are quite a few publications that describe the experience of Western countries in training and succession planning among health care providers [9,10]. The healthcare sector in America and Europe faces the same problems as the industry in Kazakhstan: training in healthcare management, despite the fact that they began to apply new training methods and involve specially selected and trained organizers in the management of the system much earlier [11].
The personnel policy in the US and European healthcare management is based on two directions: these are replacement planning and succession planning. In the first case, this is targeted preparatory work with a candidate for a key managerial position (this is similar to the domestic system of training the personnel reserve, but in a slightly more advanced version), and in the second case, this is work with personnel, where the main requirement is to evaluate the competencies of talented managers with high potential for further development.
In the United States, the main scheme is to appoint a doctor to the position of health administrator after many years of clinical practice, but more than 10 years ago, the specialty "health management" was introduced. Obtaining a certificate in this specialty involves studying the basics of financial micro-and macroeconomic analysis, the basics of management, strategic planning, the theory of managerial decision-making, time management, administrative management, etc. But at the same time, the issue of appointing medical managers or managers in the field of health management with non-medical education to the post of clinic administrator has not yet been resolved. The work of managers is very prestigious and highly paid [12]. The promotion of U.S. health care managers is strictly regulated by the Federal Civil Service Act and is only done through an exam. The best candidate is allowed to take the exam, having annually high marks based on the results of the work for the year. Public services are divided into several administrative-territorial autonomous regions. Each hospital has its own career promotion plan. If the hospital does not have a candidate who meets all the requirements, then an open competition is announced for applicants from other municipal medical institutions, or from other autonomous regions. For violators of the principles of the system of merit and promotion on the career ladder, there is a certain range of disciplinary measures [13].
The well-known American agency American Management Association conducted a study on the sudden loss of key managers. Causal factors were identified: the selection of specialists for a senior position in medical organizations was carried out based on the professional abilities of the candidate in the medical field, but leadership or organizational qualities were rarely taken into account [14]. Magali Angeloni (2019) conducted research to obtain data on the current state of public health training and the use of the real-time Partner Network (TRAIN), a public health training management platform, in state health departments, and to use the data to identify organizational features that may affect training, as well as to identify obstacles and opportunities for improving training. He and the authors conducted structured interviews in 2014 with TRAIN administrators and performance managers (n = 14) from 7 state health departments who used TRAIN to identify training practices and barriers to learning. And identified the key organizational features of the 7 agencies, including the training structure, the training required, the employment status of TRAIN administrators (full-time or part-time), obstacles to using and tracking core competencies in TRAIN,
methods for assessing training needs, support for leadership training and staff development, and the agency's interest in applying for accreditation by the Public Health Accreditation Board. The study identified 4 common elements among TRAIN-affiliated state health departments: (1) insufficient use of TRAIN as a learning tool, (2) insufficient ownership of training within the organization, (3) insufficient evaluation and budgeting of training, and (4) emerging collaboration and changing perceptions of training stimulated by the agency's preparation for accreditation. It was concluded that public health managers can increase commitment to the importance of training by assigning responsibility for training to an individual, centralizing training, and setting expectations for a new responsible training manager to update training policies and require the use of TRAIN to design, implement , evaluate, track, and report on training across the agency [15] .
Training in the field of health management in the UK differs significantly from the United States in that in the UK the process is implemented in stages and depends on the level of management, and anyone can receive training in the specialty "health organization", even if they do not have a medical education. Throughout career development, there is a change in the main activities from operational to strategic planning and directly to management, and this is reflected in the training program at various levels. The main thing in the preparation of future successors to the leadership positions of medical and preventive institutions of the health system is the rotation of personnel and mentoring. Training of managers with non-medical education is conducted at the Faculty of Health Organization according to the standard 5-year program, which is compiled and approved by the General Medical Council (GMC). In addition to the theoretical disciplines, most of the training program is devoted to practical training with mandatory rotation and testing conducted in specialized centers for the assessment of competencies (assessment). From the results of the applicant's test, the main individual plan for training and developing the necessary qualities is drawn up. Despite this, in many medical institutions, when appointing to managerial positions, preference is given to clinicians who have received additional training in the organization of health care. Because of this, there was a problem of leaving the staff of managers with non-medical education, who admitted to the presence of frequent conflicts of interest between them and clinical managers, accusing them of incompetence [16].
It should also be noted that in the UK there is a UK Public Health Register, which develops standards and monitors the activities of the heads of municipal medical institutions. Among them, standards were developed for the skills and competencies that an applicant must possess in order to be appointed to any managerial position, as well as for subsequent promotion. Today, many authors note the lack of specialists with pronounced leadership qualities, which naturally affects the effectiveness of management. According to the researchers, the demand for specialists is several times higher than the supply [17].
The Japanese management model is one of the most effective in the world, incorporating the most rational ideas of American management, but this model is based on traditional elements of Japanese culture and psychology [12]. The main quality is the ability to work with the population. The Japanese management system has become one of the reasons for the economic recovery of the country, according to some standards, this system has been more adapted to the conditions of scientific and technical modernization than, for example, the European or American system: the main slogan of Japanese business has become a focus on technical and technological innovations [18].
In Germany, a few years ago, medical organizations were led by" executive committees of institutions", which included doctors, nurses, administrators, and medical directors who led them. To date, only the director is in charge. When entering the position of director, previously the preference was given to doctors, now a manager who does not have a medical education, who has completed a master's and doctoral degree in the specialty "Public Health"can apply for this position. In addition, there are also managers of quality management in medicine. For the nomination, which is voluntary, and appointment to managerial positions, the candidate must meet the strict requirements of the position, and his work in this position is constantly monitored by self-regulating professional associations. Also, many hospitals develop a human resources strategy consisting of the following areas: maintaining continuing education, career development, manager development, and other specialists in the field of health management. The promotion of officials of the German health authorities in the career ladder is regulated by federal laws. The main principles of the transition to a higher position are professional development and gradual transition from one administrative position to another. The concept of a "reservist" of a civil servant does not exist, but the main task of this
system is to prepare and build a career path with further prospects for holding a higher administrative position [19].
In France, the system of promotion of managers at all levels is similar to the system of Germany, after competitive selection, applicants for public service are trained in a new position, which is a bit like training a personnel reserve for managerial positions [20].
In Norway and Poland, appointments to administrative positions in the health administration are made after competitive selection, but the candidate must complete a master's degree in health organization. Special attention should also be paid to the system of motivation of health care managers in Poland: every year there is a competition "Manager of the Year", and the winner receives a prize or the opportunity to complete an internship abroad [21].
In Spain, there is a "National Commission for the Development of Human Resources", developed by law and engaged in training only in the specialty "health organization", and also promotes the further professional growth and development of specialists in this field. But there is no profession of health care organizer in Spain, so the position of manager of a medical organization can be occupied by a specialist with both medical and non-medical education, for example, with an economic or legal education. The system of appointing people who are politically loyal or close to the local authorities to senior positions of municipal health care has gained great importance, while their professional qualifications are not valued. In medical organizations, there are usually 2 main directors - a medical manager and a hospital manager. The medical director must have a medical degree to lead the medical staff and the treatment process. A hospital manager is a manager with a non-medical education who is engaged in the operational management of a clinic, and is subordinate to a deputy for finance, development and quality management [22].
Public health schools established in low-income countries follow the example of their counterparts in high-income countries, i.e. they are also class-based. Nevertheless, there is a movement to integrate community experiences, such as the Rockefeller Foundation-sponsored Schools of Public Health Without Borders, which are held in Ghana, Kenya, Uganda, Vietnam, and Zimbabwe. These efforts remain relatively small-scale, due in part to a lack of quality teachers. There are many reasons for this: insufficient supply, lack of appropriate training, lack of financial and motivational incentives, and migration [18].
According to some authors, key changes in the curriculum and innovative methods of training health professionals are needed for health care reforms to bring long-term benefits. It is argued that changes often involve difficulties in inherently conservative professions, such as healthcare, especially in less established and non-integrated healthcare systems in large countries such as India, China, Brazil, and Russia [23].
Thus, in foreign countries, the system of training specialists in the organization of health care has a diverse nature, but at the same time, experts agree on the need for special training for appointment to a senior position, improving existing methods and forms of training. An integral part of the health systems of the developed countries of Europe and the United States is the developed block of public health, aimed at preserving and strengthening the health of the population; to monitor the health status of the population, conduct research aimed at identifying and assessing health risks; develop organizational models, technologies, strategies, tools, methods, programs and allow reducing these risks; as well as evaluate effective measures implemented for this purpose [24].
In conclusion, it should be noted that the beneficial solution of the problems of health management is largely due to the system of training public health professionals who are able to competently solve problems of public health protection.
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2. Choffy J. P., Lichtweld M. Y., Tilson H. Research program for the development of public health personnel.//J Public Health Manag Pract. - 2004. - Vol. 10 ( 3 ). - P. 186-192. [ PubMed] [ Google Scholar ].
3. Institute of Medicine. The future of public health . Washington, DC: National Academies of Sciences, Engineering, and Medicine; 1988. http://www.nationalacademies.org/hmd/Reports/1988/The-Future-of-Public-Health.aspx. As of January 31, 2019 [ Google Scholar ].
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5. Gebbi K. M., Ternok B. J. Public health personnel, 2006: new challenges. Aff Health (Millwood). - 2006. - Vol. 25 ( 4 ). - P. 923-933. doi: 10.1377/hlthaff.25.4.923 [PubMed] [ Google Scholar].
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