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36ЭКОНОМИКА И УПРАВЛЕНИЕ НАРОДНЫМ
ХОЗЯЙСТВОМ
RISK ASSESSMENT AND MODELING OF FACILITIES UNDER
YEREVAN MUNICIPALITY BY SWOT ANALYSIS METHOD Âkopyan L.Â.1, Mardiyan M.A.2, Chopikyan A.S.3, Dunamalyan R.A.4 (Republic of Armenia) Email: Âkopyan240@scientifictext.ru
âkopyan Levon Аkopovich - Deputy of Minister, MINISTRY OF HEALTH OF REPUBLIC OF ARMENIA; 2Mardiyan Marine Araratovna - Doctor of Medical Science, Professor; 3Chopikyan Armine Samvelovna - PhD in Medicine, Lecturer; 4Dunamalyan Razmik Ashotovich - PhD in Medicine, Аssistant, PUBLIC HEALTH AND HEALTHCARE ORGANIZATION DEPARTMENT, YEREVAN STATE MEDICAL UNIVERSITY, YEREVAN, REPUBLIC OF ARMENIA
Abstract: the most important strategic direction of state policy in Republic of Armenia at the present stage is the reform of the primary health care (PHC) system. SWOT analysis is a framework used to evaluate a company's competitive position by identifying its strengths, weaknesses, opportunities and threats. The aim of our research was to study the possibility of using methods of strategic analysis in the management of a primary health care facilities. We have also assessed the risks of strategic and tactical levels. As a result, a risk assessment map has been developed that has allowed substantiating the risks of PHC. Keywords: SWOT-analysis, health facilities, primary health care, strategic planning.
ОЦЕНКА РИСКОВ И МОДЕЛИРОВАНИЕ УЧРЕЖДЕНИЙ ПЕРВИЧНОЙ МЕДИЦИНСКОЙ ПОМОЩИ ЕРЕВАНА МЕТОДОМ SWOT-АНАЛИЗА Акопян Л.А.1, Мардиян М.А.2, Чопикян А.С.3, Дунамалян Р.А.4
(Республика Армения)
1Акопян Левон Акопович - заместитель министра, Министерство здравоохранения Республики Армения; 2Мардиян Марине Араратовна - доктор медицинских наук, профессор; 3Чопикян Армине Самвеловна - кандидат медицинских наук, преподаватель; 4Дунамалян Размик Ашотович - кандидат медицинских наук, ассистент, кафедра общественного здоровья и организации здравоохранения, Ереванский государственный медицинский университет, г. Ереван, Республика Армения
Аннотация: важнейшим стратегическим направлением государственной политики в Республике Армения на современном этапе является реформа системы первичной медицинской помощи (ПМП). SWOT-анализ - это структура, используемая для оценки конкурентной позиции компании путем определения ее сильных и слабых сторон, возможностей и угроз. Целью нашего исследования было изучение возможности использования методов стратегического анализа в управлении учреждениями ПМП. Мы также оценили риски стратегического и тактического уровней. В результате была разработана карта оценки рисков, которая позволила обосновать риски ПМП. Ключевые слова: SWOT-анализ, медицинские учреждения, первичная медицинская помощь, стратегическое планирование.
Introduction
Today, issues related to the organization of health care are quite acute. This is due to the fact that the reform of the health care system is one of the key areas of state policy in the social sphere. The main goal of this direction is to increase the availability and quality of medical services for the population. Today, medical science can be characterized by a vagueness of priorities, low innovative potential and an insufficiently developed system for integrating the results of scientific research into practical activity [1].
The most important strategic direction of state policy in Republic of Armenia at the present stage is the reform of the primary health care system. To increase the efficiency of activities, it is necessary to apply such methods that can assess both internal processes and determine the likely impact on the organization from the external environment [2-4].
The SWOT-analysis matrix for health care institutions includes all the information about the development and emergence of new diagnostic and treatment technologies, changes in the structure and composition of the organization, including the level of training of medical personnel. When conducting SWOT analysis, it is necessary to assess the competitive environment of the institution, including their material and technical equipment, professionalism and training of specialists. When conducting SWOT analysis, it is especially important to take into account the different ways of further development of the organization [5, 6].
SWOT analysis is a framework used to evaluate a company's competitive position by identifying its strengths, weaknesses, opportunities and threats. Specifically, SWOT analysis is a foundational assessment model that measures what an organization can and cannot do, and its potential opportunities and threats [7-9].
The aim of our research was to study the possibility of using methods of strategic analysis in the management of a primary health care (PHC) institution.
Material and Methods
SWOT analysis (or SWOT matrix) is a strategic planning technique used to help a person or organization identify strengths, weaknesses, opportunities, and threats related to business competition or project planning [1]. It is intended to specify the objectives of the business venture or project and identify the internal and external factors that are favorable and unfavorable to achieving those objectives. Users of a SWOT analysis often ask and answer questions to generate meaningful information for each category to make the tool useful and identify their competitive advantage. SWOT has been described as the tried-and-true tool of strategic analysis [2]. Strengths and weakness are frequently internally-related, while opportunities and threats commonly focus on the external environment. The name is an acronym for the four parameters the technique examines:
• Strengths: characteristics of the business or project that give it an advantage over others.
• Weaknesses: characteristics of the business that place the business or project at a disadvantage relative to others.
• Opportunities: elements in the environment that the business or project could exploit to its advantage.
• Threats: elements in the environment that could cause trouble for the business or project.
The degree to which the internal environment of the firm matches with the external environment is expressed by the concept of strategic fit. Identification of SWOTs is important because they can inform later steps in planning to achieve the objective. First, decision-makers should consider whether the objective is attainable, given the SWOTs. If the objective is not attainable, they must select a different objective and repeat the process.
SWOT analysis aims to identify the key internal and external factors seen as important to achieving an objective. SWOT analysis groups key pieces of information into two main categories:
1. Internal factors — the strengths and weaknesses internal to the organization.
2. External factors — the opportunities and threats presented by the environment external to the organization
Analysis may view the internal factors as strengths or as weaknesses depending upon their effect on the organization's objectives. What may represent strengths with respect to one objective may be weaknesses (distractions, competition) for another objective. The factors may include all of the 4Ps as well as personnel, finance, manufacturing capabilities, and so on.
Results and Discussion
With the help of SWOT analysis method was evaluated and analyzed the main risks PHC facility management system, which will improve the quality management system of medical care. The proposed model can be used to assess the targeted and effective use of resources.
An internal environment analysis was carried out to assess the strengths and weaknesses of PHC facilities. SWOT analysis was carried out by chief doctors of PHC providers guaranteed by the Department of Healthare of Yerevan Municipality. The criterion for inclusion was the length of service, professional qualifications, professional upgrading, and the fact that it enjoys great reputation in the system (Table 1).
Table 1. Modeling SWOT analysis components ofPHC facilities under the Municipality of Yerevan
Strengths
■ Qualified specialists;
■ modem equipment;
■ guarantied patients;
■ multifunctional system of quality assurance;
S necessary conditions for medical care providing; S state support; S creation of favorable image; S Comfortable location.
Weaknesses
■ weak marketing policy;
■ deficit of state financial sources;
■ unfavorable saturation (equipments);
■ low level of medical care accessibility.
w
Opportunities
S Expand the scope of services market; S State policy towards the growth of public health sector investments; S Increased demand for quality of medical services, accessibility to patients; S State policy on healthy lifestyle and increased demand for patients;
■ Accessibility of new medical services technology market;
■ Establishing tax privileges in the provision of medical services;
■ Relatively aging population.
Threats
S Reducing the number of working-age population; S Strengthening of competition field (increase of competitors in private sector);
S Low rating of medical profession;
S Political instability, S Public financing discrepancy for guaranteed medical services; S Shortcomings in the legal field.
We have been using SWOT analysis, a matrix of qualitative strategic analysis of the PHC framework. As a result of the review of all factors of the SWOT analysis of the PHC link, a decision has been adopted that is important for clarifying the PHC strategy and objectives.
The results of SWOT analysis of the PHC has substantiated that it is necessary to separate the sources of funding for the system, for example, increasing the volume of paid services, is a strong side for the assembled population, and the weakness factor of the insurance package (table 1).
After risk management analyzing of PHC, experts have given a quantitative assessment of these risks. For each risk management strategy, an initial assessment of the risk level (high, medium, low impact) has been performed. As a result of the matrix analysis of the
risk status, we have come to the conclusion that political and economic risks have the most impact on the PHC management. For our quantitative risk analysis, we have developed two criteria for risk assessment, consequence and probability (Table 2).
Table 2. Quantitative assessment ofpossible risks and their consequences of the PHC facilities under
the Municipality of Yerevan
Risk 1 Risk outcomes | Potential Risk
Internal risks
Risk associated with the availability of medical equipment Very high level of impact on the system Probability of risk materialization (25-50%)
Risk associated with hygienic-epidemic situation of the system High impact degree on key activities Probability of risk materialization (up to 25%)
Risk associated with the level of doctors' qualification High impact degree on key activities Probability of risk materialization (25-50%)
Risk associated with the doctor's work schedule High level of impact on the system Probability of risk materialization (25-50%)
Risks ighly adversely affecting the health of healthcare providers Main activity on high impact Probability of risk materialization (25-50%)
Professional risks Limited effect on key activities Probability of risk materialization (25-50%)
Medical risks associated with civil and legal liability High impact degree on key activities Probability of risk materialization (25-50%)
Risk related to the use of medical equipment, medicines and medical supplies High impact degree on key activities Probability of risk materialization (25-50%)
According to the survey data, 7 of risks having impacts on the main activity of the PHC network have a high impact (25-50%) and one low impact (up to 25%). According to the risk assessment of the likelihood of materialization of 1 risk involve up to 25%, and other risks remain 25-50 percent (Table 2).
Evaluating external and internal risks of PHC facilities under municipal administration, one can argue that there are no risks to the system's critical condition. We have also assessed the risks of strategic and tactical levels. As a result, a risk assessment map has been developed that has allowed substantiating the risks of PHC.
This approach allows having objective conclusions about key risks. An important conclusion is that existing high risks indicate that in the PHC facilities under the Yerevan Municipality have problems in ensuring efficiency of management system.
In the next stage of study, were assessed the management risks of the system (Table 3).
Table 3. Assessment of risk management ofPHC facilities under the Municipality of Yerevan is of
great importance
Three most "Importance" (10 "Management "The Importance
important points assessment Efficiency" (10 points of a Negative
risks system) assessment system) Effect"
1 2 3 4 (2-3)
1 (85,4%) 10 3 +7
2 (74,3%) 9 2 +7
3 (65,4%) 9 1 +8
Table 3 is complemented by answers to the following questions:
1. Is agree the strategic manager of PHC that these risks exist in the organization? (85.4%)
2. Is agree the strategic manager of PHC that these risks are important? (74.3%)
3. Is agree the strategic manager of PHC that these risks have a significant importance and significance? (65.4%)
4. Have organization a plan of risk management measures? (25.4%),
5. Do you find that the risk management is an integral part of management of the organization? (22.7%)
It was suggested to highlight the three most important risks. Each risk was assessed according to the Scale, "Importance," "Management Efficiency" and the difference between these two indicators, "Negative Effect". If "negative effect" is positive, it can be stated that there is insufficient risk management, and in the case of negative, there is a clear risk management. Conclusion
Based on the results of the survey, the organizational-functional risk-management model of the PHC facilities under the municipality was developed. The model combines all the recommendations that have been developed within the framework of effective risk management. Within the framework of the model implementation a targeted risk management program has been developed.
Thus, the results of the survey revealed that the reduction of the risks from the risk of PHC in the suburban facilities of the Municipality of Yerevan is not as effective as there are critical indicators that indicate about instability of the existing system.
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