Hadassah Academic College Jerusalem, Department of Service Organization Management, Health Track, Jerusalem, Israel.
Isr J Health Policy Res. 2020 Nov 24;9(1):65. doi: 10.1186/s13584-020-00424-y.
Health systems worldwide function in constantly changing local and global ecosystems. This is the result of economic, demographic, and technological changes, among others. In recent decades Israel has started implementing reforms in the public health services that have led to far-reaching changes in the health system, and consequently, increased competition within it. The impact of these changes has been exacerbated by pressure to reduce per capita public health costs, coupled with increased demand and greater health awareness. All these changes have created a turbulent environment for healthcare organizations in Israel. To cope with this dynamic environment, various parts of the system have had to adopt appropriate management behaviors and business styles. This study, carried out in six public hospitals in Israel, evaluates the nature and degree of adaptation, implementation, and inculcation of management strategies in public hospitals in Israel, using the Ginter model of strategic management of health organizations.
The study used semi-structured in-depth interviews of key figures in the health system and managers at various levels in the hospitals and HMOs included in the sample. The 55 interviews, conducted in two time periods, were analyzed in accordance with an established theory of qualitative methodological analysis.
The main findings are that the health market and hospitals in Israel are increasingly adopting competitive business behaviors. But strategic managerial behavior has been adopted only in part, and there is a lack of collaboration between staff and management in defining goals and strategic activity. These are obstacles to change and inculcation of the strategy in hospitals.
This study affords an important view over time and a better understanding of the behavior and adaptation of hospitals in Israel to their constantly changing surroundings. Adapting and inculcating appropriate managerial strategies in hospitals requires close collaboration between staff and management; its absence is an obstacle that contributes to partial, and possibly counter-productive, strategic behavior. The solution may lie in a combination of changes: providing hospital management with the necessary tools and broad professional support by the Ministry of Health; organizational changes in hospital management and departments; the creation of a clinical leadership role; and a self-supervised planning system .
These recommendations regarding training and the direction and organization of the change, coupled with systemic oversight of them by the Ministry of Health, will enable the system to become more efficient. They are particularly relevant today because the Covid-19 pandemic has exacerbated and highlighted Israeli public hospitals' financial and organizational problems. Hospitals that already faced many challenges have had to cope with an unfamiliar medical crisis and a reduction of elective medical activity, causing them various types of damage, especially in term of economic stability. The hospitals' fragile situation must become a top government priority because it can no longer be ignored. To achieve a strong healthcare system with stable hospitals, able to respond both to everyday challenges and to crises like the current pandemic, policymakers must provide financial and organizational support alongside managerial training, while maintaining an overall systemic plan.
全球卫生系统在不断变化的本地和全球生态系统中运作。这是经济、人口和技术等变化的结果。近几十年来，以色列开始对公共卫生服务进行改革，导致卫生系统发生了深远的变化，因此系统内的竞争加剧。在减少人均公共卫生费用的压力下，加上需求增加和健康意识增强，这些变化的影响更加严重。所有这些变化都为以色列的医疗保健组织创造了一个动荡的环境。为了应对这种动态环境，系统的各个部分都必须采用适当的管理行为和商业模式。本研究在以色列的六家公立医院进行，使用 Ginter 卫生组织战略管理模型评估了以色列公立医院管理战略的性质、适应、实施和灌输程度。
该研究使用半结构化深入访谈的方法，对卫生系统中的关键人物和纳入样本的医院和 HMO 各级管理人员进行了访谈。在两个时期进行了 55 次访谈，根据既定的定性方法分析理论进行了分析。
主要发现是，以色列的医疗市场和医院越来越采用竞争商业行为。但仅部分采用了战略管理行为，员工和管理层在确定目标和战略活动方面缺乏合作。这些是医院变革和灌输战略的障碍。
本研究提供了一个重要的视角，更好地了解了以色列医院对不断变化的环境的行为和适应。在医院中适应和灌输适当的管理策略需要员工和管理层之间的密切合作；其缺失是导致部分可能适得其反的战略行为的障碍。解决方案可能在于一系列变化：为医院管理提供必要的工具和广泛的专业支持由卫生部提供；医院管理和部门的组织变革；创建临床领导角色；以及自我监督的规划系统。
这些关于培训和变革的方向和组织的建议，加上卫生部对它们的系统监督，将使系统更加高效。它们在今天尤其相关，因为新冠疫情加剧并突出了以色列公立医院的财务和组织问题。已经面临许多挑战的医院不得不应对陌生的医疗危机和选择性医疗活动的减少，给他们造成了各种类型的损害，特别是在经济稳定方面。医院脆弱的状况必须成为政府的首要任务，因为不能再忽视了。为了建立一个拥有稳定医院的强大医疗保健系统，使其能够应对日常挑战和像当前大流行这样的危机，政策制定者必须在提供财务和组织支持的同时进行管理培训，同时保持整体系统计划。
