The elaboration of a paper with the theme of applied management in health is, without a doubt, a complicated and courageous approach. This, firstly because management is a complex science, the accumulations in this field being impressive and, secondly, because the activity in the health services involves innumerable managerial mechanisms (decision-making, coordination, maximum concentration per unit of time). limited, resource management, mobilization, etc.), mechanisms that cannot be easily theorized. All the more reveals the structural-functional complexity of neurosurgery services. To solve the first challenge, the authors decided to select from the organizational managerial literature those informational contents of first importance and relevance for the health activity and, especially from neurosurgery, contents that constitute the useful knowledge base for the development of managers in these services. Regarding the complexity of the mechanisms of managerial activity in health, we used our knowledge of health management, and especially our experience of leadership and activity to illustrate, on the one hand, the way in which models of management science can be applied in reality. medical and, on the other hand, the manner in which certain realities of the health activity can be included in the grid of scientific analysis of the organizational managerial theories and methodologies, being able to be followed by the interventions for development.
I found in the organizational management literature a series of theories, research, experiments that were a real source of understanding the functionality of the organizational life of the hospital, I discovered many effective studies in health, their design can be resumed in sample studies. autochthonous. Also, we found that in their vast majority, the works announcing the title addressing the problems of health management or health management, are limited, however, to the somewhat mechanical resumption of theories or models, without making adaptations to the reality of life, activity and staff in health organizations. All the more, there is a lack of research in the field of health management.
Currently, there is intense talk about changing the health legislation or the legislation regarding the activity of hospitals, possible economic solutions, managerial reform, European integration, etc. The reality is that these reforms have left the heads of the medical units with the same problems. The change is constantly taking place, but the results are not projected and, implicitly, cannot be recorded. The medical literature abounds with exposures on the inconsistencies of the national health system, solutions are sometimes issued, we could say that a new science has emerged, of health crises.
Undoubtedly, the activity in all medical services is influenced by socio-economic contextual factors, but internal managerial factors cannot be neglected. The staff employed in health often has to deal with actions of maximum importance and urgency, in working conditions marked by the insufficiencies of the health system. The social and economic transition does not seem to end too soon, the reforms will continue in the same style, so that the health managers can only continue to look for internal solutions and try to overcome through internal mechanisms some of the existing problems. It is useless to mention the inability to provide health resources as needed, but increasing the quality of services, improving relations between practitioners and beneficiaries, optimizing communication, the workplace climate, reducing occupational stress, increasing job satisfaction and safety , of the quality of life in the organization are aspects that can be treated directly by the decision makers from the units, the final results converging directly towards the improvement of the working conditions and the quality of the services. All health systems in the world have problems. Therefore, once again the importance of elaborating projects and management programs in health systems and structures is revealed. Whether or not there are problems, concerns for organizational managerial development must be constantly present.
No project for change in health can be achieved without reviewing and analyzing the general and specific obstacles faced by local medical life correlated with the organizational diagnosis in each medical unit. Without a complete diagnosis we cannot design interventions that lead to real results. Intervention based on research data is the law that must prevail. Training people is the key to overcoming difficult situations in structures. We cannot, however, reduce this training only to knowledge and skills specialized skills, more skills are needed to allow employees to coordinate their efforts, to communicate as effectively as possible, to cope emotionally with any situation, to never be taken by surprise, to be mobilized for action. As for us, we ask ourselves: How can we have such super people, who work hard and are also professionally satisfied? The answer is announced right from the title of the paper: by developing management in health organizations, in neurosurgery services!
This paper has been the fruit of our activity for a long time, being preceded by a series of articles, studies and research published in national periodicals or presented at conferences and symposia in the country and will certainly be followed by new appearances. The data of the organizational managerial specialized literature with the data of the health management literature and with the data of the current health literature are combined in a fluent and systematized manner. The book has several objectives. First of all, we are interested in making available to all people with managerial responsibilities in health a practical guide to use in order to better manage the activities in the departments, in order to develop their managerial skills. Secondly, we intend to offer a model to other medical managers, so that they can use the information contained in the chapters of the paper to optimize management in their own units. Thus, we try to carry forward the scientific knowledge in the field of organizational management applied in healthcare environments. The main goal that we aim at from the perspective of our specialty is that, starting from a series of specialized knowledge in management and from our experience of management and activity, to lay the foundations of a program designed to increase the efficiency / performance of staff employed in neurosurgery services, increasing the quality of services, managing all the resources of the activity.
Organizational managerial literature, counselors' manuals, practice guides provide more general information. Over time, specialized knowledge began to appear in relation to industrial organizations, with different types of work groups, certain positions, etc. but health organizations have been less approached, probably due to limited access due to the need to comply with customer safety conditions. Through this paper, organizational counselors, human resources specialists will better understand the specifics of health organizations, "areas" for which they can develop projects and management programs in the perspective of new European applications aimed at implementing quality programs and accrediting institutions according to ISO standards. . On the other hand, all categories of health personnel invested with managerial functions will have the opportunity to develop their capabilities for operationalization and application of optimization / development measures in the areas over which they have responsibility. In fact, at present, all these categories of health personnel who hold managerial roles are specifically required to acquire management knowledge and skills. The system no longer allows maintaining in managerial positions those who will not prove the following of some forms of training. Therefore, the book can be an additional support for their formation. The reader, whether he is an organizational advisor, health manager, or passionate about this field will be able to establish a direct relationship with the specifics of health services and especially with neurosurgical ones. The fascinating but impenetrable world of neurosurgery services is open to the general public. The most important aspects of managerial life in these services will be presented, in addition we will introduce some medical sequences to provide a realistic picture of the complexity of neurosurgical activity. I resorted to the presentation of images from the activity of neurosurgeons, hospital staff, images that are certainly a premiere for the overwhelming majority of readers. Many other aspects could be analyzed, but for this the pages of a single book are insufficient.
From the beginning we warn the reader that he will not find in this book administrative solutions, economic schemes, analysis charts, etc., but will find less treated aspects in the health management literature: organizational and managerial development. This is a development of the way of organizing actions, interpersonal relations at work, based par excellence, on research data. The study of attitudes, behaviors, sets of thinking and feeling of employees, skills and leadership style of bosses is at the heart of developmental progress. Intrinsic participation is gradually built by implementing practices that promote increasing the quality of life at work, finding solutions even by employees, acquiring the capacity for organizational learning, ie constructive use of experience in favorable and unfavorable situations, so that the organization as the whole and each employee to become able to notice the problems and solve them, each resolving experience becoming a good that can be taken over and used by other employees.
We insisted a lot on the format of the paper, trying to make a decision on how to work, whether it should be rigorous, the emphasis on science should be visible or whether the speech should have a more accessible note. We opted for a medium version, in which to combine scientific data with fluent exposures loaded with realism, in the manner of a practical guide. The paper has ten chapters.
The first chapter deals with the issue of requirements and arguments that drive the concerns for the development of management in health services. The global, European and national requirements are presented, but also a series of arguments such as: notifications and start of projects by managers of medical units, research results in Romanian managerial organizational environments, the existence of organizational dangers, research model and management programs in health services in other countries.
The second chapter reveals the reality of the Romanian health system, as it was reflected in the medical news press. The main problems, controversies, difficult moments, but also the proposed solutions recorded so far are reviewed. We systematized the information on several sections, being systematized in ten areas: economic system management, regulatory management, strategic change management, organizational management, technical system management, human resources management, image management, beneficiary relationship management, scientific development, goal management. The chapter is sprinkled with a series of personal analyzes and comments, and at the end, we draw conclusions about the progress of the reforms initiated so far.
In the third chapter we resort to a presentation of the situation of the representative health units: the hospitals. The analyzes start from the illustration of the tensions that took place in these organizations, the potential dangers, the perspectives of development and efficiency of these organizations are presented.
The fourth chapter, entitled "The Road to Excellence" provides a clear picture of the particularly complex issue of excellence in health systems and structures. The two orientations that have emerged are presented: managerial excellence and service excellence. For each orientation, the authors resort to the presentation of a short history and to the concrete directions that have been outlined in the two fields. Also, the chapter contains relevant information on the total quality management applied in health: specific, principles, stages.
The fifth chapter reveals the new approach for excellence in relations with the beneficiaries of neurosurgery services. A new perspective is promoted in which: the applicant for health services is understood in terms of "client", "beneficiary"; the relationship with the client is based on the explanation of health problems, it is no longer reduced to sketching the diagnosis / prognosis; services are based on the most modern technologies. In addition, we take into account the design and organization of additional services, the quality of life of the client. The client is no longer understood as a passive subject, but as an active person who has responsibility not only in relation to his state of health, the quality of personal life, but also in relation to the state of health and quality of life at the workplace of providers.
The sixth chapter presents the context of the development of organizational structures. The dimensions of the organizational structures are presented and a series of comments and analyzes are issued regarding their optimization in the health structures, especially in the neurosurgery services.
In the seventh chapter, an insufficiently explored dimension is analyzed in the management works applied in health, namely, leadership. Contextual factors and the need for leadership development in health and neurosurgery, a brief historical perspective of treating leadership in the health system are the first sections covered. The authors' approach to expound the new criteria for the development of leaders in neurosurgery is unique: it goes through the theories of leadership and applies clarifications.
The next chapter, the eighth, brings to the reader's attention one of the most Challenges of health management team building. I am exposing information of prime importance for bringing health teams to the level of excellence: factors, possible development practices. From the perspective of health services and especially those of neurosurgery, it shows the special value of building team spirit and developing mechanisms for coordinating members of neurosurgical, clinical and emergency teams. Coordination of excellence between team members and between different teams in health and neurosurgery services are the objectives explicitly stated by the authors.
In the ninth chapter, one of the major concerns of managers in neurosurgery services, namely, the promotion of quality of life at work, is supported. The excellence of the services is indirectly dependent on the excellence of the working conditions. The focus is on those practices that help promote a healthy work environment, a tonic work environment in neurosurgery services. For the first time, they are treated in the local medical literature: the problem of organizational trust, job satisfaction, organizational justice, self-esteem at work.
The last chapter, the tenth, is the culmination of the paper: for the first time in the Romanian health services is configured the project of a national program for the development of organizational management and human resources, which takes into account multiple variables: economic, structural, psychoorganization. In this sense, the management of the Romanian Society of Neurosurgery uses the presentation of a set of directions, objectives. Research conducted at Bagdasar Arseni Emergency Clinical Hospital is a model for other health managers, proving the importance of "evidence-based management", ie management that uses projects and programs only by virtue of and based on scientific results. Informative management represents the desideratum that the management representatives from the Romanian neurosurgery services promote and that they have concretely adopted. We do not exclude the fact that following the structuring of the National Program for the Development of Management in Neurosurgery Services to propose a Global Project of this kind in all neurosurgery services in the world, given our responsibility both for the Management of the Romanian Society of Neurosurgery and for the Management of the World Federation. of Neurosurgery Societies.
Before inviting the reader to resort to the work of the book, we would like to thank those who supported us in its creation: Prof. Univ. Dr. Mielu Zlate, who was kind enough to provide us with valuable ideas and to provide us with a series of bibliographic sources; Dean Prof. Univ. Dr. Catalin Zamfir, who laid the foundations of a superior form of training in health management, the Master of Health System Management, a form of training that was a valuable basis for authors to understand the mechanisms of health management; Dr. Fery Stoica, Dir. R.U.N.O.S. Ec. Doina Simion, Ec. Marian Rosoi, Assistant Chief Ana Mares and the other colleagues who carried out an intense management activity with us, contributing among others to the elaboration of the managerial documentation of the unit, the study of these documents serving partially for chapter VI of the paper, Mrs. Mariana Vantu Ionescu, who was kind enough to guide us in connection with some bibliographic sources. We thank the medical staff, the medium and auxiliary staff of the Bagdasar Arseni Emergency Clinical Hospital, which was the main source that determined us to develop the work, and which, at the same time, was a source of concrete facts that did not incite to intellectual reflection in order to find answers to the phenomena that arose in terms of efficiency, organizational behavior, structure, climate, organizational culture of the institution.
Practically, this book is dedicated to all categories of employees who contribute to the neurosurgery services in our hospital, being at the same time a symbol of our appreciation for their efforts. We are also thinking of all categories of employees of the health services in Romania, who, we hope, will feel our support for the cause of their professional life.
The National Strategy for the Development of Management in Neurosurgery represents a partly materialized intention of the Management of the Romanian Society of Neurosurgery. This strategy has as main objective the optimization of the management in these services. We designed several phases of it: documentation, research, implementation and verification of results. This approach has been an older concern of ours, becoming in the meantime an objective for all heads of clinics in neuroscience services. From this moment, the development process really takes place, being in full swing. The first stage of the documentation phase has already taken place, some of the results being presented in this volume. Also, the first stage of the research took place, the preliminary diagnosis being already structured. Other data of the documentation and research will be presented on the occasion of other appearances, which will complete the series of the applied theoretical guide.
Prof. univ. Dr. A.V. Ciurea
Dr. V. Ciubotaru
I would. univ. Psih. E. Avram