Management of different services

The management encompasses all those actions aimed at achieving the objectives of health systems. Management, as a discipline of human knowledge, arose from the economic and social changes that have occurred since the Industrial Revolution, has moved from the world of industrial companies to companies and service organizations, and logically their tools and methods have been incorporated into the health services, with their specific adaptations of the sector. There are several levels of management, health macro-management whose scope of decision is related to health systems (ministries, regional services), mesogestión associated with health centers and micromanagement in relation to health services and units, although all share techniques and skills, we are going to refer hereafter mainly to the field of mesogestión. Classically, management activities were described in the four basic functions of planning, organization, execution and control, chained in a continuous process constitute the management cycle, functions that will be developed throughout the remaining chapters of the book. Exercising these functions requires a balanced set of skills with three components · Technician, who will train you with skills and knowledge for the development of specific tasks.· Interpersonal, necessary for the interrelation and connection in the development of works with and through different groups of people, inside and outside the organization.· Conceptual, to visualize the organization from a global point, to anticipate and anticipate future changes and to be able to project actions to different term.

The set of activities and functions that health managers must exercise ranges from the preparation, execution and monitoring of the budget, human resources management, recruitment, mediation in conflicts of different origin (trade union, interprofessional, clinical departments, suppliers...), attention and resolution of user complaints, execution of teaching and research programs, allocation of resources, choice of technology, monitoring of contracts and supplier failures, and a long etcetera, that could be summed up in two concrete actions: to make appropriate decisions and to solve problems.

Most of the decisions and problem solving are associated with the obsolescence management services of conflicts of interest between patients, professionals, politicians and the managers themselves 13. The latter, exercising their functions of efficiency search among the pressures of politicians, the demands of improving citizens' services, tensions with professionals and strict compliance with the norm, which makes them a part of the hinge at the center of these multiple conflicts with limited weapons and limited use of instruments that facilitate the task, despite being always in a perpetual state of redefinition of its character and questioning its usefulness, the figure of management has allowed during the more than 20 years of existence, a high development of management in hospitals 14, 15 and in primary care centers and that we have a model that supports international organizations with sufficiency.

However, the managers themselves feel that a profound change in their management model is necessary, and many clinicians feel that the manager has little regard for their opinion, since it focuses on the goals set forth above, which (virtual realities, make-up statistics, disproportionate economic adjustments) and you are asked to make some changes in your behavior · More professionalism, greater knowledge in leadership skills and greater independence of political-electoral interests.· Be a leader so that, in addition to power, you have authority.· Move from inspector to facilitator.· That it defend and assume the values??fundamentally ethical and related to the principle that people and their development are the most important in an organization like ours.From the academic world also some elements of evolution of the profile are identified · The manager must consider that the fundamental objective is to contribute to the improvement of the levels of well-being associated to the health of the population and of the individuals, which forces to move from the management of the complementary to the management of the essential.· To understand that the culture, content and context of the management disciplines are different from those that comprise the clinical professions, but that both require an interdependence for the satisfactory performance of both.· It is not enough to make the clinic more manager, it is necessary to make more clinical the management, as a measure to bridge the gap between effectiveness and effectiveness. Whatever the profile may be, it seems necessary for this figure to negotiate with the public authorities, to maintain internal equity within the institution 18 and to facilitate the achievement of the objectives and ensure the quality of the result.

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