Juris Barzdins

Developing health care management skills in times of crisis: A review from Baltic region

Abstract Health care is now under pressure to change related to new situations in demand side (demographics, pattern of diseases, public expectations), supply side (technology and clinical knowledge, health care workforce), and wider societal changes (financial pressure, internationalization of health care systems, global market for research and development). The increase of health expenditure in most of the middle- and high-income countries exceeds GDP growth rate and threatens further competitive capacity of economies tight in bearing the burden of social costs. A period of economic slowdown is challenging for health care systems in many countries. It is also the case for countries in Baltic region now looking for ways to bring more value for money spent on health care. Several factors are listed as causes for rising health care costs. Some of them (e.g. aging and unhealthy lifestyles of individuals) are out of the sphere of direct influence of doctors, managers of health care organizations, and even ministries of health. However, other causes (e.g. introduction of new costly technologies, utilization of expensive medications, organization of care processes) are in their direct domain. There is growing evidence that organizations will benefit from additional non-clinical competencies acquired by doctors – the key persons in control of resources in health care. The goal of the study is to evaluate current practice of medical education in several universities of different countries regarding amount and content of courses aimed to develop contextual organizational, leadership, and management competencies. The study is based on analysis of content of selected undergraduate studies of medicine programs in all three Baltic countries and other selected countries in Europe. The results of this study showed wide variation in the defining courses aimed to develop non-technical core competencies and the lack of dedicated courses for developing elements of entrepreneurship in most of the analyzed programs. This study demonstrates the lack of collaboration that exists between governments, health providers, and universities with regard to adaptation of professional education programs to the needs of changing health care systems. The author suggests that further research is needed to prove the hypothesis that integration of entrepreneurship, economics, and management education into curricula of medical studies will add the systemic view and inter-professional competencies needed by all future physicians and will support development of leadership of tomorrows health care managers.

Process-oriented knowledge system for health professionals as a tool for transition to hospital process orientation

Abstract Hospitals face increasing pressure to reduce costs, improve efficiency, and guarantee a quality of services. This is perhaps the main reason why hospital process orientation (HPO) – a view on a hospital being a group of processes organized around patients with similar needs is a growing field of interest among hospital managers and researchers. The theoretical research of the content of hospital activities was performed in order to determine the main distinct characteristics in hospital organization that determine the specifics for a process-oriented knowledge system. A conceptual proposal of a technological tool was elaborated taking into account the limited control of hospital management over clinical process dominated by the doctors decision-making and self-regulating activities.

Self-service Ad-hoc Querying Using Controlled Natural Language

The ad-hoc querying process is slow and error prone due to inability of business experts of accessing data directly without involving IT experts. The problem lies in complexity of means used to query data. We propose a new natural language- and semistar ontology-based ad-hoc querying approach which lowers the steep learning curve required to be able to query data. The proposed approach would significantly shorten the time needed to master the ad-hoc querying and to gain the direct access to data by business experts, thus facilitating the decision making process in enterprises, government institutions and other organizations.

Modeling and query language for hospitals

So far the traditional process modeling languages have found a limited use in the hospital settings. One of the reasons behind this delay has been the lack of clear definition of the sequence of activities that are carried out in the hospital. We propose a new modeling language (as a profile of UML Class diagrams) that captures all the useful features from various UML diagrams and can be used in modeling of the hospitals. Based on the modeling language, we have developed an easy-to-perceive graphical query language, which allows the physicians to retrieve directly from the various hospital databases information they need to better understand the flow of clinical processes.

Facilitation of Health Professionals Responsible Autonomy with Easy-to-Use Hospital Data Querying Language.

Support for the development of responsible autonomy as opposite to management that is based on direct control is found to be by far more effective approach in healthcare management, especially when it concerns physicians as the most influential group of health professionals. It is therefore important to obtain a process-oriented knowledge system where physicians would be able to autonomously answer questions which are outside the scope of pre-made direct control reports. However, the ad-hoc data querying process is slow and error-prone due to inability of health professionals to access data directly without involving IT experts. The problem lies in the complexity of means used to query data. We propose a new natural language- and semistar ontology-based ad-hoc data querying approach which reduces the steep learning curve required to be able to query data. The proposed approach would significantly decrease the time needed to master the ad-hoc data querying thus allowing health professionals an independent exploration of the data.

Graphical modeling and query language for hospitals

BackgroundSo far there has been little evidence that implementation of the health information technologies (HIT) is leading to health care cost savings. One of the reasons for this lack of impact by the HIT likely lies in the complexity of the business process ownership in the hospitals. The goal of our research is to develop a business model-based method for hospital use which would allow doctors to retrieve directly the ad-hoc information from various hospital databases.MethodsWe have developed a special domain-specific process modelling language called the MedMod. Formally, we define the MedMod language as a profile on UML Class diagrams, but we also demonstrate it on examples, where we explain the semantics of all its elements informally. Moreover, we have developed the Process Query Language (PQL) that is based on MedMod process definition language. The purpose of PQL is to allow a doctor querying (filtering) runtime data of hospital’s processes described using MedMod.ResultsThe MedMod language tries to overcome deficiencies in existing process modeling languages, allowing to specify the loosely-defined sequence of the steps to be performed in the clinical process.The main advantages of PQL are in two main areas – usability and efficiency. They are: 1) the view on data through “glasses” of familiar process, 2) the simple and easy-to-perceive means of setting filtering conditions require no more expertise than using spreadsheet applications, 3) the dynamic response to each step in construction of the complete query that shortens the learning curve greatly and reduces the error rate, and 4) the selected means of filtering and data retrieving allows to execute queries in O(n) time regarding the size of the dataset.ConclusionsWe are about to continue developing this project with three further steps. First, we are planning to develop user-friendly graphical editors for the MedMod process modeling and query languages. The second step is to do evaluation of usability the proposed language and tool involving the physicians from several hospitals in Latvia and working with real data from these hospitals. Our third step is to develop an efficient implementation of the query language.