Marcin Kautsch

Polish and UK doctors’ engagement with hospital management

Purpose – The purpose of this paper is to present the findings of a short research project, conducted in 2010 as part of a larger EU funded action investigating the participation and impact of doctors in management. The authors sought to compare the ways in which hospital doctors in the UK and Poland – countries with distinct histories – participate in management; whether they are converging and whether the type of participation found results from changes in the governance and management of these systems. Design/methodology/approach – First, a review of existing evidence and an analysis of policy documents and healthcare statistics were conducted. Identifying a lack of empirical data in the Polish context, and a potentially changing situation in the UK, the authors proceeded to collect some exploratory data in Poland, via interviews with expert informants, and to draw on data collected alongside this study in the UK from qualified doctors participating in research on management and leadership development....

Tools of innovative public procurement in health care in Poland

This paper sets out to map the issues of innovation in public procurement in Poland with specific reference to health care and presents case studies of Polish hospitals using an innovative approach to public procurement. It is based on the analysis of secondary data collected using Internet search engines, introductory research conducted in hospitals which have recently used innovative procurement tools (e.g. technical dialogue and competitive dialogue) and the experience of two Polish hospitals involved in projects aimed at increasing the efficiency of procurement through innovations, described in a case study form. Although innovative procurement in Poland is at an early stage of development, it is also a topic of growing interest to both public authorities and hospitals and some hospitals are adopting new procurement methods such technical and competitive dialogue. However, barriers to the adoption of new procurement approaches are evident and these delay this process of adoption. Barriers encountered include the conservative organizational culture of hospitals, lack of awareness and know-how and a lack of trust and understanding of new procurement approaches.

Setting the scene for the future: implications of key legal regulations for the development of e‐health interoperability in the EU

E-health has experienced a dynamic development across the European Union in the recent years and enjoys support from the European Commission that seeks to achieve interoperability of national healthcare systems in order to facilitate free movement. Differences that can be observed between the member states in legal regulations, cultural approaches and technological solutions may hinder this process. This study compares the legal standing of e-health in Denmark, Poland, Spain and the UK, along with key legal acts and their implications. The academic literature review along with an analysis of materials found through the desk study research (reports, legal acts, press articles, governmental web pages and so on) was performed in order to identify aspects relevant to e-health interoperability. The approach to legal regulation of e-health substantially differs by country. So do the procedures that they have developed regarding the requirement for patients consent for the processing of their data, their rights to access to the medical data, to change the data, data confidentiality and types of electronic health records. The principles governing the assignment of responsibility for data protection are also different. These legal and technological differences must be reconciled if interoperability of European national e-health systems is to be achieved. Copyright

Are there just barriers? Institutional perspective on the development of e-health in Poland

Abstract Development of e-health in Poland has suffered from multiple setbacks and delays. This paper presents views on and experiences with implementation of e-health solutions of three groups of respondents: buyers, suppliers and external experts with the aim of establishing to what extent and in what way e-health development was taking place in Polish public health care and if there were any national policy targets or European targets influencing this development. It is based on desktop studies and interviews conducted in Poland in the spring and summer of 2015. The interviews largely confirmed findings from the desktop study: legal obstacles were the decisive factor hindering the development of e-health, especially telemedicine, with extensive insufficiency of basic IT infrastructure closely following. Stakeholders were deterred from engaging with telemedicine, and from procuring e-health using non-standard procedures, from fear of legal liability. Some doctor’s resistance to e-health was also noted. There are reasons for optimism. Amendment to the Act on the System of Information in Health Care removed most legal obstacles to e-health. The Polish national payer (NFZ) has started introducing reimbursement for remote services, though it is still too early see results of these changes. Some doctors′ reluctance to telemedicine may change due to demographic changes in this professional group, younger generations may regard ICT-based solutions as a norm. In the same time, poor development of basic IT infrastructure in Polish hospitals is likely to persist, unless a national programme of e-health development is implemented (with funds secured) and contracting e-health services by NFZ is introduced on a larger scale.

Migracje personelu medycznego i ich skutki dla funkcjonowania systemu ochrony zdrowia w Polsce

Migration of the medical professionals Migration of the healthcare personnel started long before Poland joined the EU. However, with the accession more and more people, especially doctors, decided to migrate. The main reason for migration was of a financial nature. In recent years the dynamics of this migration slowed down among physicians, but it increased among nurses. Though at the moment migration does not pose a serious problem for the healthcare system in Poland it may be one of the factors which will cause problems in the future. Majority of migrants are relatively young. There is a threat that there will be no replacement for nurses who will retire in the nearest future. State involvement / action is required to sustain the system.

The Innovation Procurement Policies and the Development of e‑health in the EU Member States: What Can Be Learnt?

The article presents findings of research on e ‑ health development in four European Union (EU) Member States in the context of public procurement of innovation (PPI). EU policies attempt to make public procurement leverage for innovation by introducing a number of new tender procedures. Policies and practices in PPI, including e ‑ health, were investigated for Denmark, Great Britain, Spain and Poland. For various reasons, all four countries struggle with the introduction of the European PPI procedures, and with making a transition to outcome ‑ based tenders. Though they all introduced policies implementing these procedures, Denmark and Great Britain seem to have achieved better results, having well ‑ established public ‑ private collaboration. This correlates with a more efficient adoption of e ‑ health solutions in those countries. With some minor successes, Spain, and particularly Poland, display attachment to traditional procedures despite changes in the public procurement regulations.

Rady społeczne i nadzorcze w opinii dyrektorów szpitali

This article presents the sources, nature and areas of criticism of governance. We will critically ref lect on both its theoretical-normative and its pragmatic dimension. The conclusions we will arrive at will serve to highlight the main issues around which the study of the deficits of governance is focused. Finally, we will see four hypothetical scenarios for the evolution of the public governance paradigm emerge on the basis of the critical ref lection and the resulting conclusions. (original abstract)

Funkcjonowanie i znaczenie rad nadzorczych przy niepublicznych szpitalach samorządowych

This article describes the results of research (conducted using a questionnaire) on the operation of boards of trustees in non-public local-government-owned hospitals. CEOs of the above-mentioned hospitals have positive opinions about the operation of the boards, recognizing them to be useful both for the owner authorities and the units themselves. Their supervisory function is particularly highly rated in economic and managerial areas. To a lesser extent this applies to the quality of services. No significant operational issues have been reported by respondents. The CEOs, however, stressed the fact that trustees are not always sufficiently prepared for meetings, moreover, when hospitals operated as independent public health care units, they did not have to finance the activities of such boards.

Zmiany w diagnostyce mikrobiologicznej w Polsce w latach 2007-2013

Changes in microbiological diagnostics in Poland in 2007–2013 This article presents the changes in the number, quality structure as well as in personnel structure of microbiological laboratories in Poland in 2007– 2013. The legal background of the above changes was also analysed, indicating that the issues concerning the operation of laboratories have been adopted relatively late compared to other healthcare institutions. As a result of the analysis, it was found that the number of the laboratories changes, and their number per capita in the different provinces is significantly different. These differences are also found in the number of staff per capita. At the same time an increased interest in the pro-quality activities was identified – an increasing number of laboratories have quality certificates.

Zmiany ról zarządczych lekarzy w szpitalach: czego możemy się nauczyć od Brytyjczyków?

This paper surveys the attitudes to managerial roles shown by Polish and British doctors and their evolution over the past decades. The paper is based on a review and analysis of literature, policy documents, healthcare statistic sand semi-structured interviews. Results of this research show that in the past doctors were reluctant to assume managerial roles in the UK system, whereas they were actually keen to do so in the Polish one. Changes in both countries (more market orientation in both countries, UK state policy) changed the doctors’ attitude to management. In the UK, doctors are at the moment more interested in taking on managerial responsibilities, while in Poland they are less interested in doing so in public hospitals due to the financial incentives attached to clinical work. In private hospitals, however, doctors understand the need for collaboration with general managers and other professional groups.