Reforming the Portuguese Healthcare system: Major Issues of Change Management

1. Reforming the Portuguese Healthcare system:Major Issues of Change Management EHMA Conference 2005 – IESE Barcelona J. Paulo Kuteev-Moreira PhD, University of Manchester

2. Summary • The 2002-2005 Reform Attempt • Elements of Change in Healthcare • Public opinion on health and well-being isssues • Resource shortage: a theoretical basis • Change Management in Healthcare: theory for governmental practice • Discussion (...)

3. 2002-2005 a period of yet another attempt to ‘reform’ the Portuguese NHS

4. A Dilemma for governmental intervention in healthcare management... Simple solutions for any complex problem can be found... ... but they are usually wrong...

5. Elements of change in healthcare: Healthcare defined A continuous complex process of change:constantly combining new scientific facts with pharmacological products and caring services, technological solutions, organisational arrangements, economics, politics, philosophical and ethical debates, common-sense individual/group opinions and media reports. • Science • Technology • Organisation • Economics • Politics • Ideology • Opinions • The Media

7. Healthcare organization Patients and service users Non-care customers Trade Unions and Professional associations Organisations representing patients and service users ‘Competitors’ / Rivals Purchasers/contractors Labour market Suppliers Media Regulators A contemporary healthcare corporation Challenges for The Health Manager: Needs / Interests? Power? Expectations? Perceptions? Atitudes? Culture(s)?

8. Public opinion on health and well-being isssues(An European example Portugal Marktest 2004)

9. Public opinion on health and well-being isssues: other findings I(An European example Portugal Marktest 2004) Percentage identifying important action for various organisations in improving health and well-being, by social group

10. Public opinion on health and well-being isssues: other findings II(An European example Portugal Marktest 2004) Age groups considered a priority for action to improve health and well-being Questions: Public opinion vs political agenda setting? Whose influences on setting these pubic perceptions?

11. So what?... Strategic Communication Options for healthcare organisations? • Reduced Waiting Lists (?) • Children First (?) • Elderly First (?) • ‘NHS Forever’ • Media • Patients and service users • Organisations representing patients and service users • Regulators (politics...) • Purchasers / contractors • ... Strategic Political appeal? Promoting this ‘kind of survey’ on Public opinion on health and well-being isssues... . Influence/impact on which stakeholders? But before we discuss answers...

12. Meeting Citizen/voter Expectations?Or everybody else´s?... (Laing, Angus, 2002)... Reengineering Strong centralized leadership Processual aspects Professional alienation and resistance Negotiated participation Change process Professional ownership Outcomes User empowerment Reorientation service provision Change healthcare delivery Challenge professional expertise / autonomy Resource utilization? Reconfiguring service encounter? POLITICAL INPUT Individual ‘consumer’ concerns? USER INPUT Public sector collective concerns? PROFESSIONAL INPUT GOV Message Content?

13. Specific Assets • Human Competencies • Intangible Abilities Resources Strategic Thinking:The Resource-Based View (RBV) (Barney, 2001; Peteraf, 1993) • Bundle resources • Make this ‘bundle’ inimitable by competitors Management role • Imitation through Resource accumulation • Differentiation (idiosyncratic resource accumulation) Competition • A function to obtain/deploy unique/scarce resources Performance Whose performance goals?

14. Whose Performance Goals?(Short, Palmer & Ketchen, 2002) Key stakeholders? Resource Utilization Balanced scoreboards Strategic Thinking II:The Resource-Based View (RBV) (Barney, 2001; Peteraf, 1993) Government Message Content?

15. Major Change Management Issues • The resource dependence view, also maintains that the attempts to solve resource shortages, oblige the organisation to change the balance between its dependencies. As suggested by some authors (see Harrison et al, 1992; Pfeffer & Salancik, 1978), this new balance of dependency may be achieved by one or a combination of four strategic alternatives: • Adapt to the conditions (e.g.: influence demand of services or its delivery) • Alter its interdependencies (e.g.: merger with an organisation that controls some of the scarce resources or growth by developing new services/products so that the organisation is no longer dependent) • Negotiate environmental conditions (e.g.: create partnerships to deliver joint services or share resources for instance with social services, voluntary NGOs or even the private sector) • Change by political action (e.g.: lobbying politicians to obtain subsidies, favourable regulation and contracts)

16. Major Change Management Issues Elements of change in healthcare Healthcare stakeholders Resource shortage dilemmas Organizational Strategic alternatives: Adapt Alter Negotiate Change STRATEGIC COMMUNICATION GOV Message Design

17. Two Paradigms of contemporary Healthcare andGovernment Message Design…yet another challenge In Moreira, JPK (1998)

18. A Dilemma of healthcare management... There are simple solutions to all complex problems... ... but they are usually wrong... ... Yet, do managers have time to ‘think’?...

19. THANK YOU!