Saturday, June 04, 2005

Health Systems Management

When I visited my old clinic in California, my former colleagues thought I had gone bonkers. I told them that I was working on my Master's degree in 'Health Systems Management.' I have to admit that I agree with them; when we worked together, I just hated the whole concept. I considered myself to be a clinician - willing to work overtime to see more patients, leave my day job to drive an hour to make sure the homeless clinic had a medical provider, set up health clinics at migrant farmworker camps, etc. When we had discussions about financing, quality assurance, and cost-benefit analysis, I went to sleep; it never seemed relevant to me.

Since I've been working in Laos, health systems management has grown in importance for me. I realized - quickly - that if I train medical staff in some skill, and then they can not use this skill, then it's as if they never had the training at all. However, when we have planning meetings, medical staff usually say that they need medical training, and don't address other issues.

An example: One day, in 1998, I was talking with a lab technician in a district hospital. I asked her how many Gram stains they were doing (a staining procedure so you can see bacteria to determine if they are Gram + or Gram - so you can start the decision tree about the probable causitive organism). She said that they didn't do any because she didn't have the chemicals. I remembered giving them a set of premixed chemicals and after rummaging in the cabinet, I pulled it out (unopened!). She then sheepishly admitted that although she knew how to do the procedure, and had the chemicals, the doctors were not ordering it. This led to other discussions that involved changing habits (doctors were not accustomed to ordering other tests because they didn't have the opportunities before) to advocating to patients about the need for the tests to guide treatment.

I quickly realized that upgrading medical treatment is very complex. So to pick up the skills to make the changes in behavior sustainable, I've been working my way through this program.

So next week, I'm taking the exams in Health Economics and Financing and Health Management. For the past few weeks, after studying for an hour, I've been rewarding myself with a half hour of writing. I'm trying to do the same thing this weekend.

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