Addressing the Future of Healthcare Technology ManagementThis opinion has been circulated through the Infratech email list. I thought that it might be of interest to a wider circle of biomedical engineers and asked the author for permission to publish it in the IFMBE News. Infratech is a worldwide Internet forum, initiated by WHO and put into action by PAHO in 1999. The forum serves as a discussion and communication platform for professionals who are involved in the management of healthcare technology from the policy to the implementation level. A major objective is to promote systematic healthcare technology management and maintenance systems in health services of developing economies. What's the point?Why bother about the future of Healthcare Technology Management (HTM), when there is still a dire need for even basic maintenance services in many settings? Well, it is not in vain that we have been pushing for success and become an internationally renowned group of experts and thus created a lot of expectations. This is why, involuntarily we will be calling for trouble, if we are not careful. What can be so dangerous about this? We are even using modern Internet technology to maintain contact, exchange information and to discuss important issues. It has brought us a lot of advancement and has, above all, boosted the inclusion of formerly isolated HTM groups. Well done! The danger lies - as always - in human nature. An increasing number of HTM experts feel quite comfortable now they have become a fairly close-knit community. A cosy ecological niche for us people who are more than often treated with disinterest and disrespect during our daily work. A niche with a common identity that gives us the warm feeling of mutual understanding. The result can be some sort of secret society suffering from the Mafia effect, by becoming protective and self-centred to the extent that it obstructs our ability to recognise relevant changes and opportunities around us. A broad movement of restructuring health services exists in developing countries - the trend of autonomisation of hospitals in some Asian countries is just one example - calling on our ability to adapt and to be creative. Let us recognise the Mafia effect and take up the challenge. To do this, it might be helpful to briefly review our own history. The evolution of HTM in developing countries started about 30 years ago with simple ideas about having repair services at hand. About 10 years later the first efforts to encourage Planned Preventive Maintenance systems were undertaken. Parallel to this, WHO started to develop global strategies in promoting and implementing modern maintenance and repair concepts. A broader view on keeping-up healthcare technology led to concepts such as Physical Assets Management and finally to Healthcare Technology Management that also features elements of policy development, the Essential Healthcare Technology Package etc. Again, well done! However, is there not a nagging, uncomfortable certitude that the performance of HTM leaves a lot to be desired? In addition, do we not share the same insight with other disciplines in healthcare delivery? So, let us try to leave the snug safety of our niche more often, let us promote closer and sustainable relations to the other managers in health services, even if this requires the qualities of a door-to-door salesperson, selling insurance policies or vacuum cleaners. From isolation to integrationLike other health workers, we are often confronted with a situation in which we feel surrendered to a quagmire of inefficiency, self-interest and, finally, a general powerlessness in overcoming day-to-day problems. This is partially caused by our technology fixation that was imprinted on most of us during our basic training, but even more by the fragmented way of managing health facilities. This practical part of delivering health services has almost been forgotten during recent years while developing the global strategies and policies of health sector reform. Many countries have thus fallen into the trap of decentralising health services, without providing sufficient tools to carry it through. Among others, WHO recognises this in its widely, and in some aspects controversially discussed World Health Report 2000 by focussing the report on performance improvement of health systems. To attain the objectives formulated in the report, namely
the following functions must be assured:
Where service provision is satisfactory we can observe a number of common factors of success, among others: formal and actual commitment of leaders, decentralisation, holistic (integrated) management approach and a good portion of luck, for example having the right personnel at hand at the right time. Moreover, let us not forget one crucial aspect: law and law enforcement. Without a legal system that defines mandate, liabilities and responsibilities of health organisations and their workers and which is enforceable, no country, be it an industrial or a developing one, can sustain an acceptable quality of care. If assuring service provision represents an essential part of improving performance, performance must be made measurable. What we need is to broaden the evidence base of HTM, in terms of
This would be the core of a quality management approach that would give us a tool and leverage for optimising processes related to HTM and to all the other management areas in health facilities. These areas include
If we agree that all this is - to varying degrees - connected to HTM then we should take action to make the connections work. Developing an integrated HTMThe task is complex and requires in itself an integrated approach. The different players in the game would have different roles at the different levels (policy, planning - mesomanagement at regional and district levels - micromanagement at institutional level). Who can do what?
This list is by no means complete. I suggest putting the issue onto the agenda of upcoming international meetings. We at GTZ have only recently begun with some groundwork with the objective to develop an innovative approach to Health service Delivery Management. I welcome any contribution to this theme and the issues raised in this paper. Hans Halbwachs
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