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Introduction

Management is involved with two separate items:

• Management of the Client

• Management of the Operations

It has been the recommendations of InHCc that separate Managers be appointed and be held responsible for these two entirely different fields of study and expertise (at the organization level). Asking a physician (trained for years to be a physician) to manage a business organization, sounds just as ridiculous as asking a business manager (trained for years to run a business) to treat a client [The point of this whole Web Site].  

Information is needed by managers to perform their functions. Different levels of users require different information but in generally ALL data is relevant to management. 

In general clients will vote with "their feet" and it may not really make a lot of different on what they said in their exit interviews. A better measure of client acceptance is "The Numbers." 

Client Management

Examples of information needed are the following:

Designated Indicators

Based on the requirements of the project

Service Level Requirements

Information Needed: Is all information that is required to be filled out on protocol forms filled out? 

How used: Form may be to difficult; HCP does not understand why data is collected; HCP doesn't understand the procedure; HCP not explaining to client why information is needed; client will not give information because of confidential concerns;

Where Obtained: Number of line items on the forms not completely or incorrectly filled out

Client Tracking System

Information Needed: Where is the client in the system? Has he or she completed all examinations and reported to the proper unit as directed?

How used: Follow up on the client; If clients are not completing all examinations, we need to know why and improve the health care system to make it easier for the client to understand; Follow up may also be used to schedule home visits to those that are at high risk; follow up on treatment plans, follow up on appointments; preparation for key events such as "impending pregnancy"

Where Obtained: Follow up dates missed; Procedures not complete; 

Marketing of the Services

Information Need: Is the right service offered to the right client at the right price at the right time?

How Used:

The right service should be offered to the client based on his or her profile. It is not enough just to tell the client what you have and let them pick out whatever they want. 

A knowledge of the client's ability to pay, provides information that can be used for the marketing of the service and the sustainability of the project. 

Staffing Requirement

Information Needed: Is the staffing adequacy for the amount of work required and are work objectives meet? Are waiting times to long for the client based on the goals? Are administrative duties performed when and as required? 

How Used: 

1. Staffing should be adequate in order to perform the work based on the goals and protocols set by the organization. If the amount of time spent with a client is not according to protocols (15 minutes instead of 30) is it because the HCP does not have enough time or the HCP may not be performing the protocol correctly; 

2. A long waiting time can discouraged the client from coming for the services that he or she may need. 

3. Sufficient staffing is required to not only perform their day to day duties but also "keep up with their paperwork." If no data is collected or if that data is always late in arriving, then informed decisions cannot be made and changes made as needed.

Where Obtained: Waiting time of client, number of minutes spend on client per protocol; "Lateness" of administrative reports; Functions not being performed; Client exit interview' staff suggestions.

Staff Trained 

Information Need: Are the staff properly trained for the goals set for the particular organizational unit and the demands of the clients.

How Used:  

1. The number of nurses or the number of trained individuals have no meaning outside a stated demand for services. Wither there is one nurse or a hundred nurses have no meaning. Only by stating the number of nurses or trained personal per number of clients FOR THAT REQUIRED TRAINING can a meaning method of preparedness be undertaken. One trainees may be more than enough trained for a organization unit only requiring that service once a year, whereas in a large hospital, 12 trainees may be insufficient. 

2. By understanding client needs, the "correct" training can be provided in the number, locations, and staff that require that type of training. Tremendous amount of resources an time can be saved by having this information 

3. Conflicts over "workload" will be minimized.

Where Obtained: Number of clients with the requirements for that trained Professional. Obtained from matching Human Resource File with Client Diagnosis. 

Examples Operating Data 

Generally Operating Data will come from a good accounting system. 

Inventory Level Requirements 

Information Need: Are inventory levels and items stocked appropriate for the service requirements of the clients. In order to determine this information the following information is the minimum information needed:

• Disease patterns and Service Requirements in the local area

• Health Care Practices (family planning) permitted in the local area

• The goals of your organization

• The skills of the staff in delivering each type of method 

How use:  (See full discussion on Inventory Management at Management Inventories) 

1. The number and types of methods offered [and training of personnel]  by a facility depends on the requirements of that facility's clients. It is impossible for every facility to offer every type of method and they should not be expected to do so. This is a waste of resources. "Contraceptive Choice" is NOT a component of a high quality family planning program. Different methods should be offered to different types of clients, such as based on age, health status, number of children, etc. Letting a client "choose" what they want may not be appropriate. In the long run, this can only do damage to the program. If the conceptive method is not correct for the client, then it will fail and the client may never again return. Again, only by analyzing the individual client's requirements, by the Health Care Professional, can a meaning evaluation of the "number of methods used" have any value. The evaluation should be, "does the facility offer the correct methods based on that facility's demand for services and its clients requirements?" Quality of Service can only be evaluated in terms of the HCP knowing and understanding his or her clients needs.

2. A good inventory systems "tracks" inventory. Individual items can be tracked to individual clients. By tracking inventory, pipeline wastage will be reduced because accountability can be assigned. 

3. What is generally not obtained in Inventory management systems is the total cost of carrying inventories. It may Not be good business practice to "practice a no out-of-stock policy." Carrying that extra supply may cost more that the returns. This is especially true when they is an "emergency" source such as a pharmacy or another Family Planning near by. It make better economic sense to plan for "out-of-stock" situations. 

Where Obtained: Client Diagnosis (demand); Inventory Management System (Supply); Forecast; Budget

Resource Utilization

Resource Utilization is necessary in order to maximize the organizations return of their investment. Resources should not be over utilized--where there is not enough resources to meet demand, and resources should not be underutilized--where there is more resources than needed to service the demand.

The only way to effectively use resources is by forecasting supply and demand for those resources. Without this ability, the "correct" amount of resources can not be brought together. 

Some of only a few examples of items of data that needs to be collected in order to forecast supply of resources and the demand for those resources. 

Cash Flow  Requirements 

Although, in general, project management requires a budgeted projection, very few projects require a cash flow projection. A good example of the misuse of cash flow, is when an organization "straight-line"  the budgeted amount over a year, i.e. they take a budget amount and divide it by 12 to come up with a monthly figure. Many projects just don't work that way. Most funding is needed in the beginning of the program for start up costs and other initial investments. By knowing exactly when cash may be needed (and when the organization may be short or have an access, better use of the money can be made. By knowing exactly how much money is needed and when, a donor may allow for "adjustments" over periods and allow the organization to substitute one category of expenditures for another. 

Political

Information Needed: Can the project successful operate under the political and social conditions of the area.  Political information is needed in order to keep informed of the changes in the "External Environment."  

How Used:

1. The political and social conditions of the area must be clearly known before policy statements are made. Although certain results may be desired from the organizational point of view,  the "way" you make public statements may destructive to the organizations goals. 

2. It is the client's "perception" of the political and social attitudes that may be more important than the actual statements made by political or social leaders. By directly discussing these attitudes with the client on a one to one basis, the clients concerns can be more easily addressed. 

Where Obtained: Interview with clients and directly taking with informed persons.

Planning

Information Needed: Can informed decision making be undertaken. Planning is the summation of all the previous data collected. This includes client information, health information, and the external environment. Without data informed decisions cannot be made. 

How Used:  

1. Client information helps to understand the needs or services required of the population. Without knowing the client and his or her needs then it is impossible to provide the quantity or types of services demanded.

2. Health information is needed in order to provide services efficiently and effectively. 

3. Without a knowledge of the external environment there is no way of knowing what services are lacking within the community and what services are fully provided for in the community.

4. Without knowing what other services that other organizations offer in the area, a effective referral cannot be established. 

5. When supporting data is available to substantiate decisions, "misunderstanding" are minimized and cooperation is increased. 

6. Steps in implementing the plans are more easily coordinated.

Where Obtain: Information for planning comes from the summation of all of the data collected: This includes information collected from the client, the health setting, and the collection of external statistics. 

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