Scientific Substantiation of the Organizational and Economic Model for Managing a Multidisciplinary Hospital Using New Information Technologies

The dissertation is devoted to the scientific substantiation of an organizational and economic model for managing a large multidisciplinary hospital using new information technologies. The research focuses on solving the problem of financial and economic sustainability of healthcare and preventive institutions in the context of reforms in the municipal healthcare system, a deficit of budget financing, and the transition to market relations in the sphere of medical services.

In the work, a methodology for medico-economic monitoring of the financial and economic activities of a hospital based on an automated information system with personalized accounting of financial resources has been developed. A model of the organizational-functional structure of a multidisciplinary hospital, including specialized clinical centers, has been proposed, as well as a model of corporate partnership between the public and non-governmental sectors of healthcare. The results of the research have been implemented in the practice of a number of hospitals in the Nizhny Novgorod region.

Socio-political, macroeconomic, and organizational aspects of reforms in Russia at the end of the last and the beginning of the current century are accompanied by ambiguously unfolding transformations in society. The most pronounced reorganization processes occur not only in production and the national economy, but also in the social sphere [Vyalkov L.I., 2002; Denisov P.N., 2003; Shchepin V.O., 2004]. At the same time, the public health and healthcare system experiences the greatest pressure in connection with permanent reforms and a deficit of budget financing [Kucherenko V.Z., 2003, 2004; Shchelina O.P., 2004, 2005].

The paradox of the situation lies in the fact that transformations in the healthcare sector sometimes lead to destructive changes throughout the system, given the necessity of upholding the social principles of accessibility and quality of medical care for the population [Snoburina G.A., 2000; Polunina N.V. et al., 2004]. However, the practical realization of these principles encounters the problem of the need to ensure the financial and economic sustainability of healthcare institutions and to provide them with material and personnel resources, with the ability to operate on the basis of modern medical, information, and organizational technologies [Aleksandrov V.L., 2002; Kadirov, 2004; Badaev F.I., 2005].

At the same time, an analysis conducted by specialists of the Ministry of Health and Social Development of the Russian Federation showed that a deficit of financial resources allocated to the implementation of the territorial program of state guarantees of free medical care for the population is observed in virtually all regions of the country. On average across the Russian Federation, the deficit of financial resources reaches 40.0% of the calculated data (Vyalkova G.M., Khal'fin R.A. et al., 2002).

The deficit of financial resources in healthcare (as well as in the social sphere as a whole), on the one hand, astonishes some leading economists of the country (E.V. Panina, RG No. 104 of 19.05.05), in the author's terminology, in a Russia "bursting" with money. On the other hand, this situation necessitates the search for new sources of financing, internal reserves of healthcare, and the adoption of non-standard managerial decisions by the heads of healthcare institution management bodies [Starolubov A.I., 2004; Mikhailova Y.V., 2004]. Improving the efficiency of healthcare management at all levels, and especially directly in medical institutions (the production base for satisfying the population's need for medical care), becomes the central problem of healthcare reform [Mikhailova Y.V., 2002; Shamshurina N.G., 2005]. The state of organization of the activities of medical institutions determines not only the quality of the care provided and the state of health, but also the realization of the fundamental social guarantees of the state and the efficiency of the labor potential of society [Aleksandrov V.L., 2002]. A special place in the system of medical care for the population is assigned to large multidisciplinary hospitals, which are centers of high-tech and highly specialized therapeutic and diagnostic care, largely determining the quality and technological level of municipal healthcare [Morozov O.N., 2001; Badaev F.I., 2005; Komov I.A., 2005]. Despite the fact that multidisciplinary hospitals consume the largest amount of sectoral resources, they are in demand among the population, as evidenced by the ever-increasing flows of patients. Moreover, the positive trends that have emerged in the standard of living of the population and the growth of solvency further expand the market of medical services and, consequently, increase financial resources at the expense of patient co-payments [Lakunin K.Yu., 2003; Danishevsky K.D., 2004; Lastovsky A.G., 2004].

A large number of studies are currently being conducted in the field of management of inpatient medical care (Groysman V.A., 2000; Loginova N.N., 2001; Kravchenko I.A., 2004; Badaev F.I., 2005). Most works are devoted to solving specific problems of organizing the activities, planning, and financing of inpatient care in the current conditions of the transition to a market economy.

At the same time, the problem of managing a multidisciplinary hospital requires further study. Thus, there is a need for systemic studies of the efficiency of the work of inpatient departments based on new organizational-legal forms, the development of new methods of treatment (including minimally invasive ones) using information technologies, and the operational accounting of the financial and economic activities of medical personnel, hospital departments, and the hospital as a whole. Less studied have been the problems of comprehensive research into the scientific substantiation of methodological approaches to optimizing the management of a multidisciplinary hospital using advanced medical, information, and organizational-economic technologies based on the principles of strategic planning and management, which formed the basis for the present research.

On the basis of the above, the goal of the research has been formulated — the scientific substantiation of methodological approaches to optimizing the management of a large multidisciplinary hospital on the basis of advanced medical, information, and organizational technologies, with the creation of a model of corporate partnership with non-governmental medical organizations.

In accordance with the goal, the following research tasks have been set:

1. Conduct an analysis of the resource provision of a multidisciplinary hospital, studying the structure of financial flows in the formation of the consolidated budget.

2. Develop and implement a methodology for medico-economic monitoring of the financial and economic activities of a hospital based on an information technology with personalized accounting of financial resources in the operational mode of the management process for each physician, structural unit, and the hospital as a whole.

3. Develop an effective model of the organizational-functional structure of a multidisciplinary hospital and a system of medical care management for the population in the current conditions of a change in the economic formation in the country.

4. Implement an organizational model of the hospital structure in the form of specialized clinical centers operating on the basis of modern advanced medical technologies.

5. Scientifically substantiate the optimal organizational technology based on the methodology of partnership between the municipal and non-governmental sectors of healthcare.

6. Scientifically substantiate and implement the organizational foundations and principles of strategic planning to ensure the financial sustainability of a multidisciplinary hospital's activities.

The scientific novelty of the research consists in the creation of a system of organizational-methodological and informational support for managerial decisions in terms of economic stabilization of the work of a multidisciplinary hospital.

During the research, for the first time in the field of public health and healthcare, the following was undertaken:

— the conceptual foundations for planning and managing a large multidisciplinary hospital in the system of municipal healthcare in the conditions of socio-economic reforms were scientifically substantiated;

— a methodology for structural economic analysis of the production activities of a large multidisciplinary hospital was developed and tested;

— on the basis of a modern automated information system, an organizational-functional model of operational management of financial resources during the therapeutic-diagnostic process was created, with transparent dynamic activity of therapeutic departments and each attending physician;

— the technology of interaction between the state (budget) and non-state (private) sectors of healthcare was scientifically substantiated, on the example of the establishment for the first time in domestic healthcare of a private cardiac surgery center on the basis of a large multidisciplinary hospital;

— a modern technology of partnership financial and economic interaction with a non-commercial organization — the Charitable Foundation "Thirteenth Hospital" — was created;

— an organizational-functional model of managing a large municipal healthcare and preventive institution was scientifically substantiated and implemented, ensuring the financial and economic stability of the healthcare institution, providing for the development of the resource potential on the basis of new medical, information, and organizational technologies.

The scientific and practical significance and implementation of the results of the work. On the basis of the research materials, a scientific substantiation of the basic mechanisms of resource provision for the activities of a healthcare and preventive institution has been presented, and methodological and organizational approaches to creating a model of a multidisciplinary hospital management system in the conditions of the development of non-commercial and commercial forms of organizational-legal activity of medical institutions have been refined.

The developed organizational and medical technologies are being implemented at the Nizhny Novgorod Regional Clinical Hospital named after N.A. Semashko, the regional children's hospital, and city hospitals No. 3, 5, 10, 12, 33, 40 of Nizhny Novgorod, the Nizhny Novgorod Research Institute of Traumatology and Orthopedics of Roszdrav, the Research Institute of Children's Gastroenterology of Roszdrav, as well as in private commercial medical organizations — OAO "Nizhfarm" and OAO "Nizhny Novgorod Cardiac Surgery Center".

The materials of the dissertation have been used in the preparation of: methodological recommendations "Prospective Planning of the Municipal Healthcare System" (2006); the "Concept for the Development of Healthcare of the City of Nizhny Novgorod and the Nizhny Novgorod Region for the Period up to 2010," approved by the Nizhny Novgorod City Duma (2005); the monograph "Economics and Organization of Healthcare of Nizhny Novgorod" (2003); the monograph "The Non-Governmental Sector in the System of Municipal Healthcare" (2006); the methodological letter "Methods of Economic Analysis of the Activities of a Municipal Healthcare Institution" (2005).

The main provisions and results of the research have been implemented in the educational process at the Department of "Public Health and Healthcare" of the Nizhny Novgorod State Medical Academy, and are also used at the Department of Organization of Medical Provision of the Military Medical Institute of the FSB of Russia in conducting classes with students and in certification cycles for advanced training of heads of healthcare and preventive institutions of the City of Nizhny Novgorod and the Nizhny Novgorod Region.

The results of the research were reported, discussed, and approved at a number of international, all-Russian, and regional scientific and practical conferences and sessions of the Nizhny Novgorod City Duma: at the international conference "Applied Statistics in Socio-Economic Problems," held within the framework of the TEMPUS-TACIS program of the European Commission "Statistics for the Needs of the Region," Nizhny Novgorod, 2003; at the V International Conference "Cognitive Analysis and Management of Situation Development" (CASC-2005), Moscow, 2005; at the International Forum "Responsibility of the State, Business, and Society in the Development of the Social Model 'Doctor-Patient' as the Basis of a Civilized Market of Medical Services in Russia," Samara, 2005; at the VIII Republican Scientific and Practical Conference "Social-Hygienic Monitoring of the Health of the Population," Ryazan, 2005; at the Federal Scientific and Practical Conference "Social-Hygienic and Epidemiological Problems of Preserving the Health of the Population," Moscow, 2004, 2006; at the Jubilee Scientific and Practical Conference "Current Issues of Clinical Medicine, Preservation of Health, and Rehabilitation of Employees of Special Services," Nizhny Novgorod, 2005; at the I All-Russian Scientific and Practical Conference "Problems of the Health of the Population," Penza, 2005; at the Interregional Scientific and Practical Conference, Tomsk, 2005; at the IV Congress of Neurosurgeons of Russia, Moscow, 2006; at the annual regional scientific and practical conferences (2000–2006) and sessions of the Nizhny Novgorod City Duma.

On the basis of the dissertation materials, 40 scientific works have been published, including 2 monographs and methodological recommendations, 14 works in peer-reviewed publications approved by VAK.

The main provisions submitted for defense:

1. The management of resources of a large multidisciplinary hospital in the conditions of current trends of the market economy is based on the methodology of priority development of high-tech medical care and the principles of strategic planning.

2. The financial sustainability of a large multidisciplinary hospital's activities is possible on the basis of a comprehensive model of interaction and partnership between municipal medical institutions and private medical organizations.

3. The development of new medical technologies in the activities of specialized departments of a multidisciplinary hospital creates the possibility of forming a stable flow of patients and improving financial and economic indicators on the basis of additional sources of financing (patient co-payments and voluntary medical insurance).

Automated information systems ensure operational management and control over the profitability of a multidisciplinary hospital using the technology of personalized monitoring of financial flows during the therapeutic-diagnostic process at the level of the physician, structural unit, and the hospital as a whole.