EditorialClinical Management LevelsNiveles de gestión clínica
Section snippets
THE ECONOMIC CRISIS AND THE HEALTH SYSTEM
In this scenario, health care practitioners, on the one hand, find it challenging to balance ever-increasing demand with ever-dwindling economic resources in their daily clinical practice and decision-making. Health care managers, on the other hand, have to deal with the high cost of new, technological interventions and innovations– some with limited effectiveness–, increased demand, and the major knock-on effect of longer waiting lists. Halfway along this continuum are health care
CLINICAL MANAGEMENT UNITS
In addition to structural measures to increase efficiency, productivity, and quality, it appears that a set of predominantly clinical changes is essential to achieve system sustainability.5 Improved organization of clinical processes will clearly enhance health outcomes, and this improvement depends on clinical leadership. Health care professionals continually make clinical decisions that have significant economic implications. This is a vital point. It is the physicians who decide, control,
CLINICAL MANAGEMENT LEVELS
Many health care professionals have an incomplete understanding of the concept of CMUs, their objectives, implementation, and applicability. The concept of clinical management is often used across a wide range of clinical scenarios, hindering proper understanding and masking the potential for implementation.
Cardiac CMUs should centralize related disciplines and activities that are essential in cardiology and heart surgery, sharing organization and budgets at a functional level. There are
CLINICAL MANAGEMENT UNITS, PROPOSED CHANGES, AND SYSTEM SUSTAINABILITY
To increase the efficiency, productivity, and quality of the health care system, a number of changes have been proposed that are essential if sustainability is to be achieved in the medium-term.12 The common denominator of these changes is improved efficiency and a more rational distribution of resources to match capacity, activity, and quality. One change that has been put forward to increase efficiency is to devolve management to CMUs. This change breaks with the current situation, and is a
CONFLICTS OF INTEREST
None declared.
References (15)
- et al.
El «Instituto de Enfermedades Cardiovasculares». Proyecto de rediseño de los Servicios de Cardiología y Cirugía del Hospital Clínic de Barcelona
Rev Esp Cardiol.
(1998) Designing care: aligning the nature and management of health care
(2009)Lost in translation: physicians’ struggle with cost-reduction programs
Ann Intern Med.
(2011)Leading clinicians and clinicians leading
N Engl J Med.
(2013)- et al.
What distinguishes top-performing hospitals in acute myocardial infarction mortality rates?
Ann Intern Med.
(2011) What is value in health care?
N Engl J Med.
(2010)- et al.
Management practices and the quality of care in cardiac units
JAMA Intern Med.
(2013)