73. Strategic Management of Clinical Services
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To achieve maximum health gain, many resources must come together at the same time: human, physical, and intellectual. The challenge of combining these inputs is becoming increasingly complex with the development of new diagnostics and treatments. Examples of poor quality care in countries of all levels of development reflect not only scarce resources, but inadequate management of the resources that are available. Moreover, ideological differences can complicate relations between different levels of the health care system, between the public and private sectors, and between vertical and horizontal programs.
Until recently, little attention was given to applying management principles to the health care sector. Currently, the trend is to apply private sector management principles to health care delivered through the public sector in the form of a "new public management." This approach requires managers to possess the skills and expertise that can apply to any business sector. In some countries, financial managers may be required to participate more actively in setting and monitoring standards of care, while practitioners will have to make decisions according to diagnostic and treatment protocols.
Many countries have a clear need to develop new strategies for training, career progression, and retention of health care workers. Much also can be done to better manage capital stock and the use of pharmaceuticals. However, there is surprisingly little research to inform such policy, and outcomes may be dependent on individual circumstances.