Transformation of the Health Sector Management

Introduction

Schizophrenia is a serious mental disorder and accounts for more than 7% of worldwide disabilities. People suffering from schizophrenia are usually incorrectly thought to be more dangerous, aggressive and prone to discrimination. Leadership in public health and mental hospitals is therefore an important topic of high significance (Brohan et al. 2010a). In 2012, the Political and Economic Risk Consultant (PERC) classified the health system of Singapore as the third best quality in the world, podium that reinforces the Joint Commission International (JCI) that has accredited 12 hospitals and medical centers in the country which represents one third of all medical institutions accredited by JCI in Asia. Their system is excellent because despite being composed of public and private health institutions, it offers both a high quality of medical care, at low prices and varying -in general terms- only at the level of facilities provided (Brohan et al. 2010b). The system is based on private contributions from citizens, added to state management and supervision plans to achieve greater efficiency and effectiveness. In fact, the percentage of public spending in the health sector in Singapore is approximately 33%, while in Western European countries it averages 75%.

According to Miguel Vicente Lopez, a graduate in Law and Economics from the University of Valladolid and who has studied in depth how Singapore finances its health system, the formula for success is quite simple. "This is a system based on the individual responsibility of patients, who have no incentive to abuse it because the costs are borne by their private fund." No one is left unattended, whether by one plan or another In addition, the patient has the protection of the state authorities against any possible medical malpractice and, most importantly, the companies that manage the hospitals have no interest in giving bad attention, because the patient can decide not to go back to that hospital and go to one where the care is better (Brohan, Slade, Clement & Thornicroft, 2010b). All of the above has led several countries, including the United States, to turn their attention to the Singaporean system. However, it should be noted that despite its success it is challenging to replicate since it has been established simultaneously with the development of the country for several years, in the context of a political stability and a line of government that has implemented measures relating to individual responsibility, mandatory savings and regulatory control of health services and their costs.

If we add to this that Singapore has a small population of only four million people (equivalent to Santiago) and concentrated in only 660 square kilometers, it can be assumed that the planning of the health infrastructure has been a little simpler than that which would be the case in the larger countries. Many countries intend to take Singapore as their example to follow. At the moment when health requires optimization in care, minimization of resources and connection of sectors, the doctor must seek to join teams and stimulate results (Koschorke et al. 2014). The constant search for perfect attention shows that leadership will be one of the most important medical functions for the hospital. In addition to the common challenges of the profession, which require the application of all the knowledge of anatomy, physiology, pharmacology, and pathology of the undergraduate, a doctor needs to deal with his role of authority in a health entity. One of the main misunderstandings is to believe that leaders are, simply, by vocation. Although they are CEOs, entrepreneurs and entrepreneurs need training, practice, and learning to achieve both tasks.

Literature Review

The study of the transformation of the management of the health sector requires a theoretical framework to support it, which is why it is necessary to address the administrative problems of the sector through the Taylor and Fayol (2010) studies since there is a need to increase the competition and improve efficiency. From this vision, the approach of the administrative problems of the company began, taking into consideration the following elements: the structure of the organization and the application of the general principles of the administration, fulfilling the functions of planning, organization, direction, and control, it is through these functions that organizational efficiency and effectiveness can be achieved (Kakuma et al. 2011). That inclination prevailed in the first fifty years of the twentieth century, which brought about a process of devaluation of the work of the human resource, for being mechanistic methods. According to Chiavenato (1998), it was with Mc Gregor and his theory "Y," gave rise to the social essence of man, ignored by administrative theory.

It was from the 60s when the problems of organizations began to be addressed from a different theoretical perspective, leading to consider the organization as an open and interconnected independent system that forms a unique whole that interacts with the environment. The system approach in its application to the administration gave rise to the theory of contingency, which points out that in administrative practices and organizations there is nothing absolute, administrative actions depend on the characteristics of each organization and each situation and not of universal organizational principles (Alonso et al. 2008). On the other hand when referring to organizations that provide health services, such as hospitals, the greatest asset is Human Resources, management is more necessary here, due to the high quality of health and non-health professionals, and the tradition of independence in their work which is why knowledge of leadership, delegation, and motivation is essential.

In this sense, Rodriguez (2001), states that the figure of the manager in health may or may not be a doctor, and in both cases must have specific training in the area of management. The managerial work must be done with exclusive dedication and permanent availability, so it cannot be compatible with the care work or in the teacher, since its sole purpose is to manage a large company of extraordinary complexity such as a hospital, corresponds to the direction promote, assume and lead the changes that are made in accordance with the institutional objectives. To provide development programs to the staff (Mondy, 2007, p.231), companies must take into account that individuals have different aspirations and experiences, resulting from the interrelationships with the environment and cites Schein's research, where he identified five reasons that allow people to select and prepare for a career by calling them "career anchors" among which describes managerial competence, as a goal of managers' career aimed at developing skills of interpersonal, analytical and emotional competence, with the desire to manage people; unlike individuals motivated by other anchors who do not seek managerial positions

In this sense, different points of view are analyzed below in relation to managerial development, which according to the perspective observed by Dessler, (2016, pp. 264-267), is similar to training, since it is aimed at providing managers with knowledge, attitude changes and greater leadership skills to improve their current and future performance. The author remarks that the recent trend of management development programs, take advantage of the talent of the staff by promoting from within and improve the future performance of the organization, being prepared to cover the next vacancies in executive positions, or to give a greater responsiveness in planning the needs of personnel at that level of the organization, and the needs of managers through performance evaluation. Another one of the authors consulted in this matter was Stoner, (2006, p.28) who establishes differences between the training and development programs in relation to the fact that the former is designed to maintain or improve work performance in the present, and the second to develop skills in work activities in the future and explains that there are formal development programs aimed at all levels of employees, and there are others for special groups, which include potential or new managers or executives, where the experiences vary in complexity.

The considerations on a management development program contributed by Villegas, (1996, p.48) who expresses that "it is a strategy of the company to identify, train and develop those individuals who meet desirable characteristics in the performance of management positions. As it is observed, the criterion of this author is broader and includes training in the current position and development to advance in future positions. On the other hand, the commitment to the development of human resources must coincide with the strategic development plan of the organization that includes the formulation of vision, mission, objectives, plans, and programs (Urdaneta, 2017, p.82). The preceding is in accordance with what was expressed by Villegas, (2016, p.14) who summarizes in the formulation of the mission of the organization a specific program of administration and development of the management cadres.

In relation to the implementation of a management development program, Villegas (2006, pp. 79-84) presents it as a process where ten steps are identified: Strategic analysis of the organization Personnel inventory Detection of training and development needs Design of the managerial development program Selection and recruitment of the participants Evaluation of the performance of the management personnel Audit of the management personnel Replacement tables Development program Evaluation of the project. This process must be based on clear principles of administration, andragogic education and human development, and the different authors agree that managerial training in the position, is the most important method to expand the experience and identify the strengths and weaknesses of the employee. It is necessary to mention that there is another method of managerial development outside the position, in different environments to the workplace, such as conference room, universities, national and international scientific events, where cou...