EHMA YAC Blog – Issue 2 – Are we brave enough?


Greater focus on patients’ individual needs.

More collaboration and flexibility.

Lesser administrative burden.

This sounds good, doesn’t it? Is there anyone out there who wouldn’t sign up for a healthcare system where this is the norm? I don’t think there is. So… what’s stopping us from getting there? A lack of trust?

Trust-based governance and management. I don’t know about you, my colleagues out there in wider Europe, but at least in Sweden trust-based governance and management seems to be the word on everyone’s lips – at least in the public sector. The government has appointed a Trust Delegation to study and suggest how the governance of welfare services may be developed to better make use of professionals’ competence and achieve greater quality for residents, and my experience as a management consultant is that we’re being asked to visit organisations to talk about trust-based governance and management: Why have it? What is it? And how to do it?

Trust-based governance and management has risen as a critique against New Public Management which has left healthcare professionals with a sense of increased bureaucracy and micro management: rather than spending their time focusing on their core task of meeting patients’ needs and delivering high quality healthcare they are required to spend their time documenting and reporting what they do all day long. Can we just pause for a second and ask ourselves, is that really the way to increase efficiency and quality in our healthcare services?

What if we instead reduce healthcare professionals’ administrative requirements and allow them to use their competence and commitment to make the most of every meeting with every patient in order to find solutions to meet patients’ needs in a flexible and individualised manner?

What if we don’t financially monitor each healthcare department or unit separately but rather apply a systems perspective and collaborate across organisational boundaries driven by the purpose of meeting our patients’ (often complex) healthcare needs as opposed to our organisational financial needs?

What if we simply govern and manage our healthcare systems primarily based on trust, trust in healthcare professionals on all levels and their ability, integrity, and willingness to do the right things in the right way?

Trust has been defined as “the willingness of a party to be vulnerable to the actions of another party based on the expectation that the other party will perform a particular action important to the trustor, irrespective of the ability to monitor or control the party” (Mayer, R. C., Davis, J. H., & Schoorman, F. D., 1995)

So, for the sake of our patients, are we brave enough to be vulnerable?

Vania Ranjbar – EHMA YAC Chair, February 2018

Posted in News, YAC Blog
4 comments on “EHMA YAC Blog – Issue 2 – Are we brave enough?
  1. mihai negrea says:

    Dear Vanja,

    Consider that Europe has developed separatly until now. There are countries that very liberal and democratic in the north and west and there are more iliberal countries and dictatorial, in the east and south (and now center) of Europe.

    Above everything is also the corruption aspect in wich we in Romania have a deep and profound knowledge.

    Also beside the cultural aspect there are practical aspects. I don`t think that health professionals should be only serving patient needs but also i think they need to be involved in the administrative tasks of the system. and they should have deep knowledge of the whole apparatus that works for the patient well being. otherwise theu cannot understand their role in the system.

    There is a book, Health Systems Science, edited by American Medical Association that talks a lot about the importance of this knowledge for the health professionals.

    • Vania says:

      Thank you very much for sharing your thoughts, Mihai! You’re making excellent points in that various countries’ varying development and also corruption are important aspects to consider.

      With regard to healthcare professionals being involved in administrative tasks, I have two thoughts. First, I don’t believe that healthcare professionals who primarily work clinically must necessarily also carry out administrative tasks. I personally believe that healthcare professionals who are employed for clinical work should focus on clinical work and healthcare professionals who are employed for administrative work should focus on administrative work. That is not to say that healthcare professionals should not have knowledge of the entire system; systems perspective and systems theory are fundamental to high-quality healthcare services, I believe.

      Second, if healthcare professionals are not there to primarily serve patients’ needs, then why are we there? In my opinion, administration should never be an objective on its own, administration should only be a supportive mechanism. I see no value in healthcare professionals carrying out administrative task just for the sake of it; the purpose of carrying out administrative tasks should be to meet patients’ needs – and help us improve how we meet patients’ needs.

      In doing so, however, we need of course an understanding of the entire system, including clinical and administrative aspects.

      • mihai negrea says:

        i can respect your ponit of view.

        It really depends on the system. Maybe in de the beveridge(and beverdige like) countries health professionals don`t need to have administrative tasks. but the others systems work with budgets, they have a lot of reporting, billing, estimating costs.

        I do believe that administrative tasks can be automated… with the IT industry development. But the knowledge about the administrative part of any health system should be known. i can give you lots of examples from Romania and other countries on how bad decision are made just because health professionals and healthcare professionals have different views and opinions. no healthcare system can have more administrative clerks than health professionals… and in the end any decision is political.

        on the other side here in Romania we have a lots of debating also about how medicine became more of a administrative job and how doctors are retained from the saving life activity. but top 5 DRGs are non surgical affection of the spine with cc and without cc (eg, spondilitis) fat liver, COPD… and new born.

        so … i think that in the end… doctors are complaining a lot… also maybe there is a lot beaureaucracy… but we need a middle way. and the american way with the 3rd pillar of medical education, health systems sciences beside preclinical and clinical is the way we need.

        of course this is my opinion and i`m not an authority. but it would be interesting for research. maybe cross europe research…

        • Vania says:

          The middle way you’re mentioning, that’s what trust-based governance and management is about. I believe all health systems have – and need to have – budgets, reporting, etc. The idea of trust-based governance and management is to keep the administrative burden on healthcare professionals on an appropriate level – not to remove them entirely.

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