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Ben RHM II - LZG.NRW

Ben RHM II - LZG.NRW

Benchmarking Regional Health Management II (Ben RHM II) ___________________________________________________________________________________________________________________________________________________________________ creative, innovative or developmental in nature, where various people talk to and collaborate with each other in either informal or team settings. Open – ended communication and collabo- ration are features that energise a network. The more complex the organization the more complex the organigraph will be. Or- ganigraphs illustrate relationships and processes. An organization is not restricted to one type of organigraph. There is no single correct organigraph. Instead there can be many types of organigraph. The authors of the organigraph considered that: managers of a set, allocate; managers of a chain, control; managers of a hub, co-ordinate; managers of a web link it all and energise. They also drew a distinction between the set and the chain, which they considered to be two rather conventional components not unlike the traditional “boxes” in an organisation chart, and the hub and the web, towards which there is a growing propensity in organizations of to- day. Organigraphs do not eliminate “boxes” altogether but do introduce new components which the authors called hubs and webs. Organigraphs in Ben II RHM As already indicated, the purpose of the Ben II RHM project in seeking organigraphs was to provide overviews of the organisation of the regional health management systems and programmes for the tracers of breast cancer, diabetes (type II) and measles. The aim was to depict the relationships of the different decision-making bodies to each other as well as the flow of actions within the health management process. This is essential because it is not only the outcome of regional health management that is important but also an understanding of how it is organised. As we have seen from Mintzberg and Van der Heyden, organigraphs are not just diagrams but maps, and serve to describe the interaction between people and information flow. For an optimal comparability of all organigraphs, we asked all project members to use “basic forms for the organigraphs“ and “different kinds of arrows for different functional connections” as detailed in par 4.2. The use of organigraphs in Ben II RHM has a very broad focus. As well as looking within individual organisations Ben II RHM has also been seeking to look at the relationships between organisations at the different levels and how various organisations function within an overall health management system at all levels, national, regional and local; also to look at the flow of actions within the health management process of planning, organising, delivering and monitoring of preventive, treatment and care services for the three tracers, measles, breast cancer and diabetes. It is not always possible to get such a comprehensive picture from the - 122 -

Benchmarking Regional Health Management II (Ben RHM II) ___________________________________________________________________________________________________________________________________________________________________ organigraphs and programme descriptions received and the discussion that follows is limited by this constraint. Organigraphs and Programme Descriptions for Measles All 19 of the participating regions submitted organigraphs for measles. Programme descriptions were received from 16 regions the exceptions being, Gyor-Moson-Sopron County (HU), Veneto (IT) and Madeira (PT). Whilst the organigraphs can give an overview of the health management system, the programme descriptions can give a number of more detailed insights into the system. The existence of two chains, from and to national level, can be seen in 12 of the 19 regions, Varna Oblast (BG), Moravia-Silesia (CZ), Western Greece (EL), Gyor-Moson-Sopron County (HU). Szabolcs-Szatmar (HU), Dublin/Mid-Leinster and Dublin/North-East (IE), Kaunas (LT), Madeira (PT), Chuvash Republic (Russian Federation), Vastra-Gotaland (SE), Ticino (CH), England (UK). In these regions the organigraphs and programme descriptions show one chain through which there is downward transmission from national Ministry level to regional and local levels, of a measles immunisation policy or programme, including vaccination schedules decided by the Ministry nationally, and another chain through which there is upward transmission of surveillance data to national level. Different organisational arrangements are shown in Upper Austria (AT), Flemish Community (BE), North Rhine-Westphalia (DE), Saxony-Anhalt (DE), Emilia-Romagna (IT), Sicily (IT), Veneto (IT), regions. The federal government agrees the national immunisation programme with the states or regions in Upper Austria (AT). The Flemish Community (BE) participates each year in an inter-ministerial conference at which the Federal and Community health ministers agree an immunisation schedule. In Germany there is no national immunisation plan but the two participating German regions draw up their own action programmes and targets. In doing this, the two regions adopt the recommendations of the national expert advisory institution, STIKO, without modification. In Italy all regions now agree the national plan with the Ministry through the aegis of the State Regions conference. The Austrian, German and Italian regions do show an upward chain from local through regional to national level for surveillance data but the Flemish region does not show such a chain. The reference framework for measles includes a national/regional immunisation plan with defined targets, also a law on notification of infectious diseases and also refers to a goal of improving measles immunisation surveillance. - 123 -

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