Managing the Health Program: From Problems to Decisions
Managing a Tribal health program is not simply a matter of keeping the organization running. A Health Director must continually identify problems, understand what is causing them, consider alternatives, make decisions, put those decisions into action, and determine whether they worked.
A useful management cycle is:
Problem → Information → Analysis → Options → Decision → Implementation → Follow-up
Start With the Problem
Good management begins by defining the problem clearly. Before deciding what to do, the Health Director needs to understand what is actually happening, who is affected, how significant the problem is, and whether it is a temporary issue or a continuing one.
A problem may involve staffing, financing, access, services, information, facilities, policy, or several of these at the same time. The first task is not to find a solution. It is to understand the problem well enough to make a sound decision.
Get the Right Information
The Health Director needs enough reliable information to understand the problem. That does not mean collecting every possible piece of data. It means identifying the information that will actually help explain what is happening.
The information may come from clinical services, staffing, finance, Purchased/Referred Care, eligibility, public health, patient experience, or other parts of the program. The important question is whether the information is accurate, timely, understandable, and relevant to the decision.
Analyze Before Choosing a Solution
Once the problem is understood, the Health Director needs to consider what is causing it. Is the problem temporary or persistent? Is it limited to one service or affecting the organization more broadly? Is the underlying issue demand, capacity, staffing, process, resources, policy, or authority?
Management judgment matters here. Some problems can be addressed within the Health Director’s authority. Others require additional resources, a change in Tribal policy, or a decision by Tribal Council.
Develop Options
Good management does not assume there is only one possible answer. The Health Director should consider alternatives and understand the trade-offs associated with each.
Options may involve changing how existing resources are used, changing a process, adjusting services, recruiting or reallocating staff, working with another organization, or requesting additional resources. The most expensive option is not automatically the best option.
Know Who Has Authority to Decide
A central part of Tribal health management is understanding the difference between management authority and Tribal government authority.
The Health Director can make operational decisions within the authority delegated by Tribal government. Tribal Council may need to decide matters involving budgets, major capital investments, personnel policies, Tribal policy, or other matters reserved to Tribal leadership.
A Health Director should not be expected to solve problems that require authority or resources the director does not possess. At the same time, important problems should be brought to Tribal leadership with enough information to support a decision.
Implement the Decision
A decision is not the same thing as implementation. Someone must be responsible for carrying it out, staff need to understand what is changing, necessary resources must be available, and obstacles need to be identified.
Implementation should include clear responsibility, timing, communication, and a way to determine whether the decision is producing the intended result.
Follow Up
Management does not end when a decision is implemented. The Health Director needs to determine whether the change worked.
Follow-up may involve reviewing results, asking staff what they are seeing, looking at costs or service measures, listening to patients and community members, and identifying unintended consequences. If the decision did not work, the next step is to understand why and adjust.
Not Every Problem Requires a New Program
One of the risks in health program management is responding to every problem by creating something new: a new position, service, committee, software system, or program.
Sometimes the better answer is to organize existing resources differently, clarify responsibility, improve communication, or change an existing process. New programs also create ongoing costs and responsibilities that must be sustained.
Management Is a Continuous Process
A Tribal health program operates in a changing environment. Staffing changes. Patient needs change. Funding changes. Federal and state requirements change. New health problems emerge. Community expectations change.
Good management therefore is not a one-time exercise. It is a continuing cycle:
Identify → Understand → Decide → Act → Learn
Questions for Tribal Leadership
- What is the problem?
- What information supports our understanding of it?
- What are the realistic alternatives?
- Is this a management decision or a Tribal government decision?
- What resources are required?
- Who is responsible for implementation?
- How will we know whether the decision worked?
- When should the decision be reviewed?
The Basic Principle
Good management is not having an answer to every problem. It is having a disciplined way to understand problems, make decisions, act, and learn from the results.
Identify the problem. Understand it. Make the decision. Act. Learn. Then do it again.