Management System and Performance of the Catholic Organisation for Health in Cameroon: Concepts Analysis

Management System and Performance of the Catholic Organisation for Health in Cameroon: Concepts Analysis

Eugénie Yvette NGA EBOLO^1*, Benjamin Alexandre NKOUM²¹Inf; MGHS; PhD student in Public Health, School of Health Sciences, Catholic University of Central Africa
²PhD in Educational Sciences; Professor, Director of the Doctoral Training Unit of the School of Health Sciences, Catholic University of Central Africa

Received Date: November 28, 2022; Accepted Date: December 01, 2022; Published Date: December 07, 2022;
^*Corresponding author: Eugénie Yvette NGA EBOLO. Inf; MGHS; PhD student in Public Health, School of Health Sciences, Catholic University of Central Africa. Email: yvebolo14@gmail.com

Citation: EBOLO E Y N, NKOUM B A (2022) Management System and Performance of the Catholic Organisation for Health in Cameroon: Concepts Analysis. Adv Pub Health Com Trop Med: APCTM-169.

DOI: 10.37722/APHCTM.2022602

Abstract
Concept analysis is described by some authors as being a rigorous and pragmatic method to define a concept and thus contribute to the enrichment of scientific knowledge. The choice of the method of analysis depends primarily on the nature of the problem that the researcher is trying to solve, and each method includes a set of steps that have certain similarities, but also certain variations in their progress. In the context of the present study, this analysis was made following the methodology of Walker and Avant as a strategy for presenting all that precedes or promotes the appearance of the concept (antecedents); develop their attributes (characteristics); and bring out its effects (consequences), in a transdisciplinary approach. Thus, the analysis of the concepts of “health system”, “management system”, audit and performance made it possible to describe in a meticulous way, and according to different authors each of these concepts, with its different uses in the language. Therefore, the audit of the management system allows the direction, at its highest level, to obtain essential elements on the “state of health” of the management system in place. It is essentially a diagnostic assessment process of the overall performance of management, through an objective and comprehensive review of the organizational structure; its components; its plans and policies; its operation; as well as its use of physical facilities and various resources (human, financial, material, and other). Applied to a health system, the audit of the management system is an essential tool for improving its performance. The realization of a managerial diagnosis making it possible to: identify deviations from existing management standards; Identify malfunction problems; and determine guidelines for mobilizing the necessary resources to develop an improvement strategy.

Keywords: Audit; Health System; Management System; Performance

Introduction
Concept analysis can be seen as a rigorous and pragmatic method to define a concept and thus contribute to the knowledge breakthrough. It is a meticulous and descriptive examination of a word or group of words, as well as its uses in language, coupled with the explanation of how this word looks or does not look like other words. It serves as basis to identify and evaluate the concerned phenomenon. The choice of analysis method depends primarily on the nature of the issue the researcher tries to address, and each method includes a set of steps that have certain similarities, but also certain variations in their sequence (Within the framework of this project, this analysis was made following the methodology of Walker and Avant as strategy to present all that precedes or promotes the emergence of the concept (antecedents); improve its attributes (characteristics); and bring out its effects (consequences), in a transdisciplinary approach (Masson, 2007). In this vein, the approach was grounded around four main points whose development consisted in proposing a conceptual definition of each of the concepts identified, namely: Health system, Management system, Audit, Performance.

Health system
The evolution of pathologies as well as the development of science has changed the notion of public health over the years, leading to consideration beyond the individual, the community, and the environment, to grasp health mechanisms and propose organisational systems aiming at meeting the health needs of populations (Lajarge et al., 2017).

The Health System refers to all the elements that determine the state of health of a population. It is understood as an organised system of actions whose purpose is to improve the health of the population. In a broad vision of public health, the health system, on which the state of health of a country will depend, is made up with different economic, social, cultural, political, legal, etc. “sub-systems”. (Guillemin et al., 2014). In its World Health Report 2000, the World Health Organization (WHO) states that "health systems include all people and all actions whose primary purpose is to improve health" (OMS, 2000, p. 1). And, according to the conceptual framework it suggests, the health system is based on six pillars (health service delivery; health workforce; health information system; vaccines, technologies, and medical products; health financing; leadership and governance). Its spreading aims at achieving results objectives (improvement of health; responsiveness; fairness of the financial contribution), through intermediate objectives (accessibility of services, quality of services, coverage of services, safety of services) (Marchal & Walfard, 2019).

Components and Objectives of a Health System (Mousavi et al., 2020)

Assessing the health systems performance is a very tough process to carry out given the complexity of these systems. Several organisations (WHO, OECD, etc.) have tried to set up models to assess the performance of health systems in order to facilitate comparison between countries. Among these models, the WHO one, based on health systems, is specific by its universality since this organisation works in a global context and integrates all national issues, considering the specificities of the different countries. Moreover, talking about performance, this requires comparing results of health systems to standards. In this case, the organisation whose assessment model affects all countries, and which can be taken as reference in this field is the WHO (Hassani & Moussali, 2020).

Then, referring to the conceptual framework suggested by the WHO, the performance of health systems can be summarised in their ability to: improve the health of populations; be responsive in the provision of health services (i.e. its ability to respond to expectations of the population in an efficient manner while respecting their dignity and with the best possible quality of care; and be equitable in the financial contribution of the beneficiaries (in fact people want to receive care without being ruined financially and without discrimination regardless of their income. Thus, the WHO considers that "The objective of good health is in fact twofold and breaks down as follows: quality, which is the best achievable average level, and equity, which is the smallest possible difference between individuals and between groups” (OMS, 2000a, p. 28).

Management system
A management system refers to: “a set of material, human and procedural means set as a system aiming at ensuring the exercise of the company's activities. The main activities are, of course, those of management, strategic planning, organisation, information, animation, and control” (Plane, 2019, p. 110). This is all the managerial actions that will contribute in building, implementing and monitoring the whole organisation, ensuring the running and coordination of the strategy, the development of organisation and operational management, and propelling the managerial culture. According to ISO 22301, the management system consists of a set of interrelated (or interacting) elements of an organisation, used to set up policies, objectives, and processes, to achieve these goals. It can deal with one or more disciplines. Its elements include the structure, roles, and responsibilities, planning and running of the organisation (ISO/DIS 22301, 2019). Different management systems exist in literature, and thus provide management’s “ready-to-wear” that leaders of organisation can resort to in their duties (Louazel et al., 2018).

The management system refers to the routines that govern the work of leaders, building on abstract ideas and turning them into actionable tools. These generally include strategic tools for planning, managing, monitoring, and assessing the performance of the organisation. Strategic activity then makes it possible to take stock of the initial situation, by analysing the internal and external environment. The identification process of elements that influence the development of the organisation, in terms of power, opportunities, weaknesses and threats. From a realistic portrait of the current situation, an ideal situation can be foreseen to determine strategic orientations for the future of the organisation (Alia conseil, 2013). It is therefore all about practices related to what leaders and managers achieve the processes that explain how they carry it out, and the context in which they do it (Boubakary et al., 2020). It is a system that extends to all stakeholders (person or body that can affect, be affected, or perceive itself as affected by a decision or an activity inherent to the organisation) grounding the ecosystem of the organisation. We manage, modify, improve the management system accountable to the management staff (person or group of people who directs and runs an organisation at its highest level), by relying on its influence and opportunities it offers, its environmental context, as well as by acting on its weaknesses and identified threats, in the sense of reducing or even neutralising their harmful effects (Terras & Laid, 2020).

Audit
In general, audit consists of an examination carried out by an independent professional on how an activity is carried out, and on information drawn up by the managers, related to the assessment criteria of this activity. Financial auditing is undoubtedly the most well-known and oldest aspect of auditing. Audit activity then extended to all aspects of the company's operation: social audit, legal audit, industrial audit, etc. (Whannou, 2013). The NF EN ISO (International Organisation for Standardisation) 19011: 2018 “Guidelines for the auditing of management systems” defines it as a methodical, documented, and independent process, able to objectively assess the whole or an entity of a company, so as to ensure that activities carried out comply its mission, towards the achievement of pre-established objectives. It can be considered as professional expertise, carried out by a competent and independent agent, and resulting in a judgment related to a standard on the financial statements, the internal control, the organisation, the procedure, or any operation of a business entity. Considered as a continuous improvement process, auditing helps to take stock of the existing situation in order to identify weaknesses and/or threats vis-à-vis the organisation, and thus, take the necessary actions to improve the discrepancies and malfunctions identified (Hurbin, 2019). It is a critical examination whose professional character is manifested by: the competence of the professional resulting from training and relevant experience; the use of methodology, techniques and tools to conduct the review (Tchari et al., 2019). It is the expression of a responsible and independent opinion suggested by an auditor and which refers to quality criteria, namely:

Regularity, which complies with inner or outer rules, procedures and principles of the entity issuing the information (also known as compliance audit);
The sincerity (or faithfulness) with which facts are translated into information. It refers to objectivity and good faith in the application of rules and procedures;
Efficiency: this is a set of criteria which are themselves likely to be combined with the criteria of regularity and sincerity.

Anglo-Saxons designate it in terms of "auditing" which they define as the systematic examination of financial statements and operations carried out, during a given moment. This, to establish consistency with generally accepted accounting principles, instructions of the management staff and regulations in force (Assoly Nzoho, 2009) . An examination, carried out by an independent professional, aiming at providing, an opinion on the concordance of the object examined with the applicable reference system (Burlaud, 2009). In other words, it is: an examination, therefore a process determined by the activities that compose it (content) and by how these activities are carried out (methodology); conducted by an auditor or by an audit team (independent professional(s)); relating to an “object” (this is the answer to the question “what is audited? ”). The object may be the accounts or summary statements of a company, in the case of accounting and financial auditing, or any other aspect of the management of a company; whose “output” or product is a judgment (an opinion) made by the auditor on the compliance of the subject of the audit with a reference system (Berrad, 2018).

Among the multiple "objects", the audit can relate to a management system, then we talk of "audit of the management system", viewed as control procedures used to assess whether the processes of a management system comply with the requirements and directives of the organisation. The purpose of the audit is therefore to assess the management system on several levels, in particular: its compliance with the organisation's requirements criteria as well as its effectiveness (PME, 2020). A tool for continuous quality improvement, audit of the management system helps to improve the overall performance of the company, by examining the existing situation to identify areas of weakness that require corrective action, so as to improve the overall results of the organisation (Dahlab, 2019).

Performance
Etymologically, the word performance comes from the old French parformer, which, in the 13th century, meant "to accomplish, to execute" (Pesqueux, 2021). It is also possible to emphasise on the performative aspect of the notion that is, its vocation to translate the idea of obtaining effects, creating a transformation and suggest the ideological content. This is why Ehrenberg refers to a society that has become both entrepreneurial and athletic because of the importance given to sports media coverage, championing the organisation and social success (Ehrenberg, 2008). The concept is commonly used both in literature and in organisational circles to show a certain level of excellence (Issor, 2017).

Literature in the fields of clinical, management, public administration, economics, politics, operational research, and information systems shows that although central and unavoidable, the concept of performance is probably one of the most inflected and intangible. The only consensus: there is a great deal of conceptual confusion, each conception of organisations raising different conceptualisation of performance (El Hasnaoui, 2017). But it is at the same time a notion based on the idea of creation indicating that, reference to it is to indicate the existence of an act of creation (Pesqueux, 2021). A notion that is also transdisciplinary, which takes on a colouring specific to the discipline that refers to it, the management sciences constructing their own context as regards the ontology and the use of the notion, by making it the metaphor of management (Pesqueux, 2020). His ideology raises several questions:

The porosity with regard to several areas of social life under pretext of quantification bonus;
The acceptance of a model of the competition insofar as the performance is only valid in the comparison by coming to outdo the competitive from the moment when one considers that the measurement is a reliable representation of the "reality even though it is a social construction;
Enhancement of the effect, the fruit of a championed will;
Apology of “causal and instrumental reason”, because performance is part of a necessarily teleological order aiming at instrumentalising the individual;
Primacy granted to individual autonomy, the fact to unthink its ambivalences acting as if the performance referred to a defined framework;
Use of the notion to suggest success or its use as a product of composition with it;
The necessity for limits without which the search for performance leads to exhaustion (Aubert, 2004).

According to the Comprehensive and Integrated Health Systems Performance Assessment Model (EGIPSS), organisational performance is a multidimensional completion to enable various stakeholders to discuss and form a judgment on the requisite and specific qualities of the organisation according to their beliefs, knowledge, responsibilities, interests, projects. Ii comes from its ability to: achieve its four functions Ø achieve its goals, Ø adapt to its environment acquire resources and meet needs), Ø produce quality services with productivity Ø and maintain and develop common values (organisational culture) ; establishing and maintaining a dynamic tension between the achievement of these four functions (El Hasnaoui, 2017). In short, performance can be considered as a "strange attractor" in its ability to absorb several translations: economic (competitiveness), financial (profitability), legal (solvency), organisational (effectiveness/efficiency) or even social (cohesion within of a team of collaborators). From its French etymology (to accomplish, to execute) to its English one (performance), it can be summed up in three main meanings: accomplishment of a process or task; result arising from the completion of a process or task; and the success resulting from it (Pesqueux, 2021). In the same sense, and in relation to the criteria of effectiveness and efficiency, Bourguignon grouped the meaning of the word performance, in the field of management, around three primary meanings, namely:

The first meaning is performance-success: when performance is synonymous of success. This meaning contains a value judgment, with regard to a reference, which represents success from the point of view of the observer;
The second meaning is performance-result, here performance refers to the result of an action, the ex-post assessment of results obtained without value judgment;
Finally, the last meaning is performance-action: performance can mean an action or a process (the implementation of a skill which is only a potentiality) (Ancelin-Bourguignon, 1997).

In management sciences, organisational performance is a core concept. The essence of managerial action is in fact part of a constant quest for better organisational performance. This quest is a major challenge, especially in complex organisations such as healthcare organisations in which continuous performance improvement management aims to provide a vision, way, unifying objectives, cohesion, and motivation towards excellence (Minvielle et al., 2018).

Conclusion
Analysis of the concepts of: “health system”; “management system”; audit and performance, key words of this work, allowed to describe in a meticulous way and according to various authors each of them, with their various uses in the language. Thus, the audit of the management system allows the management staff, in its fullest high level, to get relevant information on the “state of health” of the management system in place. It is mainly a process of diagnostic assessment of the overall performance of management, through: an objective and comprehensive review of the organisational structure; its components; its plans and policies; its operation; as well as its use of physical facilities and miscellaneous resources (human, financial, material and other). Applied to a health system, the audit of the management system remains a relevant tool for improving its performance. The realization of a managerial diagnosis making it possible to: identify deviations from existing management standards; Identify malfunction problems; and determine guidelines for mobilizing the necessary resources to develop an improvement strategy. Objective of this research project, on the management system and performance of the Catholic Organization for Health in Cameroon.

References