EDITORIAL

Abstract

Over 1700 participants from over 100 countries
attended the Second Global Symposium on Health
System Research in Beijing from October 31 to
November 3, 2012. The Symposium discussed stateof-
the art health system research and strategies for
strengthening health systems research through keynotes,
plenaries, concurrent sessions, satellites,
posters, films, informal discussions and debates.
One of the symposium sessions presented a
conceptual framework for health system research
which encompasses systems at macro-, meso- and
micro- levels. Health service research was depicted
at the meso- and macro- level of the systems, and
management research was noted as part of the
health service research domain. Thus, health service
management was viewed as a part of the overall
health system research domain.
The panelists highlighted that there are important
differences between research to support policymaking
at macro-level and research to support management
decision making. They first emphasized
that the nature of the evidence required would differ,
depending much on whom the evidence is supporting,
e.g. goverment official, hospital manager, health
professional, citizens. Second, they noted that it
would also be different depending on whether we are
supporting them: (1) to select which programs, services
and drugs to fund; or (2) to strengthen governance,
financial and delivery arrangements within
systems.
They further argued that decisions about services
and programmes are typically a single decision
made at a single point in time by a clearly defined
decision-maker as part of routine decision
making. In contrast, policy making decisions are
typically consisted of a number of heterogenous
decisions, made over a long period of time, by a
broad range of different decision makers, with little
or no routinization. They also highlighted that the
benefits, harms and costs of programs, services and
drugs are less context dependent, while the pros
and cons of policies at macro-level is much more
context dependent. Hence, in health policy research,
local tacit knowledge, views and experiences matter
much more.
The debate described above represents an effort
to clarify the boundaries of health system research,
health policy research and health service
research. There are however critical issues which
needs to be examined further, particularly in the interest
of health services management research.
Firstly, it is rather misleading to portray health service
management decision as typically technical,
routine and clear cut. The health service management
decision spectrum arguably spans from complete
certainty in one end to absolute ambiguity on
the other end, and many in between. There can be
political dimensions to these decisions, eventhough
they are at the organization or sub-organization level,
as they often entail allocation of scarce resources.
Thus, there are considerable rooms for local tacit
knowledge, views and experience as well within
health service management research. Secondly,
many management interventions are also context
specific. A management decision to adopt clinical
pathway may lead to significantly better clinical outcomes
in one hospital, but may result in minute
improvement of clinical outcomes in another
hospital.Thus, it is too risky to emphasize that health
service managementdecisions are not so much influenced
by context. Health service management
researchers who fail to discuss contextual matters,
may risk having their results haphazzardly generalized
or replicated. These points suggest that important
characteristics of health service management
research have not been adequately considered in
the symposium discourse above.
The relative neglect of health service management
research in the current discourse reflects the
lack of active contribution from health service management
researchers, and perhaps also reflects the
nature of a field which has not been much well developed
scientifically. This calls for efforts to strengthen
health service management research as a scientific
field. Drawing from efforts to strengthen health system
research as a field, we can think of several possible
ways to do this. First, we need to establish a
common language by developing authoritative textbooks,
journals and courses in health service management
research. Secondly, we need to promote
cross-disciplinary learnings as heallth service management
research is typically multidisciplinary. Third,
we need a society for health service management
research at national and international level. Fourth,
we need more professors, authoritative scientific leaders,
in health service management research.
98  Jurnal Manajemen Pelayanan Kesehatan, Vol. 15, No. 3 September 2012
Yodi Mahendradhata & Adi Utarini: What do we mean by health service ...
JMPK, the Indonesian Journal of Health Service
Management, remains committed to contribute
toward strengthening health service management
research by providing an accessible common peerreviewed
platform for state-of-the art health service
management researches since more than a decade
ago. We have attempted to make JMPK as accessible
as possible by providing online access to published
content. We will soon expand further by providing
possibility for online submission as well.
However, we are still left with the absence of
authoritative textbooks and society of health service
management research community in the country, in
contrast to what we have in epidemiology or clinical
research for instance.In the field of epidemiology,
there is the International Epidemiological Association
which publishes the International Journal of Epidemiology
and organizes the World Congress of
Epidemiology. At the national level, we also have
the National Epidemiology Network (JEN). The field
of epidemiology also benefits from authoritative textbooks,
such as those written by Kenneth J Rothman.
For clinical research, there is the International Clinical
epidemiology network and the field benefits from
authoritative textbooks such as those written by David
Sackett or Robert Fletcher. At the national level, the
Indonesian Clinical Epidemology and Evidence
Based Medicine Network has also been established.
We are looking forward to work with the health
service management research community to move
forward with strengthening health service management
research as a scientific endeavour.