1. Introduction

Enterprise management is a complex process, in which certain actions are focusing on the resources being at the disposal of the enterprise, with an intention to achieve specific objectives in an efficient and effective way (Griffin, 2005). P.F. Drucker (2007) points out that the efficiency in achieving the objectives is expressed by the fact, that we do things in a proper way, and the effectiveness – that we do the appropriate things. Responsibility for the management process is the burden of the enterprise managers' team, or rather it depends on their skills and predispositions to efficient and effective achievement of assumed objectives. J.F. Garrigo's Simo'n et al. (2008) rightly notice that "In the turbulent environment of the post-Internet era, situations arise that are incomparable with those in the past, and consequently the perception of new situations is a crucial variable to improve the effective bases of competitiveness and for the success of the firm. Therefore, it becomes critical to establish mechanisms that can help managers to improve their conditions" (p.374). This is no different in the case of companies, which mission is to provide health services, especially the spa treatment facilities, which are a very important element of the health system in Poland. Due to the complex economic situation of the Polish health sector establishments, some questions regarding their management are becoming of a significant socio-economic importance.

2. Background of the Study

Socio-economic transformations which have taken place in Poland after 1989, have had some implications in relation to a change in the management of enterprises acting in different sectors of the Polish economy. Also in case of the spa services the situation has changed, where previously they had worked almost exclusively as state-owned companies. Besides, economic transformation has also resulted with a number of difficulties to be challenged by decision makers, including a complex reform of the health-care system, both in the aspect of its administration, and financing. A broader description of the reform processes is presented by K. Krajewski-Siuda and P. Romaniuk (2008). The sources of problems in the spa services in recent years should also include:

1. The declining state assistance, as reflected in the systematic reduction of the funds spent by public insurance companies for spa treatment; as illustrated by the fact that expenditure on spa treatment in Poland in 1997 amounted to 4% of the total health care budget, and 4.5% a year later. In subsequent years, expenditures has been reduced to about 1% of the total public health insurance budget;

2. Implementation of difficult socio-economic reforms in 1999 (particularly mass privatization program, which is still being implemented);

3. Lack of sufficient training of the managers, which would enable them to create competitive spa market deals;

4. Taxing the spa enterprises and introduction of unfavorable tax regulations regarding the spa municipalities.

Undoubtedly, an important problem of Polish spa municipalities are also the thermal waters, which potential remains untapped. This should be regarded as a serious failure of the public authorities, both on the central, and local level. Although 80% of the area of Poland has been identified as covering some springs of thermal waters, there is no thermal spa in Poland to use them. At the same time the positive influence of such waters in treatment of many kinds of illness has been proved in different countries (Titymann, Balda, 1996; Omulecki, Nowak, Zalewska, 1996; Vassileva, 1996; Katsambas, Antoniou, 1996; Andreassi, Flori, 1996; Picoto, 1996; Belkova, Tazaki, Zakharova, Parfenova, 2007; Varsanyi, Kovacs, 2006; Kris, Marton, 1995). The influence of mentioned factors on the spa services market is discussed by A. Kapczyński and A.R. Szromek (2008), who analyze the process of development spa market, in relation to the development of health tourism destination. They propose the directions of development of the spa and touristic areas in Poland, based on the conception of R.W. Butler (1980, 2006).

Currently, the role of spa treatment companies in the Polish health system is regulated by, The Law on Spa Treatment, Health Resorts and Its Protected Areas, and on Health Resort Administrative Districts” (Polish Parliament, 2005). The new regulations however, did not preserved the spa municipalities, nor the companies operating on their territory, from the necessity of change, especially in the area of management. J. Jafari (2000) underlines, that on this ground the management can be analyzed at four levels: scope, ownership, industry sector and management function.

One of the key problems of Polish managers in recent years was a necessity to adapt to the market economy. Managers accustomed to the ossified rules of the centrally planned economy, as well as to the fact that each expenditure they need is covered from the state budget, suddenly have been placed in an extremely difficult situation of the emerging and growing competition. While the invalid legal regulations for some period ensured their security, giving them a kind of monopoly on the market of spa treatment, finally they faced a necessity of changing their attitude to the market rules, and consistently – the way they perceived the visitors. In consequence we can assume, that the new economic system forced the changes in the quality of management of this specific segment of the health system. An example of this change is a new way of perceiving the visitor-patient, where managers regularly face the choice of strategy for the spa places allocation, having regard to many characteristics of the visitor, or rather the source of funding for his stay. Literature rarely refers to this issue, but provides the evidence of the issue topicality. For example S. Glied and J.G. Zivin (2002) notice, although their statements are really conservative, that there is a relationship between the doctors' behavior and the way they provide the medical care to patients, with the different types of insurance. On the basis of analysis of the data provided by the National Ambulatory Medical Care Survey, they say: "We find that financial incentives do matter. Treatment intensity varies between patients, according to the method by which their insurers pay physicians. But variations in treatment intensity depend as much - or more - on the insurance status of other patients treated by the same physician as they do on the insurance status of an individual patient" (p. 1051). The problem of differentiation of patients based on the payer for their treatment is also referred by J. Glazer and T.G. McGuire (2002). They examine not only the major payers, but also employers and other private payers, but, they relate them to the quality and price level of services provided to patients.

In Poland the stay of patient who require the prevention or treatment of chronic disease is financed primarily by the public health insurer (National Health Fund – Narodowy Fundusz Zdrowia) or public social insurer (Social Insurance Company – Zakład Ubezpieczeń Społecznych). This category of patients/visitors constitute the “A” type. The basis of the treatment in those cases is a referral issued by an authorized medical doctor. The second group of visitors (spa tourists) are individuals who came to a spa without a doctor's referral (“B” type). They pay for the stay with their own financial resources. It can therefore be assumed that the recipients of services provided by the spa companies are two groups of payers: public insurance companies, which cover the costs of stay and treatment of “A” type visitors, and individual clients, constituting the “B” type visitors.

In context of the fact, that public insurance companies are institutions purchasing a huge number of services provided to visitors at the same time, they obviously are able to negotiate lower rates for all the services provided (treatments, accommodation, catering). Individual clients (“B” type), who stay in a spa in the same conditions as the “A” type visitors, pay higher rates for the services received. Thus, the spa enterprise receives nominally higher revenues, while providing services for the “B” type visitors, than in case of the “A” type. On the other hand, the lower rates imposed by the wholesale customers are compensated by the contract size, which is usually implemented in full. Obviously, is such circumstances the best economic situation would be the full occupancy by “B” type visitors, which however is impossible due to the imbalance between the amount of demand and the volume of supply of spa services.

Nonetheless, the problem may be analyzed from a completely different perspective. Places that are not offered to the public insurance companies, at the same time create a potential which may be offered to individual visitors (“B” type). Usually, the structure of places designed for visitors of both types is planned in advance (from 1 to 3 years), and derives from the adoption of management strategies. But usually there is no full occupancy of the places offered, mainly because of insufficient number of “B” type visitors. For example in case of Zakład Uzdrowisk Kłodzkich S.A. (Kłodzko Spa Company Inc.), which owns several spa treatment facilities in southern Poland, the average occupancy rate in the years 2002-2006 was 78%. The structure of visitors shows, that in this period 27.8% were visitors of the “B” type, and 72.2% were of the “A” type. However, due to the fact that the type B visitors stays are significantly shorter, in reality the number of places occupied by “A” type visitors is even higher, reaching the level of 82%. Average length of stay of “A” type visitor is 22.14 ± 5.69 days, and in case of “B” type visitor it is 12.53 ± 1.85 days, resulting in a total of 20.12 ± 4.44 days. The difference between income earned on stays of visitors of “B” type, and potential income (what the enterprise could achieve by offering a places reserved for visitors of “B” type to visitors of the “A” type) is the compensation for the risk taken while planning the structure of stays (based on data provided by the Kłodzko Spa Company Inc.).

3. Aim of the Study

This article is intended to refer to three issues.

1) The first concerns the characteristics of the management boards of the Polish spa treatment facilities.

2) The second refers to the new way of perceiving a visitor by the managers.

3) Third refers to the perception of economic condition and perspectives of the spa services sector by the managers.

The three outlined areas are a foundation for the principal objective of the paper, which is to presend the profile of managers, who are leaders of the spa companies in Poland, in terms of their professional qualifications and experience, as well as the way they locate their companies on the market of spa services.

If to take into account the dynamics of the environment, in which the spa companies are operating, as well as the need to adapt to the rapidly changing market conditions, presented study may have important implications in at least two areas:

1) It provides an essential knowledge about the internal factors that determine the transformation process of the organizations;

2) It allows to adapt the structure of the organization to the needs that arise of the transformation process.

4. Methods

To obtain the characteristics of the managers of Polish spa treatment facilities, and to obtain answers to the question about the importance of both groups of visitors, there was the research carried out among the managers of Polish spa companies. The study referring to the spa treatment companies managers was done based of surveys carried out in June 2008 on a representative sample of 124 Polish spa facilities. Acceptable statistical error is at the level of ±5%, and adopted border of statistical significance is p=0.05. The study covered the entire area of Poland, where spa enterprises from different geographical regions were taken into consideration, including those located in mountainous areas as well as on seaside and lowlands.

The study included an analysis of the structure of managers in terms of parameters that characterize their age, gender, professional experience, education, management level, the spread of management (span of control) and the intensity of contact with the visitor. Managers were also asked for their opinion on the economic condition of the spa treatment facilities in Poland and the importance of both types of visitors (“A” and “B” type). In the analysis of the collected data, there was also the importance of differences of the structure of the answers tested, by using Chi-square test. Two hypotheses were tested. First was the zero hypothesis (H₀), assuming equal structure indicators s₁=s₂ (there are no significant differences between structure indicators). Second was the alternative hypothesis H₁, assuming significant variation in the examined structure indicators (s₁≠s₂). For some variables also descriptive statistical parameters were used, such as the median (Me), quartile deviation (QD) and quartile interval (for example, interval between the first Q₁ and the third Q₃ quartile).

5. Results

Of the general number of spa facilities, that were asked to take part in the study, 25 agreed to participate. This gave a general number of examined managers of 125. Statistical analysis of the respondents' answers indicated, that the average age of Polish managers is 43.25 ± 6.56 years. Half of the managers is 43 years old or younger, and the second half is 43 years old or older. The overwhelming majority of respondents (40%) are middle-aged people (41-50 years). The second largest age group (32% of examined group) are the young managers (31-40 years). One in five managers (20%) was 51-60 years old. The smallest is the group of novice managers, who is not older than 30. Two out of three managers (64%) are women. 80% of respondents has finished university education. Managers are varying in regard to the professional experience on managerial position. Those, who acted as a manager for six to ten years account for 28% of the examined population. Slightly larger group of respondents (36%) has relatively small managerial experience (up to five years), and the same number (36%) declare an extensive experience (more than ten years). However, the differences between the structure indicators in the various subgroups of respondents (examined with the Chi-square test) are insignificant (p=0.3176), and therefore we can not reject the zero hypothesis (equality of structure indicators). More than a half of respondents (54%) perform their function of management at the middle management level.

Only one of four managers (24%) have the education related to health and medicine (usually balneology or physical medicine). The rest of respondents most frequently declare the education related to administration (12%), tourism (12%), and management (44%). The management range (span of control) of the majority of Polish managers (40%) closes within the number of subordinate employees of 21 to 50. One of three managers supervises the work of more than 100 employees. Half of managers has 46 or fewer subordinate employees. Two out of three managers (64%) are in direct contact with the visitors arriving to the facility, and only 12% of them do not contact the visitors at all. The summary of the characteristics of the examined sample is presented in the table No. 1.

Table 1. General characteristics of the sample

Respondents were also asked about their opinion regarding the economic condition of the Polish spa treatment enterprises and the possible direction of this sector development. As many as 92% of them considered that the economic situation is average. However, this group of managers may be divided into two sub-groups: 52% of respondents considered that the situation is becoming better and 40% of respondents think that it is going to worsen. Opinions regarding the economic condition of Polish spa treatment enterprises that were expressed by the respondents are presented in the Figure No. 1.

Figure 1. Opinions about the economic condition of Polish spa treatment enterprises

While preserving the typology of visitors adopted at the beginning (“A” type - visitors whose stay is paid by the public insurance institutions, and “B” type - visitors funding the stay by their own), managers were asked for their opinion on the key recipient of spa services in their facility. Three out of four respondents (76%) stated that both types of visitors are equally important to them. 16% of managers indicated the “B” type visitors as a key recipients, and the rest (8%) indicated the “A” type of visitors. Opinions of respondents regarding this problem are presented in the figure No. 2.

Figure 2. Opinions about the types of visitors as recipients of spa services. Visitors of “A” type: a patient-visitor whose stay is paid by the public health or social insurance. Visitor of “B” type: a tourist-visitor, who pay for the stay and treatment by himself

It should be mentioned however, that the distribution of responses was varied in different groups of managers. An interesting distribution of responses was observed in case of different age groups. In a group of young managers (31-40 years) the same is percentage of managers, who balance the two types of visitors, as of those, who give the higher significance to self-financing visitors (37.5%). In the other age groups the prevailing opinion is that both groups of visitors are equal. The opinion that visitors of “B” type are more significant is more frequent among the top-level managers – up to 40%. The same situation occurs in case of managers, who do not have contact with visitors – one of three recognizes the higher economic importance of the “B” type visitors. The higher percentage of managers indicating the “B” type visitors as economically more important is also among those with the average managerial experience (42.9%). Table No. 2 below presents how economic importance of the two types of visitors were described by different categories of persons examined.

Table 2. The economic importance of two types of visitors

The analysis of correspondence revealed also some relationship between the characteristics of managers (Figure 3). We have observed that there is a relationship between the intensity of contact with patient, and the range of control the manager hold. This is also confirmed by a Spearman's rank correlation coefficient (r=0.4806, p<0.05). Interestingly, managers who control the work of many employees find more time to contact the recipient of their services, while managers heading small teams (in the lower positions) have no contact with tourists.

Figure 3. The correspondence analysis of managers characteristics

A constant contact with the customer at the spa is more often in case of managers with medical education and at least average work experience, who occupy high managerial position. It thus appears that the experience of managers allows them to notice the needs of customers in direct contact. Managers at lower levels, who are heading small teams, as well as younger and unexperienced managers, often abstain from the direct contact with recipients of spa services.

6. Discussion

The presented study have shown that the Polish spa treatment enterprises are managed mainly by matured and well-educated persons, but with different work experience. Most managers have a profile of education related to their administrative function (management, marketing), but there is also a tendency to appoint people educated in the field of medicine, or the tourism services. This is understandable, if to relate such a tendency to the trends that are observable on the world market of spa services. European spas, for example, usually perform both functions: treatment (balneology) and spa tourism (Szromek, 2006). The experience of recent decades have shown that these features may be complement to each other, and that both may have a positive impact on the development of spa municipalities, as well as the entities operating on their territory (Szromek, 2007). In Poland, this process began just before the decade.

The study also showed that most managers keep regular contact with visitors using the services provided by their facility. This is important, while enables the manager to get the detailed knowledge about the needs and preferences of the visitors. It is worth of remembering, that the facility is not only a spa center providing health-care services, but (for most visitors) also the place they get the accommodation and catering. To ensure visitor comfort appropriate to his expectations, it is necessary to know his needs, while the simplest way to achieve this, is to contact him directly.

Based on the opinion of managers regarding the economic condition of the Polish spa treatment enterprises we can assume, that in the overwhelming majority of cases this situation is assessed as average. At the same time the opinion on the direction of development of these enterprises is divided, where more managers express the opinion that the current trend of development will have positive economic consequences. Meanwhile, The National Association of Polish Spa Municipalities, during the XVIII Congress of Polish spa municipalities in 2009 has pointed the key barriers to the development of spa treatment companies. These are:

− low percentage of the National Health Fund budget guaranteed to cover the cost of spa treatment services;

− contracting cycle is too short (not to allow the planning and implementation of long-term marketing strategies);

− too complicated legal requirements for sale of medicinal raw materials;

− worsening economic situation of households, which are the primary recipient of spa services;

− limited possibilities of applying for funding from European Union structural funds;

− unclear future of spa treatment facilities designated by the Treasury to be privatized;

− lack of development strategies regarding the spa treatment companies owned by the Treasury.

When referring to the key opinion on the economic importance of the two types of spa visitors, the advantage of a balance between the importance of both groups of visitors should be noted. However, 16% of managers are focusing primarily on gaining attention of potential visitors self-financing their stay (“B” type). This is twice the result of what was observed regarding the managers who turn mainly towards the mobilization of visitors of “A” type. These are managers who are satisfied with the rates offered by social insurers. At the same time it must be underlined, that tourism is not the primary business activity of the spa companies, and they are legally obliged to provide care for insurance-payed patients at the first place. On the other hand, contracts for spa treatment are not automatically signed by the insurers, but only with those companies, which offer suitable conditions of the treatment and acceptable price. However, financial limitations of the national health insurer in practice cause a situation in which managers are forced to propose low (hardly profitable) rates for the services. Otherwise, the insurer may sign contracts with other (smaller) suppliers, causing the company offering higher rates to fall, or to change the profile of activity from therapeutic to touristic. It means, that in reality managers do not have much ground for negotiations with insurer who purchase the services, and have nothing to do, but to accept the proposed conditions. Hence, such an important is the skill of balancing the proportion of stays of tourist and patients. Strategies of spa treatment companies generally include dichotomous division of the revenue streams. These are contracts with the insurer to secure the basic coverage of costs (break-even), and significantly more profitable revenue from commercial stays.

Interesting are the results of cross-analysis, which clearly shows that most divided group are young managers (aged 31-40 years). Distribution of opinions on the economic significance of visitors is almost regular, while respondents in the other groups are trying to balance the economic importance of both groups of visitors. Further comparisons can be generally concluded, that as the contact between manager and visitors is getting weaker, the economic importance of self-financing visitors is growing. This may be the result of the fact, that usually the least contact with visitors characterize the top management level, and at the same time in this group of managers the highest focus on visitor of “B” type may be observed. Since the top management is responsible for strategic activities, it can be assumed that the direction of attracting the “B” type visitors is more often included in the catalog of basic purposes of the enterprise, than the generalized results of the study might shown. However, there is a fundamental inconsistency in the selection of objectives at different levels of spa enterprises management, since at the medium and low-level such an orientation of targeting is noticeably less observable.

7. Conclusions and Recommendations

1. Polish spa companies managers are usually middle-aged, relatively well educated and experienced. The structure of boards seems to be adequate to the needs of effective and efficient management of the spa companies.

2. Most of the spa companies underline the desire to acquire both types of visitors: directed by the social insurance, and the self-financing. At the same time, there is an inconsistency observable in regard to the management strategies of spa companies, where the objectives formulated on different levels of management seem to be not coordinated with each other.

3. The economic situation of Polish spa treatment enterprises is assessed as average, but most usually – improving. Generally, the results should be regarded as optimistic, since they confirm, that Polish managers are highly aware of the need to adapt the spa facility offers to the expectations of both groups of visitors, despite the fact of operating in the turbulent environment of both the national economy and health system being at the transition.

4. Despite the generally optimistic picture of managers in Polish spas, and their awareness of the changing circumstances their organizations act in, it seems reasonable to improve the process of training of the younger managers at lower levels, to make them more aware of the need to intensify contacts with the recipients of spa services. This can be crucial to the process of adapting the catalogue and quality of provided services to the expectations of customers, particularly the more demanding customers covering their stays with own resources, whose importance for the spa enterprises is becoming more and more weighty.