WEBVTT 1 00:00:00.240 --> 00:00:02.790 Hi everyone, and welcome back to module one. 2 00:00:02.790 --> 00:00:05.550 In this lecture, we'll be discussing the functions, 3 00:00:05.550 --> 00:00:07.230 structure, and physical resources 4 00:00:07.230 --> 00:00:09.420 of healthcare organizations. 5 00:00:09.420 --> 00:00:13.410 Before we begin to give a brief overview of the module, 6 00:00:13.410 --> 00:00:15.060 this week we're gonna be talking about key functions 7 00:00:15.060 --> 00:00:17.220 of healthcare organizations. 8 00:00:17.220 --> 00:00:19.860 Talk about the ways in which organizations will assess 9 00:00:19.860 --> 00:00:21.900 their performance, plan and prioritize 10 00:00:21.900 --> 00:00:24.570 their physical resources, and integrate physical, human, 11 00:00:24.570 --> 00:00:26.043 and technological resources. 12 00:00:27.060 --> 00:00:30.660 Key concepts include facility design and management, 13 00:00:30.660 --> 00:00:32.160 low resource management, 14 00:00:32.160 --> 00:00:35.160 operations management, organizational design, 15 00:00:35.160 --> 00:00:38.010 performance improvement, physical resources management, 16 00:00:38.010 --> 00:00:39.213 and medical equipment. 17 00:00:40.560 --> 00:00:42.720 The chapter this week starts off with this diagram, 18 00:00:42.720 --> 00:00:44.070 which I like a lot. 19 00:00:44.070 --> 00:00:47.610 I think it really does a good job of showing some many, 20 00:00:47.610 --> 00:00:49.470 but not all of the factors 21 00:00:49.470 --> 00:00:52.920 that go into determining good health. 22 00:00:52.920 --> 00:00:55.798 So for example, we see on the left the structures 23 00:00:55.798 --> 00:00:59.820 or the resources in the population upon which the health 24 00:00:59.820 --> 00:01:01.830 status of a population is based. 25 00:01:01.830 --> 00:01:03.480 These might look familiar to some of you 26 00:01:03.480 --> 00:01:05.664 who have taken other public health courses 27 00:01:05.664 --> 00:01:08.490 and be reminiscent of the social instructional 28 00:01:08.490 --> 00:01:10.170 determinants of health. 29 00:01:10.170 --> 00:01:13.260 We see things like the number of medical providers, 30 00:01:13.260 --> 00:01:15.930 the number of physicians, the number of specialists, 31 00:01:15.930 --> 00:01:17.329 the number of hospitals, 32 00:01:17.329 --> 00:01:20.520 the amount of physical infrastructure, 33 00:01:20.520 --> 00:01:22.680 whether medications are available, 34 00:01:22.680 --> 00:01:25.470 and then also population characteristics like age, 35 00:01:25.470 --> 00:01:28.635 comorbidities, life expectancy, et cetera. 36 00:01:28.635 --> 00:01:33.357 We see that these set the stage for the health services 37 00:01:33.357 --> 00:01:36.210 that are available and the health services 38 00:01:36.210 --> 00:01:37.500 that are used. 39 00:01:37.500 --> 00:01:38.935 From these health services, 40 00:01:38.935 --> 00:01:42.810 we have a mediator before we get to the ultimate outcome. 41 00:01:42.810 --> 00:01:44.490 This mediator, this output, 42 00:01:44.490 --> 00:01:46.746 is very important to assessing the effectiveness 43 00:01:46.746 --> 00:01:49.530 or efficiency of a health system. 44 00:01:49.530 --> 00:01:52.830 So for example, when you're looking at the productivity 45 00:01:52.830 --> 00:01:57.830 of a certain hospital, health organization, individual, 46 00:01:58.080 --> 00:02:02.073 et cetera, you can gauge their effectiveness. 47 00:02:03.090 --> 00:02:06.780 You can first gauge their productivity 48 00:02:06.780 --> 00:02:08.965 before gauging how effective they are 49 00:02:08.965 --> 00:02:12.693 at changing health outcomes or health statuses. 50 00:02:15.780 --> 00:02:18.210 There are six core domains of the performance 51 00:02:18.210 --> 00:02:20.820 of health systems, access, utilization, 52 00:02:20.820 --> 00:02:24.480 efficiency, quality, sustainability, and learning, 53 00:02:24.480 --> 00:02:27.120 and we'll go through each of these in turn. 54 00:02:27.120 --> 00:02:30.630 The access dimension of health organizations 55 00:02:30.630 --> 00:02:33.060 entails different aspects. 56 00:02:33.060 --> 00:02:36.090 There's physical asset access, financial access, 57 00:02:36.090 --> 00:02:39.030 linguistic access, and information access. 58 00:02:39.030 --> 00:02:41.190 The first three are fairly straightforward, 59 00:02:41.190 --> 00:02:44.963 though information access is related to the prior three 60 00:02:44.963 --> 00:02:47.863 as someone's access to a language. 61 00:02:47.863 --> 00:02:51.240 For example, if someone doesn't speak the main language 62 00:02:51.240 --> 00:02:53.850 of a country, they might not have as much access 63 00:02:53.850 --> 00:02:55.050 to information as someone 64 00:02:55.050 --> 00:02:57.750 who speaks the main language of a country. 65 00:02:57.750 --> 00:02:59.070 It's also important to remember 66 00:02:59.070 --> 00:03:00.750 that equitable treatment should be provided 67 00:03:00.750 --> 00:03:03.930 regardless of gender, race, ethnicity, religion, 68 00:03:03.930 --> 00:03:07.293 age, or any other physical or socioeconomic condition. 69 00:03:08.400 --> 00:03:10.680 Next, we look at the utilization, efficiency, 70 00:03:10.680 --> 00:03:12.420 and quality dimensions. 71 00:03:12.420 --> 00:03:14.220 Utilization refers to the patient 72 00:03:14.220 --> 00:03:16.980 or procedure volume relative to capacity 73 00:03:16.980 --> 00:03:20.010 and/or the population health characteristics. 74 00:03:20.010 --> 00:03:23.743 The efficiency refers to the cost or staff to service ratios 75 00:03:23.743 --> 00:03:27.390 and the patient or procedure volume. 76 00:03:27.390 --> 00:03:30.060 Finally, the quality refers to both clinical quality 77 00:03:30.060 --> 00:03:31.590 and managerial quality. 78 00:03:31.590 --> 00:03:34.154 What is the experience of a patient receiving medical care, 79 00:03:34.154 --> 00:03:35.610 and what is the experience 80 00:03:35.610 --> 00:03:38.730 of a provider working within a certain health organization? 81 00:03:38.730 --> 00:03:42.450 Are they able to be effective based on the structures 82 00:03:42.450 --> 00:03:44.703 and management strategies that are in place? 83 00:03:46.410 --> 00:03:48.720 Next, we turn to look at the multidimensional pillars 84 00:03:48.720 --> 00:03:50.980 of healthcare sustainability. 85 00:03:50.980 --> 00:03:53.790 The first, the environmental pillar, 86 00:03:53.790 --> 00:03:56.550 represents the initial point of focus for sustainability, 87 00:03:56.550 --> 00:03:58.710 and it includes, but it's not limited to, 88 00:03:58.710 --> 00:04:00.450 the use of clean and renewable energy 89 00:04:00.450 --> 00:04:02.910 and the conservation of the natural environment. 90 00:04:02.910 --> 00:04:05.370 This pillar incorporates recycling techniques 91 00:04:05.370 --> 00:04:07.110 to preserve the quality of the atmosphere, 92 00:04:07.110 --> 00:04:08.880 to reuse solid and liquid waste, 93 00:04:08.880 --> 00:04:11.670 and to safely dispose of contaminants. 94 00:04:11.670 --> 00:04:14.640 Next, the sociocultural pillar strengthens community support 95 00:04:14.640 --> 00:04:17.024 and promotes the identification of key cultural, ethic, 96 00:04:17.024 --> 00:04:20.160 and other values among the community of staff, 97 00:04:20.160 --> 00:04:22.020 patients, and users. 98 00:04:22.020 --> 00:04:25.050 Number three, the institutional capacity development pillar, 99 00:04:25.050 --> 00:04:28.680 promotes the strategic management of the organization. 100 00:04:28.680 --> 00:04:31.770 It aims to strengthen competencies at all levels, 101 00:04:31.770 --> 00:04:34.530 and instill an empowering knowledge management culture, 102 00:04:34.530 --> 00:04:37.770 facilitating coordinated efforts of governance, 103 00:04:37.770 --> 00:04:40.953 leadership, and personnel integration and participation. 104 00:04:42.060 --> 00:04:44.940 Next, the financial pillar ensures the delivery 105 00:04:44.940 --> 00:04:46.380 of healthcare programs and activities 106 00:04:46.380 --> 00:04:48.210 that are cost effective and efficient 107 00:04:48.210 --> 00:04:49.860 in the use of resources. 108 00:04:49.860 --> 00:04:51.480 It is indispensable for achieving 109 00:04:51.480 --> 00:04:54.300 the organization's goals and objectives. 110 00:04:54.300 --> 00:04:56.370 Number five, the political pillar, 111 00:04:56.370 --> 00:04:59.280 involves staff, patient, and community advocacy 112 00:04:59.280 --> 00:05:01.563 to advance the interests of the organization. 113 00:05:04.287 --> 00:05:06.690 Over many years of technological development 114 00:05:06.690 --> 00:05:08.070 and interaction among professional, 115 00:05:08.070 --> 00:05:09.630 political and economic forces, 116 00:05:09.630 --> 00:05:12.300 three, enduring organizational folks that have emerged 117 00:05:12.300 --> 00:05:15.840 for achieving the optimum health status of a population. 118 00:05:15.840 --> 00:05:18.570 They're hospitals, primary care provision, 119 00:05:18.570 --> 00:05:20.790 and regionalization. 120 00:05:20.790 --> 00:05:21.623 To begin with, 121 00:05:21.623 --> 00:05:23.880 in every country, hospitals are the most visible symbol 122 00:05:23.880 --> 00:05:26.550 of healthcare development and care for the sick. 123 00:05:26.550 --> 00:05:28.590 They represent public assurance that there's a place 124 00:05:28.590 --> 00:05:31.800 for people to go for care when needed. 125 00:05:31.800 --> 00:05:33.630 The development of primary care has emerged 126 00:05:33.630 --> 00:05:36.150 as essential strategy to achieve universal access, 127 00:05:36.150 --> 00:05:38.520 comprehensive care, and cost containment, 128 00:05:38.520 --> 00:05:40.080 not only in developing countries, 129 00:05:40.080 --> 00:05:41.930 but also in industrialized countries. 130 00:05:42.900 --> 00:05:45.270 We also will refer to throughout the course, 131 00:05:45.270 --> 00:05:47.610 developing countries as low and middle income countries 132 00:05:47.610 --> 00:05:50.940 and industrialized countries as high income countries. 133 00:05:50.940 --> 00:05:53.130 The goal for these low resource settings 134 00:05:53.130 --> 00:05:55.020 is to provide essential services 135 00:05:55.020 --> 00:05:56.700 that are realistically within their reach 136 00:05:56.700 --> 00:05:58.890 with community participation. 137 00:05:58.890 --> 00:06:01.920 One key concept related to this 138 00:06:01.920 --> 00:06:05.605 is the Alma-Ata declaration of 1978, 139 00:06:05.605 --> 00:06:09.387 which came out of a meeting of the World Health Organization 140 00:06:09.387 --> 00:06:12.030 in which they endorsed the development 141 00:06:12.030 --> 00:06:14.310 of primary care for everyone. 142 00:06:14.310 --> 00:06:16.920 Finally, regionalization is the third enduring 143 00:06:16.920 --> 00:06:18.480 organizational focus, 144 00:06:18.480 --> 00:06:21.300 but a specific definition of the term is evasive. 145 00:06:21.300 --> 00:06:22.950 The term has had many definitions 146 00:06:22.950 --> 00:06:25.560 as it has plans and applications. 147 00:06:25.560 --> 00:06:28.301 One definition states that regionalization 148 00:06:28.301 --> 00:06:30.750 cannot be defined on the basis of experience, 149 00:06:30.750 --> 00:06:32.490 but that agreement can be reached 150 00:06:32.490 --> 00:06:34.590 with regard to its objectives. 151 00:06:34.590 --> 00:06:36.960 The following general objectives have emerged with a degree 152 00:06:36.960 --> 00:06:39.180 of agreement across applications essential 153 00:06:39.180 --> 00:06:41.490 to the regionalization process. 154 00:06:41.490 --> 00:06:43.500 First, the efficient utilization 155 00:06:43.500 --> 00:06:45.360 of limited health resources. 156 00:06:45.360 --> 00:06:47.070 Second, the efficient utilization 157 00:06:47.070 --> 00:06:49.500 of expensive health resources. 158 00:06:49.500 --> 00:06:51.600 Third, the provision of adequate, appropriate, 159 00:06:51.600 --> 00:06:54.210 and accessible health services to a population. 160 00:06:54.210 --> 00:06:56.670 And fourth, the improvement in maintenance of standards 161 00:06:56.670 --> 00:06:58.120 of health services provision. 162 00:07:00.090 --> 00:07:03.510 Next, we turn to organizational planning and design. 163 00:07:03.510 --> 00:07:04.860 This enables managers 164 00:07:04.860 --> 00:07:06.960 to align the healthcare organization's functions 165 00:07:06.960 --> 00:07:09.090 and resources with its mission, vision, values, 166 00:07:09.090 --> 00:07:10.650 goals, and objectives. 167 00:07:10.650 --> 00:07:13.110 The planning process incorporates a variety of tools 168 00:07:13.110 --> 00:07:15.870 to facilitate work relations and interactions. 169 00:07:15.870 --> 00:07:19.023 Efficient resource allocation and effective decision making. 170 00:07:21.240 --> 00:07:24.540 Next, the discussion of the management 171 00:07:24.540 --> 00:07:27.630 of physical resources will focus on two main elements. 172 00:07:27.630 --> 00:07:30.150 The first element involves the planning processes 173 00:07:30.150 --> 00:07:32.760 of healthcare units of a pre architectural, 174 00:07:32.760 --> 00:07:35.460 medical functional program that defines the services 175 00:07:35.460 --> 00:07:38.250 to be offered and the resources required. 176 00:07:38.250 --> 00:07:40.170 The second element involves the supplies 177 00:07:40.170 --> 00:07:42.480 and utilities needed by healthcare units. 178 00:07:42.480 --> 00:07:47.160 For example, electrical power, water, fuel, medicinal gases, 179 00:07:47.160 --> 00:07:48.870 telephones, internet, 180 00:07:48.870 --> 00:07:51.090 which can be provided by either public services 181 00:07:51.090 --> 00:07:52.233 or private companies. 182 00:07:53.795 --> 00:07:56.550 The requirement for the operation of a healthcare unit 183 00:07:56.550 --> 00:07:59.040 should be assessed using the management model 184 00:07:59.040 --> 00:08:01.121 with attention to organizational design, 185 00:08:01.121 --> 00:08:02.580 the staff or personnel 186 00:08:02.580 --> 00:08:04.937 necessary to meet the established work shifts, 187 00:08:04.937 --> 00:08:08.460 job positions, and descriptions, organizational procedures 188 00:08:08.460 --> 00:08:12.240 and manuals, rules and regulations, and necessary inputs. 189 00:08:12.240 --> 00:08:14.730 The functional units of the clinical area correspond 190 00:08:14.730 --> 00:08:17.340 to the provision of direct services to patients 191 00:08:17.340 --> 00:08:20.580 and include outpatient care, auxiliary diagnostic, 192 00:08:20.580 --> 00:08:23.040 auxiliary treatment, hospitalization, 193 00:08:23.040 --> 00:08:25.440 and specialized care units. 194 00:08:25.440 --> 00:08:27.540 I really like this diagram that the book presents 195 00:08:27.540 --> 00:08:31.230 as it lists many, though not all, 196 00:08:31.230 --> 00:08:35.640 of essential physical resources in healthcare units. 197 00:08:35.640 --> 00:08:37.170 I'd encourage you all to think about things 198 00:08:37.170 --> 00:08:39.272 that are missing from this diagram, 199 00:08:39.272 --> 00:08:41.100 and also some things 200 00:08:41.100 --> 00:08:43.560 that might be found in a healthcare unit, 201 00:08:43.560 --> 00:08:45.693 but perhaps not all healthcare units. 202 00:08:47.898 --> 00:08:49.722 As I mentioned, 203 00:08:49.722 --> 00:08:52.775 the process of defining a functional unit 204 00:08:52.775 --> 00:08:56.730 involves looking at the structure, the process, 205 00:08:56.730 --> 00:08:57.900 what does it do? 206 00:08:57.900 --> 00:08:59.160 What functions does it carry out? 207 00:08:59.160 --> 00:09:00.390 What supplies does it need? 208 00:09:00.390 --> 00:09:01.500 What equipment does it need? 209 00:09:01.500 --> 00:09:03.630 Does that equipment need to be maintained? 210 00:09:03.630 --> 00:09:07.110 Do personnel need to be trained weekly, biweekly, monthly, 211 00:09:07.110 --> 00:09:08.700 yearly, et cetera? 212 00:09:08.700 --> 00:09:12.243 And then what are the outputs or the outcomes from that? 213 00:09:13.140 --> 00:09:16.890 And remember, outputs refer to things like efficiency 214 00:09:16.890 --> 00:09:18.210 and productivity, 215 00:09:18.210 --> 00:09:22.170 whereas outcomes can refer to health outcomes. 216 00:09:22.170 --> 00:09:23.943 Are people getting healthier? 217 00:09:25.181 --> 00:09:28.020 This image is an example of a functional unit. 218 00:09:28.020 --> 00:09:30.210 Notice how it diagrams a lot of things like 219 00:09:30.210 --> 00:09:34.830 where restrooms are, which angle doors open at. 220 00:09:34.830 --> 00:09:37.732 It almost looks like the architectural schematic 221 00:09:37.732 --> 00:09:40.863 of a certain geographic space. 222 00:09:43.020 --> 00:09:45.510 Next, the management of the physical infrastructure 223 00:09:45.510 --> 00:09:47.700 of a certain healthcare organization 224 00:09:47.700 --> 00:09:49.590 focuses on the conservation, maintenance, 225 00:09:49.590 --> 00:09:52.590 and operation of buildings, facilities, and equipment. 226 00:09:52.590 --> 00:09:54.360 The department responsible for this area 227 00:09:54.360 --> 00:09:56.070 represents a key structural element, 228 00:09:56.070 --> 00:09:58.029 both for the functioning of the unit services 229 00:09:58.029 --> 00:10:00.150 and for the development of the processes 230 00:10:00.150 --> 00:10:02.910 that transform inputs into services. 231 00:10:02.910 --> 00:10:05.100 Its main objective is to ensure the good condition 232 00:10:05.100 --> 00:10:06.930 of the property and the maintenance of the facility 233 00:10:06.930 --> 00:10:09.090 and equipment allowing for a correct 234 00:10:09.090 --> 00:10:10.860 and continuous operation with high levels 235 00:10:10.860 --> 00:10:13.203 of energy efficiency and security. 236 00:10:14.227 --> 00:10:17.100 We see that medical equipment and technology 237 00:10:17.100 --> 00:10:18.510 is certainly a key aspect 238 00:10:18.510 --> 00:10:21.510 of the different materials available 239 00:10:21.510 --> 00:10:23.520 within a certain functional unit. 240 00:10:23.520 --> 00:10:25.530 And it's important to think about the operation, 241 00:10:25.530 --> 00:10:27.390 maintenance and replacement of medical equipment 242 00:10:27.390 --> 00:10:31.080 and instruments, whether it's important the users are 243 00:10:31.080 --> 00:10:35.492 trained or receive technical assistance on the equipment 244 00:10:35.492 --> 00:10:38.283 and the development of health technology assessments. 245 00:10:40.260 --> 00:10:45.260 Next, don't forget the numerous services 246 00:10:45.840 --> 00:10:50.137 and the numerous personnel that either can be part 247 00:10:51.000 --> 00:10:53.924 of the primary employment of a healthcare organization 248 00:10:53.924 --> 00:10:57.360 or come in the form of personnel 249 00:10:57.360 --> 00:10:59.755 that are coming in externally. 250 00:10:59.755 --> 00:11:04.755 For example, certain agents or certain contractors 251 00:11:05.610 --> 00:11:09.450 that might come in to take care of janitorial services 252 00:11:09.450 --> 00:11:12.243 or carpentry services or electrical services. 253 00:11:13.140 --> 00:11:16.530 At the same time, you might have personnel 254 00:11:16.530 --> 00:11:17.910 that are core to the functioning 255 00:11:17.910 --> 00:11:20.900 of a certain healthcare system like a pharmacist 256 00:11:20.900 --> 00:11:22.920 or like nutritionists, 257 00:11:22.920 --> 00:11:27.843 and other people working in the catering or food system. 258 00:11:30.150 --> 00:11:31.910 So to conclude this week, 259 00:11:31.910 --> 00:11:35.220 we discussed different ways that organizations 260 00:11:35.220 --> 00:11:37.770 align their structure and their physical resources 261 00:11:37.770 --> 00:11:41.100 with their mission, vision, goals, and objectives. 262 00:11:41.100 --> 00:11:43.980 It's important to remember that like many things in life, 263 00:11:43.980 --> 00:11:46.397 the structure, process and outcomes 264 00:11:46.397 --> 00:11:48.420 of a healthcare organization determine 265 00:11:48.420 --> 00:11:50.490 the functional unit process. 266 00:11:50.490 --> 00:11:53.550 And there is a need to constantly reshape, realign, 267 00:11:53.550 --> 00:11:55.530 and redesign resource management 268 00:11:55.530 --> 00:11:57.543 to achieve value-based outcomes.