Jack: Hi everyone, and welcome back to module one.
In this lecture, we'll be discussing the functions,
structure, and physical resources
of healthcare organizations.
Before we begin to give a brief overview of the module,
this week we're gonna be talking about key functions
of healthcare organizations.
Talk about the ways in which organizations will assess
their performance, plan and prioritize
their physical resources, and integrate physical, human,
and technological resources.
Key concepts include facility design and management,
low resource management,
operations management, organizational design,
performance improvement, physical resources management,
and medical equipment.
The chapter this week starts off with this diagram,
which I like a lot.
I think it really does a good job of showing some many,
but not all of the factors
that go into determining good health.
So for example, we see on the left the structures
or the resources in the population upon which the health
status of a population is based.
These might look familiar to some of you
who have taken other public health courses
and be reminiscent of the social instructional
determinants of health.
We see things like the number of medical providers,
the number of physicians, the number of specialists,
the number of hospitals,
the amount of physical infrastructure,
whether medications are available,
and then also population characteristics like age,
comorbidities, life expectancy, et cetera.
We see that these set the stage for the health services
that are available and the health services
that are used.
From these health services,
we have a mediator before we get to the ultimate outcome.
This mediator, this output,
is very important to assessing the effectiveness
or efficiency of a health system.
So for example, when you're looking at the productivity
of a certain hospital, health organization, individual,
et cetera, you can gauge their effectiveness.
You can first gauge their productivity
before gauging how effective they are
at changing health outcomes or health statuses.
There are six core domains of the performance
of health systems, access, utilization,
efficiency, quality, sustainability, and learning,
and we'll go through each of these in turn.
The access dimension of health organizations
entails different aspects.
There's physical asset access, financial access,
linguistic access, and information access.
The first three are fairly straightforward,
though information access is related to the prior three
as someone's access to a language.
For example, if someone doesn't speak the main language
of a country, they might not have as much access
to information as someone
who speaks the main language of a country.
It's also important to remember
that equitable treatment should be provided
regardless of gender, race, ethnicity, religion,
age, or any other physical or socioeconomic condition.
Next, we look at the utilization, efficiency,
and quality dimensions.
Utilization refers to the patient
or procedure volume relative to capacity
and/or the population health characteristics.
The efficiency refers to the cost or staff to service ratios
and the patient or procedure volume.
Finally, the quality refers to both clinical quality
and managerial quality.
What is the experience of a patient receiving medical care,
and what is the experience
of a provider working within a certain health organization?
Are they able to be effective based on the structures
and management strategies that are in place?
Next, we turn to look at the multidimensional pillars
of healthcare sustainability.
The first, the environmental pillar,
represents the initial point of focus for sustainability,
and it includes, but it's not limited to,
the use of clean and renewable energy
and the conservation of the natural environment.
This pillar incorporates recycling techniques
to preserve the quality of the atmosphere,
to reuse solid and liquid waste,
and to safely dispose of contaminants.
Next, the sociocultural pillar strengthens community support
and promotes the identification of key cultural, ethic,
and other values among the community of staff,
patients, and users.
Number three, the institutional capacity development pillar,
promotes the strategic management of the organization.
It aims to strengthen competencies at all levels,
and instill an empowering knowledge management culture,
facilitating coordinated efforts of governance,
leadership, and personnel integration and participation.
Next, the financial pillar ensures the delivery
of healthcare programs and activities
that are cost effective and efficient
in the use of resources.
It is indispensable for achieving
the organization's goals and objectives.
Number five, the political pillar,
involves staff, patient, and community advocacy
to advance the interests of the organization.
Over many years of technological development
and interaction among professional,
political and economic forces,
three, enduring organizational folks that have emerged
for achieving the optimum health status of a population.
They're hospitals, primary care provision,
and regionalization.
To begin with,
in every country, hospitals are the most visible symbol
of healthcare development and care for the sick.
They represent public assurance that there's a place
for people to go for care when needed.
The development of primary care has emerged
as essential strategy to achieve universal access,
comprehensive care, and cost containment,
not only in developing countries,
but also in industrialized countries.
We also will refer to throughout the course,
developing countries as low and middle income countries
and industrialized countries as high income countries.
The goal for these low resource settings
is to provide essential services
that are realistically within their reach
with community participation.
One key concept related to this
is the Alma-Ata declaration of 1978,
which came out of a meeting of the World Health Organization
in which they endorsed the development
of primary care for everyone.
Finally, regionalization is the third enduring
organizational focus,
but a specific definition of the term is evasive.
The term has had many definitions
as it has plans and applications.
One definition states that regionalization
cannot be defined on the basis of experience,
but that agreement can be reached
with regard to its objectives.
The following general objectives have emerged with a degree
of agreement across applications essential
to the regionalization process.
First, the efficient utilization
of limited health resources.
Second, the efficient utilization
of expensive health resources.
Third, the provision of adequate, appropriate,
and accessible health services to a population.
And fourth, the improvement in maintenance of standards
of health services provision.
Next, we turn to organizational planning and design.
This enables managers
to align the healthcare organization's functions
and resources with its mission, vision, values,
goals, and objectives.
The planning process incorporates a variety of tools
to facilitate work relations and interactions.
Efficient resource allocation and effective decision making.
Next, the discussion of the management
of physical resources will focus on two main elements.
The first element involves the planning processes
of healthcare units of a pre architectural,
medical functional program that defines the services
to be offered and the resources required.
The second element involves the supplies
and utilities needed by healthcare units.
For example, electrical power, water, fuel, medicinal gases,
telephones, internet,
which can be provided by either public services
or private companies.
The requirement for the operation of a healthcare unit
should be assessed using the management model
with attention to organizational design,
the staff or personnel
necessary to meet the established work shifts,
job positions, and descriptions, organizational procedures
and manuals, rules and regulations, and necessary inputs.
The functional units of the clinical area correspond
to the provision of direct services to patients
and include outpatient care, auxiliary diagnostic,
auxiliary treatment, hospitalization,
and specialized care units.
I really like this diagram that the book presents
as it lists many, though not all,
of essential physical resources in healthcare units.
I'd encourage you all to think about things
that are missing from this diagram,
and also some things
that might be found in a healthcare unit,
but perhaps not all healthcare units.
As I mentioned,
the process of defining a functional unit
involves looking at the structure, the process,
what does it do?
What functions does it carry out?
What supplies does it need?
What equipment does it need?
Does that equipment need to be maintained?
Do personnel need to be trained weekly, biweekly, monthly,
yearly, et cetera?
And then what are the outputs or the outcomes from that?
And remember, outputs refer to things like efficiency
and productivity,
whereas outcomes can refer to health outcomes.
Are people getting healthier?
This image is an example of a functional unit.
Notice how it diagrams a lot of things like
where restrooms are, which angle doors open at.
It almost looks like the architectural schematic
of a certain geographic space.
Next, the management of the physical infrastructure
of a certain healthcare organization
focuses on the conservation, maintenance,
and operation of buildings, facilities, and equipment.
The department responsible for this area
represents a key structural element,
both for the functioning of the unit services
and for the development of the processes
that transform inputs into services.
Its main objective is to ensure the good condition
of the property and the maintenance of the facility
and equipment allowing for a correct
and continuous operation with high levels
of energy efficiency and security.
We see that medical equipment and technology
is certainly a key aspect
of the different materials available
within a certain functional unit.
And it's important to think about the operation,
maintenance and replacement of medical equipment
and instruments, whether it's important the users are
trained or receive technical assistance on the equipment
and the development of health technology assessments.
Next, don't forget the numerous services
and the numerous personnel that either can be part
of the primary employment of a healthcare organization
or come in the form of personnel
that are coming in externally.
For example, certain agents or certain contractors
that might come in to take care of janitorial services
or carpentry services or electrical services.
At the same time, you might have personnel
that are core to the functioning
of a certain healthcare system like a pharmacist
or like nutritionists,
and other people working in the catering or food system.
So to conclude this week,
we discussed different ways that organizations
align their structure and their physical resources
with their mission, vision, goals, and objectives.
It's important to remember that like many things in life,
the structure, process and outcomes
of a healthcare organization determine
the functional unit process.
And there is a need to constantly reshape, realign,
and redesign resource management
to achieve value-based outcomes.