Health system responsiveness

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Responsiveness
Response to individuals’ legitimate expectations regarding the non-health enhancing aspects of the health system

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  • 1. Health System Responsiveness Dr. Ahmed-Refat AG Refat www.SlideShare.Net/AhmedRefat 18-12-2012 Health SystemResponsiveness ‫االستجابة كمؤشر اداء النظام الصحي‬ "‫"اإلعزاز و اإلحسان‬ Dr. Ahmed-Refat AG Refat 1
  • 2. Health System Responsiveness Dr. Ahmed-Refat AG Refat www.SlideShare.Net/AhmedRefat 18-12-2012 Contents Dimension and objectives of health system Definition of responsiveness Legitimate expectation Patients vs customer Elements of responsiveness  Dignity  Autonomy  Confidentiality  Prompt attention  Quality of amnesties  Access to social support  Choice of Care Provider 2
  • 3. Health System Responsiveness Dr. Ahmed-Refat AG Refat www.SlideShare.Net/AhmedRefat 18-12-2012The World Health Organisation’s new framework for health system performance assessment has health improvement, responsiveness and fairness of financing 3
  • 4. Health System Responsiveness Dr. Ahmed-Refat AG Refat www.SlideShare.Net/AhmedRefat 18-12-2012as the three goals of the health system 4
  • 5. Health System Responsiveness Dr. Ahmed-Refat AG Refat www.SlideShare.Net/AhmedRefat 18-12-2012 5
  • 6. Health System Responsiveness Dr. Ahmed-Refat AG Refat www.SlideShare.Net/AhmedRefat 18-12-2012Functional Form for Overall Health System Attainment The general form of the overallmeasure of health system attainment is simply: Composite = f (H,HI,R, RI,FF)Health system attainment is simply: 6
  • 7. Health System Responsiveness Dr. Ahmed-Refat AG Refat www.SlideShare.Net/AhmedRefat 18-12-2012 Composite = f (H,HI,R, RI,FF)WhereH is the level of health,HI is health inequality,R is responsiveness,RI is responsiveness inequalityand FF is fairness of financial contribution. 7
  • 8. Health System Responsiveness Dr. Ahmed-Refat AG Refat www.SlideShare.Net/AhmedRefat 18-12-2012 What is Responsiveness Response to individuals’ legitimateexpectations regarding the non-health enhancing aspects of the health system. 8
  • 9. Health System Responsiveness Dr. Ahmed-Refat AG Refat www.SlideShare.Net/AhmedRefat 18-12-2012 Why ResponsivenessPatient satisfaction with non-medical aspects of care, is often associated with better compliance with treatment instructions, prompt seeking of care and a better understanding and retention of medical information . 9
  • 10. Health System Responsiveness Dr. Ahmed-Refat AG Refat www.SlideShare.Net/AhmedRefat 18-12-2012 WHAT IS Health System RESPONSIVENESS?Responsiveness in the context of a system can be defined as: the outcome that can be achieved when institutions and institutional relationships are designed in such a way that they are respond appropriately to the universally legitimate expectations of individuals. 11
  • 11. Health System Responsiveness Dr. Ahmed-Refat AG Refat www.SlideShare.Net/AhmedRefat 18-12-2012Responsiveness can be viewed from two angles. Firstly The user of the health care system is often portrayed as a consumer, with greater responsiveness being perceived as a means of attracting consumers. 11
  • 12. Health System Responsiveness Dr. Ahmed-Refat AG Refat www.SlideShare.Net/AhmedRefat 18-12-2012 Secondly,Responsiveness is related to the safeguarding of rights of patients to adequate and timely care. “treat those who use health services as consumers within a market based and people centred system”. 12
  • 13. Health System Responsiveness Dr. Ahmed-Refat AG Refat www.SlideShare.Net/AhmedRefat 18-12-2012 Patient orClient /Customer/Consumer ??? Patient Vs Customer 13
  • 14. Health System Responsiveness Dr. Ahmed-Refat AG Refat www.SlideShare.Net/AhmedRefat 18-12-2012The use of the word patients is considered tounderrate the status of the individual, as it cratesa hierarchy.The patient should be defined as a consumer, arationale that originates from the emphasis onthe market mechanism. 14
  • 15. Health System Responsiveness Dr. Ahmed-Refat AG Refat www.SlideShare.Net/AhmedRefat 18-12-2012 Patient Vs Customer The term consumer dignifies theprofessional/patient relationship in a way that the traditional term patient with its association of powerlessness against the medical establishment does not. 15
  • 16. Health System Responsiveness Dr. Ahmed-Refat AG Refat www.SlideShare.Net/AhmedRefat 18-12-2012 Patient Vs Customer Using the word client, customer or service usersimilarly moves away from the idea of the user of medical services being passive and dependent. 16
  • 17. Health System Responsiveness Dr. Ahmed-Refat AG Refat www.SlideShare.Net/AhmedRefat 18-12-2012 Patient Vs CustomerThe seven principles should relate to consumers: 1. access, 2. choice, 3. information, 4. redress, 5. safety, 6. value for money 7. and equity 17
  • 18. Health System Responsiveness Dr. Ahmed-Refat AG Refat www.SlideShare.Net/AhmedRefat 18-12-2012 Responsiveness Vs SATISFACTION (1) Scope: patient satisfaction focuses on clinical interaction in specific health care settings whereas responsiveness evaluates the health system as a whole; (2) Range: patient satisfaction generally covers bothmedical and non-medical aspects of care while responsivenessfocuses only on the non-health enhancing aspects of the health system; (3) Rationale: patient satisfaction represents a complex mixture of perceived need, individually determined expectations and experience of care. 18
  • 19. Health System Responsiveness Dr. Ahmed-Refat AG Refat www.SlideShare.Net/AhmedRefat 18-12-2012 Legitimate EXPECTATIONS a- ExpectationsExpectations are often simply defined as individual’s beliefs regarding desired outcomes. 19
  • 20. Health System Responsiveness Dr. Ahmed-Refat AG Refat www.SlideShare.Net/AhmedRefat 18-12-2012 Four types of expectations: - Ideal: similar to aspirations, desires or preferred outcomes - Predictedrealistic, practical or anticipated outcomes that result from personal experiences, reported experiences of others and sources of knowledge such as the media 21
  • 21. Health System Responsiveness Dr. Ahmed-Refat AG Refat www.SlideShare.Net/AhmedRefat 18-12-2012 Four types of expectations: - Normativeexpectations that are based on what should or ought to happen - Unformed – the situation that occurs when individuals are unable or unwilling for various reasons to articulate their expectations, which may either be because they do not have expectations, have difficulty expressing their expectations or do not wish to reveal their expectations due to fear, anxiety or conforming to social norms. 21
  • 22. Health System Responsiveness Dr. Ahmed-Refat AG Refat www.SlideShare.Net/AhmedRefat 18-12-2012 Legitimate EXPECTATIONS b- Legitimate can be defined as conforming to recognised principles or accepted rules and standards.Ethical norms can be set in most instances without much debate as to the optimal desired behavioural process 22
  • 23. Health System Responsiveness Dr. Ahmed-Refat AG Refat www.SlideShare.Net/AhmedRefat 18-12-2012 Elements ofResponsiveness 23
  • 24. Health System Responsiveness Dr. Ahmed-Refat AG Refat www.SlideShare.Net/AhmedRefat 18-12-2012 1 Dignity The right of a care seeker to betreated as a person in their own right rather than merely as a patient 24
  • 25. Health System Responsiveness Dr. Ahmed-Refat AG Refat www.SlideShare.Net/AhmedRefat 18-12-2012 Dignity includes:♦ the safeguarding of human rightssuch as the liberty to free movementeven for individuals who haveleprosy, tuberculosis or are HIV+♦ treatment with respect by healthcare staff; 25
  • 26. Health System Responsiveness Dr. Ahmed-Refat AG Refat www.SlideShare.Net/AhmedRefat 18-12-2012♦ the right to ask questions andprovide information duringconsultations and treatment;♦ privacy during examination andtreatment Patients satisfaction levels are increased by doctorstaking time to make conversation with the patient, such as make comments that are not related to health or crack a joke. 26
  • 27. Health System Responsiveness Dr. Ahmed-Refat AG Refat www.SlideShare.Net/AhmedRefat 18-12-2012 Assessment of dignity 27
  • 28. Health System Responsiveness Dr. Ahmed-Refat AG Refat www.SlideShare.Net/AhmedRefat 18-12-2012 2-AutonomyAutonomy is self-directing freedom. 28
  • 29. Health System Responsiveness Dr. Ahmed-Refat AG Refat www.SlideShare.Net/AhmedRefat 18-12-2012The Four rights of individual ♦ The right of an individual toinformation on his/her disease andalternative treatment options (this facilitates informed choice) 29
  • 30. Health System Responsiveness Dr. Ahmed-Refat AG Refat www.SlideShare.Net/AhmedRefat 18-12-2012The Four rights of individual ♦ The right to be consulted about treatment 31
  • 31. Health System Responsiveness Dr. Ahmed-Refat AG Refat www.SlideShare.Net/AhmedRefat 18-12-2012The Four rights of individual♦ Informed consent in the context of testing and treatment 31
  • 32. Health System Responsiveness Dr. Ahmed-Refat AG Refat www.SlideShare.Net/AhmedRefat 18-12-2012The Four rights of individual♦ The right of patients of sound mind to refuse treatment 32
  • 33. Health System Responsiveness Dr. Ahmed-Refat AG Refat www.SlideShare.Net/AhmedRefat 18-12-2012 Models of Autonomy. 1- The first the paternalistic modelhas the health care provider making all decisions on behalf of the patient,since the provider is considered to bebetter informed this is considered to be optimal. 33
  • 34. Health System Responsiveness Dr. Ahmed-Refat AG Refat www.SlideShare.Net/AhmedRefat 18-12-2012 2- The second model termed theinformed decision making model,imposes the need for information dissemination on theprovider and the responsibility of decision making on the patient. 34
  • 35. Health System Responsiveness Dr. Ahmed-Refat AG Refat www.SlideShare.Net/AhmedRefat 18-12-2012 3- The professional agent model, has the patient willingly foregoingthe right to decision making, though well informed, through voluntarily and explicitly transferring the decision making task to the provider. 35
  • 36. Health System Responsiveness Dr. Ahmed-Refat AG Refat www.SlideShare.Net/AhmedRefat 18-12-20124- The final model termed the shared decision making model focuses on the sharing of both information and decision making between the patient and the provider, including the determination of preferences. 36
  • 37. Health System Responsiveness Dr. Ahmed-Refat AG Refat www.SlideShare.Net/AhmedRefat 18-12-2012Assessment of Autonomy 37
  • 38. Health System Responsiveness Dr. Ahmed-Refat AG Refat www.SlideShare.Net/AhmedRefat 18-12-2012 3- Confidentiality Information relating to the patientand his illness should not be divulged during the course of care, except in specific contexts, without the prior permission of the patient. 38
  • 39. Health System Responsiveness Dr. Ahmed-Refat AG Refat www.SlideShare.Net/AhmedRefat 18-12-2012Assessment of Confidentiality 39
  • 40. Health System Responsiveness Dr. Ahmed-Refat AG Refat www.SlideShare.Net/AhmedRefat 18-12-2012 4- Prompt Attention Prompt attention is consist of three characteristics:♦ Patients should be entitled to rapid care in emergencies, and 41
  • 41. Health System Responsiveness Dr. Ahmed-Refat AG Refat www.SlideShare.Net/AhmedRefat 18-12-2012♦ Patients should be entitled to care within reasonable time periods even in the case of non-emergency health care problems or surgery..♦ Patients seeking care at healthcare units should not face longwaiting times for consultations and treatment. 41
  • 42. Health System Responsiveness Dr. Ahmed-Refat AG Refat www.SlideShare.Net/AhmedRefat 18-12-2012Assessment of Prompt attention 42
  • 43. Health System Responsiveness Dr. Ahmed-Refat AG Refat www.SlideShare.Net/AhmedRefat 18-12-2012 5- Qualities of clean amenitiesThis aspect relates to the provision of physical infrastructure and a conducive care environment. The study defines basic amenities in the following manner: 43
  • 44. Health System Responsiveness Dr. Ahmed-Refat AG Refat www.SlideShare.Net/AhmedRefat 18-12-2012♦ clean surroundings♦ regular procedures for cleaning andmaintenance of hospital buildings .♦ adequate furniture♦ sufficient ventilation♦ clean water♦ clean toilets♦ clean linen♦ healthy and edible food 44
  • 45. Health System Responsiveness Dr. Ahmed-Refat AG Refat www.SlideShare.Net/AhmedRefat 18-12-2012Assessment of the qualities of clean amenities 45
  • 46. Health System Responsiveness Dr. Ahmed-Refat AG Refat www.SlideShare.Net/AhmedRefat 18-12-20126 -Access to socialsupport networks during careThe patient welfare is best served ifthe individual has access to support networks during care. 46
  • 47. Health System Responsiveness Dr. Ahmed-Refat AG Refat www.SlideShare.Net/AhmedRefat 18-12-2012 The procedures in the provision of inpatient health care should allow♦ regular visits by relatives and friends♦ provision of food and other consumablesby relatives and friends, if not provided bythe hospital♦ religious practices that do not prove ahindrance to hospital activities or hurt thesensibilities of other individuals 47
  • 48. Health System Responsiveness Dr. Ahmed-Refat AG Refat www.SlideShare.Net/AhmedRefat 18-12-2012Assessment of Social Support Network 48
  • 49. Health System Responsiveness Dr. Ahmed-Refat AG Refat www.SlideShare.Net/AhmedRefat 18-12-20127- Choice of Care ProviderThe ability to choose between care providers . 49
  • 50. Health System Responsiveness Dr. Ahmed-Refat AG Refat www.SlideShare.Net/AhmedRefat 18-12-2012 Assessment 51
  • 51. Health System Responsiveness Dr. Ahmed-Refat AG Refat www.SlideShare.Net/AhmedRefat 18-12-2012 Cited ReferencesAmala de Silva. A FRAMEWORK FOR MEASURING RESPONSIVENESS .GPE Discussion Paper Series: No. 32EIP/GPE/EBD. World Health OrganizationChristopher JL Murray,Jeremy Lauer,Ajay Tandon,Julio Frenk. OVERALL HEALTH SYSTEMACHIEVEMENT FOR 191 COUNTRIES Discussion Paper Series: No. 28 EIP/GPEWorld Health OrganizationAna-Lucia Ristea1, Ion Steg_roiu2, Valeriu Ioan-Franc3 and Vasile Dinu4 Responsiveness of Health Systems: aBarometer of the Quality of Health Services. Amfiteatru Economic Vol XI • Nr. 26 • June 2009WHO- World Health report 2000. http://www.who.int/whr/2000/en/whr00_en.pdf 51