Health policy and planning.pptx

HPP MS HCM
BATRASIAN_67@HOTMAIL.COM

CONCEPT AND IMPORTANCE
Public policy is a course of action created, typically by a government,
in response to public, real-world problems
"the principles that govern action directed towards given ends“
"an institutionalized proposal to solve a central problem, guided by a
conception"
public policy has been conceptualized in a variety of ways
One of the most known and controversial concepts of public policy is
that of Thomas R. Dye, according to whom "public policy is whatever
governments choose to do or not to do“
Public policy focuses on the decisions that create the outputs of a
political system, such as transport policies, the management of a
public health service, the administration of a system schooling and
the organization of a defense force etc.
Public policy making can be characterized as a dynamic, complex,
and interactive system through which public problems are identified
and resolved through the creation of new policy or reform of existing
policy

policymakers bear responsibility
to reflect the interests of a host
of different stakeholders.
Policy design entails conscious
and deliberate effort to define
policy aims and map them
instrumentally

A popular way of understanding and
engaging in public policy is through a
series of stages known as
"the policy cycle".
The characterization of particular stages
can vary, but a basic sequence is:
 agenda setting
 formulation
 legitimation
 implementation
 evaluation

AGENDA SETTING
Agenda
setting identifies
problems that require
government
attention, deciding
which issue deserve
the most attention
and defining the
nature of the
problem

ISSUE ATTENTION CYCLE
The 'issue attention cycle' is a concept developed by Anthony Downs (1972) where problems progress
through 5 distinct stages. This reinforces how the policy agenda does not necessarily lead to policy
change, as public interest dissipates, most problems end up resolving themselves or get ignored by
policymakers.
Its key stages include:
Pre-problem stage: The problem is not recognized by the public, media or policy makers.
Alarmed discovery and euphoric enthusiasm: something is identified as a problem, supported
awareness by media to pursue seriousness of problem
Realization of costs which will be incurred by the solutions: Investigating through cost-benefit
analysis, bringing awareness of financial, environmental, structural curbs to consider solutions and
what makes for their consequences.
Decline in public interest in issue: Citizens acquire acceptance of the problem and it becomes
'normalized'. Newer issues attract the attention of the public. Limited attention span encourages
policymakers to delay developing policy to see which public troubles demand necessary and
worthwhile solving.
Issue slips off, or back down, the policy agenda: The issue effectively disappears, although it has the
possibility to re-emerge in other pressing circumstances

POLICY FORMULATION
This is the setting of
the objectives for the
policy, along with
identifying the cost and
effect of solutions that
could be proposed from
policy instruments.

LEGITIMATION
Legitimation is when
approval and support for
the policy instruments is
gathered, involving one of
or a combination of
executive approval,
legislative approval, and
seeking consent through
consultation or referenda.

IMPLEMENTATION
Policy implementation is
establishing or employing
an organization to take
responsibility for the policy,
making sure the
organization has the
resources/legal authority to
do so, in addition to
making sure the policy is
carried out as planned. An
example of this would be
the Health Department
being set up.

EVALUATION
Evaluation is the process of
assessing the extent to
which the policy has been
successful, or if this was
the right policy to begin
with/ was it implemented
correctly and if so, did it go
as expected

POLICY MAINTENANCE
Maintenance is when the
policy makers decide to
either terminate or continue
the policy. The policy is
usually either continued as
is, modified, or discontinued

RESPONSIBILITY OF POLICY
MAKERS
Each system is influenced by different public
problems and issues, and has different
stakeholders; as such, each requires different
public policy.
In public policy making, numerous individuals,
corporations, non-profit organizations and
interest groups compete and collaborate to
influence policymakers to act in a particular
way.
The large set of actors in the public policy
process, such as politicians, civil servants,
lobbyists, domain experts, and industry or
sector representatives, use a variety of tactics
and tools to advance their aims, including
advocating their positions publicly, attempting
to educate supporters and opponents, and
mobilizing allies on a particular issue BATRASIAN_67@HOTMAIL.COM

Many actors can be important in the public policy process,
but government officials ultimately choose public policy in
response to the public issue or problem at hand. In doing
so, government officials are expected to meet public sector
ethics and take the needs of all project stakeholders into
account
Since societies have changed in the past decades, the public
policy making system changed too. In the 2010s, public
policy making is increasingly goal-oriented, aiming for
measurable results and goals, and decision-centric,
focusing on decisions that must be taken immediately
Furthermore, mass communications and technological
changes such as the widespread availability of the Internet
have caused the public policy system to become more
complex and interconnected. The changes pose new
challenges to the current public policy systems and
pressures leaders to evolve to remain effective and efficient BATRASIAN_67@HOTMAIL.COM

USA PICTURE
Public policies come from all
governmental entities
legislatures,
courts,
bureaucratic agencies, and
executive offices at national, local and
state levels.
On the federal level, public policies are
laws enacted by Congress, executive
orders issued by the president, decisions
handed down by the US Supreme Court,
and regulations issued by bureaucratic
agencies
In Pakistan
Senate and National/Provincial
Assemblies/Ministry of planning
development and special initiatives.

HEALTH POLICY
A set of decisions or
commitments to pursue
courses of action aimed at
achieving defined goals for
improving health.
Aim of Health Policy-Maintain
and improve the health status
of population
Risk factor which influence
health differ between
countries.

HEALTH POLICY, GOVERNANCE
The 18th Amendment in the 1973 Constitution has devolved health
planning, service delivery and programme implementation to the
provincial level.
The National Health Vision 2025 aims at universal access to quality
essential health services and ensuring financial protection, focusing
on vulnerable and delivered through resilient and responsive health
systems.
The National Health Vision is articulated on the health system
functions and is aligned with the health-related Sustainable
Development Goals (2030).
WHO supports the development of a monitoring framework for the
national health vision, design of provincial health sector strategies
and capacity-building in health policy and strategic planning

After the 18th amendment the provinces in addition to service
delivery and programme implementation also became responsible for
strategic planning. To meet the new responsibility of strategic
planning all the provinces established health policy units and also
developed provincial health policies; WHO provided technical support
in this process of devolution.
However; some federal function in health became fragmented and
distributed between different ministries and divisions. In 2012, WHO
fielded a high-level mission to assess the effects of devolution in
health. The mission highlighted the fragmentation of federal health
functions and lack of a national entity to represent Pakistan at
international forums. In 2013, using this report a federal ministry of
Health Service regulation & Coordination was created

NATIONAL HEALTH VISION
The vision of National Health vision 2025 is to improve the health of
all Pakistanis, particularly women and children, through universal
access to quality essential health services and ensuring financial
protection, with a focus on vulnerable groups, and delivered through
resilient and responsive health systems.
The purpose of National Health vision 2025 is to provide an
overarching national vision an agreed upon common direction,
harmonizing provincial & federal efforts, inter-provincial efforts and
intersectoral efforts for achieving the desired health outcomes and to
create an impact. It provides a jointly developed account of suggested
priority actions to achieve the common vision and which gives a
guideline of best practices for the provinces/ areas to carve their
respective policies and initiatives within their domains

AIMS OF HEALTH POLICIES
The prime aim of health policies is
to maintain and improve the health
status of population
However the risk factors which
influence health status may differ
between different regions and
countries
Thus the policies for health are
influenced by different factors in
each country and region.

ROLE OF PUBLIC HEALTH
Surveillance of health of population
Identification of its health needs
Fostering of policies which promote health
Evaluation of health services

CRITERIA,ACCESS, AND
UTILIZATION
The first criteria that needs to be
established is whether care is necessary
or not
The second criteria is the effectiveness
of the services provided,the efficiency
with which they are provided, and
whether the individual could take
responsibility for providing them

INTERNATIONAL TRENDS
Every citizen in a country has the same rights to healthcare.
A policy must be knowledge based and result oriented
Careful planning and skilled management can achieve good
results even where financial resources are limited.
Many lives can be saved and disability can be prevented by
simple measures like boosting immunization programs,
access to safe water, good sanitation, treatment of
childhood ailments and skilled care during childbirth.

PREMATURE DEATHS-DISCUSSION

PAKISTAN
Ministry of Planning
Development & Special Initiatives

BACKGROUND
The Planning Commission (denoted as PC) is a financial and public
policy development institution of the Government of Pakistan. The
Commission comes under Ministry of Planning, Development and
Reforms. The Planning Commission undertakes research studies and
state policy development initiatives for the growth of national
economy and the expansion of the public and state infrastructure of
the country in tandem with the Ministry of Finance

ORGANOGRAM
Chairman
Deputy Chairman
Member coordination/secretary PDS------Advisory committee
Members
https://www.pc.gov.pk/web/orag

ACTS AND ORDINANCES-
ASSIGNMENTS
PAKISTAN INSTITUTE OF DEVELOPMENT ECONOMICS ACT,2010
GENERAL STATISTICS (REORGANIZATION) ACT,2011
PUBLIC PRIVATE PARTNERSHIP AUTHORITY ACT,2017
PUBLIC PRIVATE PARTNERSHIP AUTHORITY (P3A) AMENDMENT
ORDINANCE,2020
CHINA PAKISTAN ECONOMIC COORIDOR(CPEC) AUTHORITY
ORDINANCE,2019
PUBLIC PRIVATE PARTNERSHIP (AMENDMENT BILL)

EXAMPLE OF COMPLETED
PROJECT
School of Dentistry, Shaheed Zulfiqar Ali Bhutto
Medical University, Islamabad
Benefits of the Project
128000 patients will be investigated and treated
annually, 100 BDS graduates will pass out every
year, 50 post graduate students will be trained in
four years, training of staff from peripheral hospital.
Approved Cost: Rs.1294.36 Million
Final Expenditure: Rs.1200.14 Million
Expenditure During FY 2019-20: Rs.400.14 Million
Date of Commencement: July, 2015
Date of Completion: June, 2020
Operationalized (Yes/No), if no reasons: Yes

EXAMPLE OF COMPLETED
PROJECT
Establishment of Specialized Medium Range Weather
Forecasting Center (SMRFC) and Strengthening of Weather
Forecasting system
Benefits of the Project
Further strengthen the forecasting capabilities of PMD
From short range forecast, PMD would be able to issue
medium range forecast.
Approved Cost: Rs.2502.532 Million
Final Expenditure: Rs.2502.53 Million
Expenditure During FY 2019-20: Rs.365.785 Million
Date of Commencement: September, 2015
Date of Completion: June, 2020
Operationalized (Yes/No), if no reasons: Yes
Date of Inauguration (if inaugurated): N/A
Physical Progress (%)

PLANNING AND DEVELOPMENT
BOARD
The Planning and Development Board, Government of Punjab, is the
principal planning organization at the provincial level. It coordinates
and monitors development programs and activities of various
departments of the provincial government. The department also
prepares an overall Medium Term Development Framework (MTDF) of
developmental activities in the province. The Medium Term
Development Framework lays down the developmental activities to be
carried out in the province in various sectors of the provincial
economy. In this manner, the Planning & Development Board is one of
the main actors in the growth of the economic potential of the
province.
The mandate of the Planning and Development Board includes
provision of technical support and coordination to various
Government departments in their planning activities. The department
is also the main government agency working with foreign donors in
the province BATRASIAN_67@HOTMAIL.COM

OBJECTIVES
The main objectives of the department are as follows:
Assessment of the material and human resources of the province
Formulation of long and short term plans
Recommendations concerning prevailing economic conditions,
economic policies or measures
Examination of such economic problems as may be referred to it for
advice
Coordination of all economic activities in the provincial government

ANNUAL DEVELOPMENT
PROGRAMS
Improvement of Infrastructure & Equipment in Selected RHCs of South
Punjab 01381703919 / 28-07-2017 / Bahawalnagar,Bahawalpur,Dera Ghazi
Khan,Khanewal,Layyah,Lodhran,Multan, Muzaffargarh,Rahim Yar
Khan,Rajanpur,Vehari
Remodeling of Urban Health Facilities in South Punjab 01381703921 / 28-
07-2017 / Bahawalnagar,Bahawalpur,Dera Ghazi
Khan,Layyah,Lodhran,Multan,Muzaffarg arh,Rahim Yar Khan,Rajanpur,Vehari
Rehabilitation / Improvement of Government Eye Hospital, Khanpur, Rahim
Yar Khan 01031800175 / 31-12-2018 / Rahim Yar Khan
Upgradation of RHC Mianwali Qureshian to 60 Bedded THQ Level Hospital,
District Rahim Yar Khan 01031902777 / 01-07-2019 / Rahim Yar Khan
Provision of Ultra Sonography Machines at 24/7 BHUs in South Punjab
01372002065 / Un-Approved / Bahawalnagar,Bahawalpur,Dera Ghazi
Khan,Khanewal,Layyah,Lodhran,Multan, Muzaffargarh,Rahim Yar
Khan,Rajanpur,Vehari BATRASIAN_67@HOTMAIL.COM

ASSIGNMENT/GROUP DISCUSSION
& PRESENTATION
Discuss in detail the foreign funded projects of planning and
development board Punjab preferably in health and education sector.

MINISTRY OF NATIONAL HEALTH
SERVICES, REGULATIONS &
COORDINATION DIVISION
The Ministry of National Regulations and Services was established in April, 2012. Later
on the scope of work of the ministry was expanded and its nomenclature was also
changed to Ministry of National Health Services, Regulations and Coordination
Ministry of National Health Services, Regulations and Coordination is committed for
helping the people of Pakistan to maintain and improve their health and to make our
population among the healthier in the region.
Our vision is the provision of a health system that:
• Provides efficient, equitable, accessible & affordable health services with the
objective to support people and communities to improve their health status.
• National and International Coordination in the field of Public Health
• Oversight for regulatory bodies in health sector
• Population welfare coordination
• Enforcement of Drugs Laws and Regulations
• Coordination of all preventive programs, funded by GAVI/GFATM

DEPARTMENTS
Pharmacy council of Pakistan
Universal Service Funds
National Health Emergency Preparedness Network
National Trust for Population welfare
National Council of Homeopathy
Pakistan Medical Research Council
Health Service Academy
Pakistan college of physicians and surgeons
National Institute of Population studies

POLICY & STRATEGIC
PLANNING UNIT PUNJAB
Designed originally to improve and monitor primary health care
system, Project Management Unit Punjab Health Sector Reforms
Program (Punjab Health Sector Reforms Project) started in 2006. It
was obliged to undertake multifaceted functions including but not
limited to monitoring and improvement of both primary and
secondary healthcare facilities.
It had been working as focal office not only for implementation of
Millennium Development Goals sponsored by Asian Development
Bank (ADB) but also remained intimately involved in launching and
coordinating other priority initiatives like
 Maternal Newborn and Child Health Program (MNCH),
 Chief Minister’s Initiative for Attainment and Realization of MDGs (Chief Ministers
Health Initiatives for Attainment and Realization of Millennium development goals),
integration of Maternal Newborn and Child Health, Lady Health Worker and
Nutrition Program under Integrated Reproductive, Maternal, Newborn & Child
Health and Nutrition Program (IRMNCHNP) BATRASIAN_67@HOTMAIL.COM

ASSIGNMENT
Discuss in detail the new initiatives by Integrated Reproductive, Maternal, Newborn &
Child Health and Nutrition Program (IRMNCHNP).

The ability of a country to meet its health
goals depends largely on the knowledge,
skills, motivation and deployment of the
people responsible for organizing and
delivering health services
The formulation of national policies and
plans in pursuit of human resources for
health development objectives requires
sound information and evidence.
WHO is working with countries and
partners to strengthen the global evidence
base on the health workforce

The health workforce can be defined as “all
people engaged in actions whose primary
intent is to enhance health.
These human resources include clinical staff
such as physicians, nurses, pharmacists and
dentists, as well as management and support
staff – those who do not deliver services
directly but are essential to the performance
of health systems.
It has been estimated, however, that
countries with fewer than 23 physicians,
nurses and midwives per 10 000 population
generally fail to achieve adequate coverage
rates for selected primary health-care
interventions, as prioritized by the
Millennium Development Goals

SOURCES OF INFORMATION ON
HEALTH WORKFORCE
Perceived shortages of health workers have
many causes and may be a result of
inadequate numbers and skills mix of
persons being trained or mal distribution of
their deployment
Population census
Labor force surveys
Health Facility Assessments
Administrative records including civil
services payroll registries/registries of
professional regulatory bodies

NUMBER OF HEALTH WORKERS
PER 10 000 POPULATION
The number of health workers available in a
country relative to the total population.
Numerator: The absolute number of health workers
at a given time in a given country or region (that is,
all persons eligible to participate in the national
health labour market by virtue of their skills, age,
ability and physical presence in the country).
Denominator: The total population for the same
geographical area.
Monthly, quarterly or annually for routine
administrative records. A validation exercise should
be conducted every 3–5 years against a national
population BATRASIAN_67@HOTMAIL.COM

The most complete and comparable data
currently available on the health workforce
globally pertain to physicians, nurses and
midwives. However, the health workforce
includes a wide range of other categories of
service providers (e.g. dentists, pharmacists,
physiotherapists, community health workers)
as well as management and support workers
(health service managers, health economists,
health information technicians and others).
Information should ideally be captured on all
of these categories of human resources for
health.

DISTRIBUTION OF HEALTH
WORKERS
Equal distribution in accordance with detailed
population surveys
Because counts of workers in the private sector are
likely to be less accurate when drawing on
administrative sources than counts of those in the
public sector, and because private for-profit
providers are often less accessible to low-income
populations, it is recommended that national and
international reports include statistics
disaggregated by employment sector (public,
private for-profit and private not-for-profit).
Additional information on health workers’
demographic characteristics may also be
important for policy and planning, e.g. the age
distribution can lend insights into the numbers of
workers approaching retirement age. BATRASIAN_67@HOTMAIL.COM

ANNUAL NUMBER OF GRADUATES OF
HEALTH PROFESSIONS EDUCATIONAL
INSTITUTIONS PER 100 000
POPULATION
Data on the output of health
professions educational institutions
can be used to assess health
workforce renewal or the ratio of
entry to the health workforce (that is,
the number of graduates relative to
the total active health workforce).
When combined with information on
the numbers of foreign-trained
health workers in the country, this
information can be used to assess
the level of national self-sufficiency
in human resources for health

ADDITIONAL CONSIDERATIONS FOR
MONITORING NATIONAL
WORKFORCE PLANS AND ACTIONS
Strengthening the performance of
health systems depends on more
than just increasing the numbers
of health workers: actions for
assessing and strengthening their
recruitment, distribution, retention
and productivity are also
important.

OCCUPATIONAL TITLES RELATED TO
HEALTH IN THE INTERNATIONAL
STANDARD CLASSIFICATION OF
OCCUPATIONS (ISCO-08)
HEALTH PROFESSIONALS
Medical doctors
Generalist medical practitioners
Specialist medical practitioners
Nursing and midwifery professionals
Traditional and complementary medicine
professionals
Paramedical practitioners
Other health professionals
Dentists
Pharmacists
Environmental and occupational health
Physiotherapists
Dieticians and nutritionists BATRASIAN_67@HOTMAIL.COM

Health Associate Professional
Medical and Pharmaceutical technicians
Medical imaging and therapeutic equipment technicians
Medical and pathology lab technicians
Pharmaceutical technicians
Medical and dental prosthetic technicians
Other health associate professionals
Dental assistants and therapists
Medical records and health information technicians
Community health workers
Dispensing opticians
Physiotherapy technicians and assistants
Medical assistants
Environmental and occupational health inspectors and associates
Ambulance workers

Additional health related unit groups
Health service managers
Aged care service managers
Psychologists
Social work and counselling professionals
Medical secretaries
Health care assistants
Home-based personal care workers
Personal care workers in health services.

ECONOMIC SECTORS RELATED TO
HEALTH IN THE INTERNATIONAL
STANDARD INDUSTRIAL
CLASSIFICATION OF ALL ECONOMIC
ACTIVITIES
Manufacture of pharmaceuticals, medicinal chemical and botanical products,
dental supplies
Water collection, treatment and supply
Sewerage
Retail sale of pharmaceutical and medicinal goods, cosmetics
Testing and analysis(food hygiene, water pollution)
Regulation of activities of providing healthcare, education
Compulsory social security activities
Residential nursing care facilities, mental retardation, mental health and
substance abuse
Social work activities for elderly and disabled. BATRASIAN_67@HOTMAIL.COM

UNDERSTANDING HEALTH POLICY
PROCESS
Disrupted Health Sector often confront the actors with the dilemma of
deciding whether
1 to struggle to maintain the system’s basic functions, mending
cracks as they emerge and if feasible introducing novelties at the
margin and pace that the system can absorb
2 to declare the system irreparably wrecked, abandon it to its fate
and design a new system from scratch

SOCIOLOGY OF HEALTH
The sociology of health and illness, alternatively the sociology of health and wellness (or
simply health sociology), examines the interaction between society and health.
The objective of this topic is to see how social life affects morbidity and mortality rate,
and vice versa.
This aspect of sociology differs from medical sociology in that this branch of sociology
discusses health and illness in relation to social institutions such as family, employment,
and school, and also interfaces more extensively with sociology of the body. The sociology
of medicine by contrast tends to focus specifically on the patient-practitioner relationship
and the role of health professionals in society.
The sociology of health and illness covers sociological pathology (causes of disease and
illness), reasons for seeking particular types of medical aid, and patient compliance or
noncompliance with medical regimes
There are obvious differences in patterns of health and illness across societies, over time,
and within particular society types. There has historically been a long-term decline in
mortality within industrialized societies, and on average, life-expectancies are
considerably higher in developed, rather than developing or undeveloped, societies

EQUALITY AND EQUITY IN
HEALTHCARE
In relation to access to healthcare for people with intellectual
disabilities reference is often made to inequalities and inequities.
Equality and equity are thus often defined by their absence and
sometimes the two terms are used interchangeably without
consideration of differences in meaning.
Misunderstandings around terminology can also lead to
inappropriate interventions whereby practitioners believe they are
doing the right thing whereas they may be compounding the
problem. If equality and equity of access are desired goals it is
essential to have clarity regarding both meaning and purpose

The need to treat people equally can be interpreted as the need to
treat everyone in an identical manner. Indeed when questioned
concerning their provision of services for people with intellectual
disabilities some healthcare staff say quite proudly that they do not
discriminate but rather treat everyone the same. However, if people
have different needs then simply providing the same intervention will
inevitably result in some needs not being met. Take for instance the
sending out of a letter giving an appointment for an out-patients’
clinic. It could be argued that people with intellectual disabilities are
respected and treated the same as everyone else by sending them a
letter. However, what if the letter is received by someone who has a
mild learning disability, who lives alone and who cannot read? It is
unlikely that they will attend the clinic, they may not be followed up
(other than via another letter) and their health needs will not have
been met. Michaels (2008) in his review of healthcare provision for
people with intellectual disabilities thus notes that he had to learn
that treating people equally does not always mean treating them the

HUMAN RESOURCES IN
HEALTHCARE.
Human resource (HR) managers are vital to the
health care industry. Working in hospitals,
clinics, and insurance companies, they interact
with health administrators, clinicians, and
patients. The policies enacted by HR managers
support a facility’s goals and help ensure
quality care. Human resource managers also
exhibit great communication and leadership
skills that enable them to manage hiring,
training, claims, and administrative affairs in
an organization.
Those looking for a career in human resource
management in health care can prepare by
pursuing an advanced degree in health BATRASIAN_67@HOTMAIL.COM

Human resource management in health care requires human resource
professionals to navigate the evolving world of the health care
industry. HR managers are mainly responsible for ensuring services
are efficient for administrative staff, clinicians, and patients. They
also address the many areas of concern in the health care industry,
including managing financials, promoting employee retention, and
ensuring that health care regulations are being met. To address all
these concerns, HR managers must focus on the big picture and have
the organizational skills to manage these different areas
HR managers are required to stay abreast of health care laws and
regulations

THE TOOLS FOR INCREASING
STAFF PRODUCTIVITY IN A
HEALTHCARE SYSTEM
(A.B) BATRASIAN_67@HOTMAIL.COM

1. TRAIN FOR SUCCESS.
No one can do it better and more productively, unless they know how
to do it.
Many employers fail to not only train employees initially, but as an
on-going process. They are fearful of taking people offline and losing
their immediate output. The result is, however, that people are so
busy doing it the wrong way because they cannot take out some time
to learn how to do it the right way.
The training process ought to help employees handle their current
responsibilities more effectively and to prepare them for what they
need to know a year from now, and five years from now, as the
information explosion changes the way we all do business in Health
industry.

2. PROVIDE THE RIGHT TOOLS
These tools include not only the physical resources and proper
staffing but also the personal tools of self-development.
Many employers will send a painter out in the field with a ladder
that’s three feet short. Employees are the Rolls Royce’s of the
company. If you fail to spend a little to give the Rolls the proper fuel
and maintenance, that $200,000 machine will not operate properly.
Same way if a Doctor is not provided with the right tool(stethoscope,
Neuro Hammer etc) he will not be able to perform his job rightly.

3. KEEP EMPLOYEES IN THE LOOP
Let employees know what the “big picture” is, where the company is
going(strategic objectives/vision/Mission), and how they fit into the
scheme of things.
There is nothing less productive than a Health Professional (Doctor,
Allied Health Staff, Paramedics) who doesn’t understand how they fit
into that “big picture,” how their every act and contribution is vital to
the success of the entire organization(Hospital/Clinic/Rehabilitation
Center).

4. RECOGNIZE AND REWARD
Most employees want recognition above money.
Sure, the money is important but so is the pat on the back.
Catch people doing it right. Praise publicly.
Send complimentary notes. (It’s an event in most people’s lives.
When was the last time your received one?)
This is not about spending money, it’s about giving what employees
want and need the most.
Apples shine when you polish them.

5. EMPOWER
What they write, they will underwrite.” Push decision making to the
lowest levels.
Help employees to feel a part of the decision making process.
Give them some authority to make decisions that will make their job
more productive.
Will they make “bad” decisions? Sure. But over time, the “good”
decisions will far overshadow the “bad.”
Never empower an under qualified individual for an over qualified
position in Hospital Patient Dealing setting.

MAJOR WORKFORCE DIVERSITY
CATEGORIES IN A HEALTHCARE
SYSTEM TO BE CONSIDERED IN
POLICY MAKING
GENDER
DISABILITY
AGE
NATIONAL ORIGIN
RACE
NON MUSLIM
ANY OTHER

Performance
improvement
in health care
industry and
Quality
assurance

Performance improvement is all about doing what is
right for one patient while ensuring that the
organization has the resources to continue doing what
is right for the next patient.
Entire healthcare industry is in the business of
providing the right care to the right patients at the
right time and in the right place
Performance improvement is about making that
possible.

Safe: avoiding injuries to patients from care that is intended to
help them.
Effective: providing services based on scientific knowledge to
all who could benefit, and refraining from providing services to
those unlikely to benefit (avoiding underuse and overuse).
Patient-centered: providing care that is respectful of and
responsive to individual patient preferences, needs, and
values and ensuring that patient values guide clinical
decisions.
AIMS FOR HEALTHCARE IMPROVEMENT

Timely: reducing waits and sometimes harmful delays for both those who receive
and give care.
Efficient: avoiding waste, such as waste of equipment, supplies, ideas, and energy.
Equitable: providing care that does not differ in quality because of personal
characteristics such as gender, ethnicity, geographic location, and socioeconomic
status.

Efforts Toward Error Reduction
In the United States, healthcare lags behind other
industries with respect to attention to ensuring safety.
Aviation has focused on building safe systems since World
War II. Although the risk of dying as a result of a medical
error far exceeds that of dying in an airline crash, much
more public attention has focused on improving safety in
the airline industry than in healthcare. Some believe that
public concern about airline safety, in response to the
impact of media stories, has played an important role in
the improvement of safety in the airline industry.
Healthcare has begun to follow companies such as General
Electric and Motorola in embracing the six sigma
philosophy to reduce errors. Six sigma seeks to reduce
variation in processes that lead to defects. It relies on
statistical analysis of data and strong problem-solving
techniques. Sigma is the Greek letter of the alphabet used
to describe variability, or standard deviation. By achieving
six sigma, the failure rate is minimized to 3.4 defects
(errors) per million opportunities, which translates to a
99.9996% success rate. Like six sigma, continuous
improvement emphasizes scientific methods to seek

6 SIGMA
6 SIGMA IS A SYSTEMIC METHODOLOGY THAT UTILIZES INFORMATION
AND STATISTICAL ANALYSIS TO MEASURE AND IMPROVE A
COMPANY’S OPERATIONAL PERFORMANCE

SIX SIGMA APPLIES A FIVE STEP METHOD CALLED
Define the business issue(what is the pain?)
Measure the process(how bad is the pain?)
Analyze the data, verify root causes of
variation(what is the root cause of pain?)
Improve the process(which solution will eliminate
the pain?)
Control the process, sustain improvement(how do
we make sure the pain will not return

QUALITY IN HEALTHCARE
ORGANIZATIONS MAY BE EVALUATED
AS:
structure (how care is organized,
such as ICU staffing );
process (what is done by caregivers,
such as the percentage of patients
with cardiac diseases who have gone
through cardiothoracic surgery )
outcomes (the results achieved, such
as mortality rates following coronary
artery bypass graft).

EVALUATING IMPROVEMENT
Process measures can be based on scientific evidence,
can be relatively easily measured and compared, and
are within physicians' control.
Outcome measures are clearly valued by patients and
appear to be more closely aligned with the goal of
clinical care.
Hospitals that perform well on process measures have
better outcomes, although different studies have
found that the strength of this association varies.

COST AND QUALITY IN
HEALTHCARE
Knapp medical center in
weslaco,texas, attributes
approximately $ 2.8 million in
saving through performance
improvement.
In one year, knapp’s reduction
in average length of stay
resulted in eliminating 1,304
days of un necessary care.
Hospital also saved 98 days
through eliminating re
admissions, 27 deaths were
prevented, and it avoided
complications in 28 patients

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