5. What Do You Mean by “Primary Care”?
(การดูแลปฐมภูมิหมายถึงอะไร?)
1. Basic medical services
2. Self-care, and health for all
3. First-contact, continuous, coordinated, and
comprehensive care
4. Health promotion practices, and actions on social
determinants of health
6. 1. Basic medical services
2. Self-care, and health for all
3. First-contact, continuous, coordinated, and
comprehensive care
4. Health promotion practices, and actions on social
determinants of health
(=What a layman usually thinks of primary care)
(The Declaration of Alma-Ata 1978)
(Starfield 1992, 1998)
(Ottawa Charter 1986, The 66th World Health Assembly 2013)
What Do You Mean by “Primary Care”?
(การดูแลปฐมภูมิหมายถึงอะไร?)
7. Action on Social
Determinants of Health
(การสร้างเสริมสุขภาพ)
Community-based
Primary Healthcare
(การสาธารณสุขมูลฐาน)
Primary Care Medicine,
Family Medicine
(เวชศาสตร์ปฐมภูมิ, เวชศาสตร์ครอบครัว)
Basic Medical Care
(บริการการแพทย์ระดับพืDนฐาน)
• Health promotion practice at
the population health level
• “Health in All Policies”
• Self-care
• Community health worker
• Community health volunteer
• “Health for All”
• First-contact care
• Continuous care
• Coordinated care
• Comprehensive Care
•Health center (สอ./รพ.สต.)
•OPD, physician office
•Mobile medical units
What Do You Mean by “Primary Care”?
(การดูแลปฐมภูมิหมายถึงอะไร?)
8. Community-based
Primary Healthcare
Clinical Practices
at Primary Care
Level
“The Doughnut Hole” of Primary Care
• Primary care services in
developed countries
• Medical facilities in urban
settings
• Medical facilities in private-
sector (without public health
functions)
• Primary care services in
developing countries
• Medical facilities in rural
settings
• Medical facilities in public-
sector (with public health
functions)
Ø What exactly policies & systems are we talking about?
9. “Level” of Healthcare Delivery Systems:
(Primary Care vs. Acute Care)
Primary Health Care
(population-level, public health-type functions)
What’s probably missing?
• How’s about Sub-acute Care?
• How’s about Emergency Care?
• How’s about Long-term Care?
• How’s about Palliative Care?
• How’s about Hospice Care?
Community
(Self-care)
Primary Care Services
(family doctor-type services)
Secondary Care Services
Tertiary Care Services
Supra-tertiary/Quaternary Care Services
2
3
1
10. What Do You Mean by “Community Health”?
(สุขภาพชุมชนหมายถึงอะไร?)
1. Health of people in the community
2. Community-based health programs/interventions
3. Population-based health programs/interventions
4. Health promotion practices, and actions on social
determinants of health
11. Source: W. Simpson del.; E. Walker lith.; Day & Son, Lithrs. to the Queen.
Pix source: http://en.wikipedia.org/wiki/History_of_hospitals#mediaviewer/File:Hospital_at_Scutari_2a.jpg
“Hospital at Scutari” - A ward of the hospital at Scutari where
Florence Nightingale worked and helped to restructure the modern hospital
12. Primary Care vs. Chronic Care
Figure Source: www.improvingchroniccare.org
13. Primary Care vs. Palliative Care
“Palliative care is care provided based on patient & family needs &
goals and independent of prognosis.”
15. Primary Care vs. Long-term Care
Source: Tishihiko Hasegawa (2013)
“Care Cycle”
16. First
Contact/Access
Continuity Coordination Comprehensivenes
s
• Cost sharing
• Distance to PC
practice
• Distribution of
PC physicians
• List size
• Home visits in
PC
• Electronic access
• Computerization
of the practice
• Patient habits
with first contact
visits/referrals
• Endurance of
patient–provider
relationship
• PC practice
management
• Collaboration
among
practitioners
• Referral system
• Shared care
arrangements
• Premises,
equipment
• Medical
procedures
• Preventive,
rehabilitative,
educational
activities
• Disease
management
• Community links
• Technical skills
Desirable Primary Care Functions
Source: WHO/Europe (2010)
Ø Selected proxy measures from WHO/Europe’s Primary Care Evaluation Tool (PCET)
17. Delivery of Primary Care Services
Pix source: www.free-ed.net/free-ed/HealthCare/Physiology/default.asp
Structure & Organizations
of primary care services
• Patient Care Teams
• PCUs/Clinics
• Systems/Networks
• Governance policies
• Community programs
Four Cardinal Functions
of primary care services
• First Contact/Access
• Continuity
• Coordination
• Comprehensiveness
“Anatomy of Primary Care” “Physiology of Primary Care”
19. กระบวนการนโยบายสุขภาพสุขภาพ
Pix source: Adapted from: www.wellcome.ac.uk
①
②
③
⑤ ④
Where are
we going?
How are we going there?
What do policymakers
need to do?
How do we know
if we arrive there
as planned?
What do we need to do to be
there?
How to get an
attention of
policymakers?
20. Pix source: Adapted from: www.wellcome.ac.uk
กระบวนการนโยบายขาขึ้น (Upstream Policy Process)
กระบวนการนโยบายขาขับเคลื่อน (Downstream Policy Process)
①
②
③
⑤ ④
กระบวนการนโยบายสุขภาพสุขภาพ
โครงการ/
แผนงานพัฒนา
สุขภาพชุมชน
21. Q: บทบาทของ PCPs ในการพัฒนาสุขภาพชุมชนคืออะไร?
(What is the roles of PCPs in community health?)
22. “Do things right” vs. “Do right things”
Source: http://www.slideshare.net/vickymoto/leaders-vs-manager
33. #2 Complicated Systems
Pix Source: www.edrawsoft.com/example-service-workflow.php
• An example of complicated “engineering” model:
34. #3 Complex Systems
Source: www.nature.com/nrclinonc/journal/v11/n3/fig_tab/nrclinonc.2014.6_F1.html
• A complex interactions between molecular networks within cells:
40. คุณสมบัติของระบบซับซ้อน
Source: Adapted from Glouberman and Zimmerman (2002)
• องค์ประกอบภายในระบบ “เชื่อมโยงกันอย่างใกล้ชิด” (tightly linked)
• “คุณสมบัติผุดบังเกิด” หรือ“คุณสมบัติอุบัติใหม่” (emerging property)
ที่เกิดขึ้นใหม่จากปฏิสัมพันธ์ระหว่างองค์ประกอบย่อยภายในระบบ
(“The whole is not equal to the sum of its parts.”)
• “การจัดการตัวเอง” (self-organizing) และการเรียนรู้ผ่านกลไก
“การตอบสนองย้อนกลับ” (governance by feedback)
• “การเปลี่ยนแปลงอย่างต่อเนื่อง” (constantly changing)
45. • เรากำลังเดินทางไปที่ใดและเมื่อไหร่?
(“Where” are we going to, and when?)
Vision/Mission
• เราจะเดินทางไปสู่จุดหมายได้อย่างไร?
(“How” are we going there?)
Strategy
• เราต้องทำอะไรบ้างที่จะไปถึงจุดหมาย?
(“What” do we need to do to be there?)
Action
49. • Five Steps in the Strategic Management Process:
①การวิเคราะห์สถานการณ์/สภาพแวดล้อม (Situation analysis)
②การจัดวางทิศทางขององค์กร (Setting organizational
direction)
③การกำหนดกลยุทธ์ (Strategic formulation)
④การปฎิบัติตามกลยุทธ์ (Strategic implementation)
⑤การควบคุมเชิงกลยุทธ์ (Strategic control)
กระบวนการจัดการเชิงกลยุทธ์
Source: Adapted from: Wheelan and Hunger. (2006); วัฒนา วงศ์เกียรติรัตน์ และคณะ (2537)
50. ตัวอย่าง: CNMI’s Strategic Management
Adapted from: Wheelan and Hunger. (2006) Strategic Management and Business Policy.
To set a
shared vision
and mission
of the
project:
“To build a
medical
institute that
is publicly
perceived as
the incubator
of change
towards a
better
societal
health"
To identify
specific
goals of the
new campus
from the
perspectives
of customer,
learning and
growth,
process,
and
resource
To decide
on how we
can achieve
such
specific
goals in
BE 2560
and beyond
To set a
broad
guideline
for team’s
decision-
making,
(esp.
when
conflicting
ideas
arise)
To launch
initiative or
activities in
each
division/sec
tion/depart
ment
To figure
out what
the whole
project
really costs
To determine
sequence of
steps
needed to do
the jobs
To monitor
performance
of the
management
team and
take
corrective
actions if
needed
1
2
3
4
5
6
#1 #2 #3 #4 #5
62. Combined
Strategy
Customer Perspective
How can we develop our students
to be change agents in health systems?
Process Perspective
At what process do we need to excel
to fulfill our customer expectations?
Learning & Growth
Perspective
How will we sustain
our organizational ability to improve?
Resource Perspective
How will we secure
our most important financial resources
and non-financial resources?
Figure source: Adapted from www.slidehunter.com
Balanced Scorecard (BSC)
63. Strengths
Advantages
Financial reserves, likely returns
Qualifications, certifications
Competitive advantages
Capabilities
Location and geography
Innovative aspects
Resources, Assets, People
Processes, systems, IT, communications
Culture, attitudes, behaviours
Management cover, succession
Experience, knowledge, data
Strong brand names
Marketing - reach, distribution, awareness
Unique selling points “USP”
Price, value, quality
Weaknesses
Lack of competitive strength
Gaps in capabilities
Disadvantages of proposition
Weak brand name
Financials
Cash flow, start-up cash-drain
High cost structure
Our vulnerabilities
Timescales, deadlines and pressures
Reliability of data, plan predictability
Continuity, supply chain robustness
Processes and systems, etc
Management cover, succession
Morale, commitment, leadership
Opportunities
Market developments
Competitors vulnerabilities
Niche target markets
New USP's
New markets, vertical, horizontal
Partnerships, agencies, distribution
Geographical, export, import
Unfulfilled customer need
New technologies
Loosening of regulations
Changing of International trade barriers
Business and product development
Seasonal influences
Technology development and innovation
Threats
Environmental effects
Seasonal, weather effects
Economy - home, abroad
Political effects
Legislative effects
Market demand
New technologies, services, ideas
IT developments
Shifts in consumer preferences
Obstacles
Sustainable financial backing
Insurmountable weaknesses
Competitor intentions
New policies or regulations
Emergence of substitute products
Positive Negative
InternalExternal
SWOT Analysis
Figure source: Adapted from conceptdraw.com
64. Sun Tzu’s the Art of War
Pix source: th.wikipedia.org/wiki/
"การชนะร้อยทั้งร้อยมิใช่วิธีการอันประเสริฐแท้
แต่ชนะโดยไม่ต้องรบเลย จึ่งถือว่าเป็นวิธีอันวิเศษยิ่ง”
หลักการสำคัญในตำราพิชัยสงครามของซุนวู: รู้เขารู้เรา รบร้อยครั้ง มิพ่าย
"หากรู้เขารู้เรา
แม้นรบกันตั้งร้อยครั้งก็ไม่มีอันตรายอันใด
ถ้าไม่รู้เขาแต่รู้เพียงตัวเรา
แพ้ชนะย่อมก้ำกึ่งอยู่
หากไม่รู้ในตัวเขาตัวเราเสียเลย
ก็ต้องปราชัยทุกครั้งที่มีการยุทธนั้นแล”
65. Pix source: Leerapan et al. (2014). Poster Presentation at 3rd Global Health Symposium, Cape Town, South Africa
“รู้เขา” Opportunity/Threat
Stakeholders in
Health System
of Thailand
71. “รู้เรา” Strength/Weakness
Pix source: WHO’s framework for action. (2007)
Your Organization/Program/Project is a little health system!
Ø วางแผนโดยพิจารณาความสัมพันธ์/ปฏิกิริยาในระบบ (interactions)
76. Adapted from: Wheelan and Hunger. (2006) Strategic Management and Business Policy.
To set a
shared vision
and mission
of the
project:
“To build a
medical
institute that
is publicly
perceived as
the incubator
of change
towards a
better
societal
health"
To identify
specific
goals of the
new campus
from the
perspectives
of customer,
learning and
growth,
process,
and
resource
To decide
on how we
can achieve
such
specific
goals in
BE 2560
and beyond
To set a
broad
guideline
for team’s
decision-
making,
(esp.
when
conflicting
ideas
arise)
To launch
initiative or
activities in
each
division/sec
tion/depart
ment
To figure
out what
the whole
project
really costs
To determine
sequence of
steps
needed to do
the jobs
To monitor
performance
of the
management
team and
take
corrective
actions if
needed
1
2
3
4
5
6
#1 #2 #3 #4 #5
Strategic Management Process
77. Project/Program Management Tools
Planning Tracking
Reporting
Managing
Risks
• Project charter
• Gantt chart
• Timeline chart
• Project status dashboard
• Program status dashboard
• Team to-do list
• Burndown chart
• Issues tracking
78. #1 Situation Analysis
-Analyze internal factors of organization
-Analyze external factors of organization
-Define strategic advantages & challenges
Tools
-Self-assessment
-Market Survey & Public hearing
-SWOT analysis
#2 Direction Setting
-Define organizational visions
-Define organizational missions
-Set organization level strategies
Tools
-Mandates from the government
-Consultations with internal and external
stakeholders
#3 Strategy Formation
-Define strategic objectives of business units
-Set business unit level strategies
-Set functional level strategies
-Define strategic objectives of functional units
Tools
-SWOT analysis & 7S analysis
(Business Units)
-SWOT analysis & 7S analysis
(HR, IT, LR, PR, Finance, etc.)
#4 Strategy Implementation
-Launch initiatives/projects/activities
-Change organizational structure and culture
Tools
-Performance agreement
-Project management
-Organizational change & development
#5 Strategy Control
-Monitor & Evaluate
Tools
-BSC/KPIs, Strategic Map, Gantt Chart
Review
þ
☐
☐
☐
Review
Review
Review
As of 2013-11-4
þ
Strategic Management: Project Methodology
90. Pix: B Leerapan. Lutsen Mountain, MN. Oct 2009.
• เรากำลังอยู่ที่ไหน?
(Where are we now?)
• เรากำลังเดินทางไปที่ไหนและเมื่อไหร่?
(Where are we going to, and when?)
• เราจะเดินทางไปสู่จุดหมายได้อย่างไร?
(How are we going there?)
• เราต้องทำอะไรบ้างที่จะไปถึงจุดหมาย?
(What do we need to do to be there?)
• รู้ได้อย่างไรว่าเราไปถึงจุดหมายปลายทางแล้ว?
(How do we know if we arrive there?)
การทำงานโครงการ
เปรียบเสมือนการเดินทาง!
96. Care-seeking
Behaviors
Health
Behaviors
3Ps in “Health Systems”
Source: Adapted from WHO 2000; Roberts et al. 2003; WHO 2007)
Customers
Stakeholders
(1) Performance(2) Process
(3) People
ผลลัพธ์
(outcome)
ผลงาน (output)
คณะทำงาน
(process owner)
97. Source: Claude Monet’s Le Parlement de Londres (1900-1905); http://en.wikipedia.org/wiki/Palace_of_Westminster
QUAL “สังเคราะห์, เข้าใจ/เข้าถึงได้”
QUAN “วิเคราะห์, วัดได้/KPIs”
MMRประเมินอย่างไร (how)