advanced leadership and management

1. Salale University
College of Health Science
Department of Nursing Masters Program
Course: Advanced Nursing Leadership and Management
Topic: Organization of Nursing and health delivery system
Presented to: Mr. Ayele T. (MSc)
November , 2023
Fiche, Ethiopia
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2. Group members
S/no Name Program ID No
1 Abdi Bayisa PCHN RM0071/15
2 Amansisa Debessa AHN RM0176/15
3 Azazhu Abate AHN RM0177/15
4 Tamirat Mogasa PCHN RM0089/15
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3. Presentation outline
 Organizing nursing services
 Health care Delivery System
 Hospital development
 Development of Community health service
 Role of NGO's in health service delivery
 Organizing emergency support services
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4. Learning Objectives
At the end of this session, learners will be able to:
» Define organization of nursing and health
management at district, regional and national
levels.
» Describe hospital development, regionalization
types and function of hospitals.
» Discuss community development health services
» Explain the different between private hospitals and
government hospitals.
» Identify the role of NGO health delivery system.
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5. Organizing nursing services
 Nursing service is the part of the total health organization
which aims at satisfying the nursing needs of the
patients/community.
 WHO expert committee defines as the part of the total
health organization which aims to satisfy major objective
of the nursing services is to provide prevention of disease
and promotion of health.
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6. Organizing nursing services…
 Organizing Nursing service: the process and action
of engaging co-workers of nurse to build a workplace
which upholds high standards of care, fairness and
transparency.
 Nursing service administration is a complex of
elements in interaction and is organized to achieve
the excellence in nursing care services.
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7. Health care delivery system
 Staying healthy is an important part of everyone's
life.
 Since good health determines how productive a
person can be and how much they can participate
in daily activities.
 People with good health are free from disease,
and their bodies function efficiently.
 People need guidance in how to stay healthy.
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8. Health care delivery system…
 Is an organization that provides resources and
treatments that help people when they are sick or
injured, and helps them stay healthy through
preventive care.
 Includes institutions, organizations, people and
resources that help a particular group of people
stay healthy.
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9. Health care Delivery System…
 Health care delivery systems have 4 components:
¤ Services: Health care assistance available
¤ Consumers: People who require health care
¤ Personnel (providers): All the people who provide
health care
¤ Payment: Method of paying for the health care
 The health care setting organization to country extends
from the national to distinct level.
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10. Health care Delivery System…
 This include the setting of health care system at national,
state district, regional level.
 Ethiopia is structured in 3 tiered health care delivery.
¤ Primary
¤ Secondary and
¤ Tertiary levels with defined populations to be served at
each level.
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11. Health care Delivery System…
 For rural settings: at the base is the primary health care unit
(PHCU).
¤ Health centre with five satellite health posts catering to a
population of 25,000
¤ Primary hospital, serving a population of 60,000 to 100,000
 For urban setting: at the base is a health center, serving 40,000
people.
 Secondary level: general hospital, services to 1 up to 1.5million
 Tertiary level: at the apex and includes specialized hospitals,
serves 3.5 to 5 million people
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12. Health care Delivery System…
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13. Health center
◊ Provides services to approximately 25,000 people
together with five satellite health posts.
◊ HC is staffed with an average of 20 staff.
◊ It provides both preventive and curative services.
◊ It serves as a referral center for health posts and a
practical training institution for HEWs.
◊ HC has an inpatient capacity of 5 beds.
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14. Primary hospital
 Provides inpatient and ambulatory services to an average
population of 100,000.
 In addition to what a HC can provide, a primary hospital
provides emergency surgical services, including C/S and
gives access to blood transfusion service.
 Serves as a referral center for HCs under its catchment
areas, a practical training center for nurses and other
paramedical health professionals.
 Has an inpatient capacity of 25-50 beds.
 staffed by an average number of 53 persons.
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15. General hospital
 Provides inpatient and ambulatory services to an
average of 1,000,000 people.
 Staffed by an average of 234 professionals.
 Serves as a referral center for primary hospitals.
 Serves as a training center for health officers,
nurses and emergency surgeons.
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16. Specialized hospital
Serves an average of five million people.
Staffed by an average of 440 professionals.
staffed by specialists and sub-specialists
Serves as a referral for general hospitals.
Provides highly specialized services.
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17. District Health system management
The district is the most peripheral fully organized
unit of local government and administration.
It differs greatly from country to country in size
and degree of autonomy, and population may vary
from less than 50 000 to over 300 000.
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18. Characteristics of District
¤ A hub – where national goals and local needs
meet
¤ Large opportunity for inter-sectoral
collaboration
¤ Social capital-people know each other
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19. District Health Care System
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20. Primary Healthcare Mandate
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21. Functions of district health department
Planning
Service delivery
Leadership
HR and Incentive management
Logistics management
Financial management
Supervision and monitoring
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22. Functions of district health department…
 Planning:
Community diagnosis, Priority setting
Objectives and targets
Health and healthcare
Action plan
Coordination mechanism
Resources, incentives, logistics
Monitoring and control
Periodic evaluation
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23. Functions of district health department…
 Service delivery:
Environmental, occupational
Location of HCs
Organization of services
Physical design
Drugs and supplies –availing
Community needs –alignment
Affordability
Outreach services
Adequacy and training of staff
r/ship with hospital –referral mechanisms
Learning
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24. Functions of district health department…
Leadership:
Interpretation of events,
choice of objectives, and strategies,
the organization of activities,
the motivation of people,
the maintenance of cooperative relationships,
the development of skills, and
the enlistment of support and cooperation from
outside
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25. Functions of district health department…
Incentives:
Recognition – awards
Scholarships
Training opportunities
Housing allowance
Salary increases
Fellowships
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26. Functions of district health department…
Logistics – drugs and medical equipment :
Trained staff
Selection and quantification process
Purchasing? Who? When? Specification
Receiving and inspection
Storage
Distribution
Stock management –inventory, min/ max stock, stock-out
Wastage rate
Reserve stocks
Re-order levels
Records management
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27. Functions of district health department…
Financial management:
The degree of authority of the district
Capital and recurrent
Cost of alternative interventions
Lowest cost for the most effective outcome
Expenditure tracking – Under-spending vs. over-
spending
Shifting between budget lines during implementation t
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28. Functions of district health department…
Supervision and monitoring:
Supportive supervision
Monitoring of performance indicators
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29. Primary Health Care (PHC)
 The health care that is available to all the people at the first
level of health care.
 According to WHO, ‘Primary Health Care is a basic health
care and is a whole of society approach to healthy well-
being, focused on needs and priorities of individuals,
families and communities.’
 Primary Health Care (PHC) is a new approach to health care
which integrates at the community level all the factors
required for improving the health status of the population.
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30. Primary Health Care (PHC)…
 Primary health care is both a philosophy of health care and an
approach to providing health services.
 It addresses the expansive determining factor of health and
ensures whole person care for health demands during the course
of the natural life.
 It is developed with the concept that the people of the country
receive at least the basic minimum health services that are
essential for their good health and care.
 It is the first level of contact of individuals, the family and, the
community with the national health system, bringing healthcare
as close as possible to where people live and work, and
constitutes the first element of a continuing health care process.
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31. History of Primary Health Care
¤ In 1950’s there were vertical health service
strategies, which were expensive & unsuccessful.
¤ 1960’s basic health service with the attention of
rural health service.
¤ 1970’s integration of specialized disease programs.
¤ Before 1978, globally, existing health services were
failing to provide quality health care to the people.
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32. History of Primary Health Care…
¤ Different alternatives and ideas failed to establish a well-
functioning health care system.
¤ As a result;
Millions of people in the world had unacceptable level of
health despite fundamental right
Health status of disadvantaged remain low
Limited health institutions failed to satisfy demand
Isolated health sector
Lack of community participation in the care they receive
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33. History of Primary Health Care…
¤ These has led WHO & its partners to re-examine the existing
health policies.
¤ Considering these issues, a joint WHO-UNICEF international
conference was held in 1978 in Alma Ata (USSR), commonly
known as Alma-Ata conference.
¤ The conference included participation from governments of
134 countries and other different agencies.
¤ The conference has jointly called for a revolutionary
approach to the health care
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34. History of Primary Health Care…
¤ The conference declared ‘The existing gross inequality in the
health status of people particularly between developed and
developing countries as well as within countries is politically,
socially and economically unacceptable’.
¤ The points stressed at the conference were:
– Health is basic human right
– Governments are responsible to assure this right
– It is Right & duty of people to participate in their own health care.
– The need for scientifically, socially & economical sound technologies.
¤ Thus, Alma-Ata conference called for acceptance of WHO goal
of ‘Health for All’ by 2000.
¤ Finally a strategy to attain the “health for all” declaration was
designed & adopted and that strategy was PHC.
¤ In this way, the concept of Primary Health Care came into
existence globally in 1978 from the Alma-Ata Conference
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35. Objectives of Primary Health Care
» To increase the programs and services that affect the
healthy growth and development of children and youth.
» To boost participation of the community with government
and community sectors to improve the health of their
community.
» To develop community satisfaction with the primary
health care system.
» To support and advocate for healthy public policy within
all sectors and levels of government.
» To support and encourage the implementation of
provincial public health policies and direction.
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36. Objectives of Primary Health Care…
» To provide reasonable and timely access to primary health care
services.
» To apply the standards of accountability in professional
practice.
» To establish, within available resources, primary health care
teams and networks.
» To support the provision of comprehensive, integrated, and
evidence-based primary health care services.
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37. Elements/Components of PHC
 There are 8 elements of Primary Health Care.
 These 8 elements are also known as ‘essential health care’. They are:
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38. Function of Primary Health Care
 Primary Health Care focuses more on quality health service
and cost-effectiveness.
 Primary Health Care focuses on “Health for all”.
 Primary Health Care integrates preventive, promotive, curative,
rehabilitative and palliative health care services.
 Primary Health Care encourages new connection and
community participation.
 It includes services that are readily accessible and available to
the community.
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39. Function of Primary Health Care…
 Can be easily accessible by all as it includes services that
are simple and efficient with respect to cost, techniques
and organization.
 promotes equity and equality.
 Improves safety, performance, and accountability.
 Advocates on health promotion and focuses on
prevention, screening and early intervention of health
disparities.
 Also perceived as an integral part of country’s socio-
economic development.
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41. Hospital
Hospital is an institution which possesses adequate
accommodation and well qualified and experienced
personnel to provide services of;
 curative
 restorative,
 preventive and
 promotive character of the highest quality
possible to all people regardless of race,
color, creed or economic status.
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42. Factors responsible for development of hospital
Advance in medical science
Development of technological and specialization
Development professional nursing
Advance in medical education
Contribution by industrialist
Support by health insurance
Role of government
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43. Hospital development
Data required in planning the hospital
 Geographic data
 Morbidity and mortality status
 Need and demand
 Details of existing facilities
 Financial feasibility
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44. Hospital development…
Basic objectives which are to be meet by
the hospital;
 Quality patient care
 Effective community orientation
 Economic viability
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45. Regionalization
 Is the integrated organization of a health care system,
where in regional structures are responsible for providing
and administrating health services in a specific region.
 Geographic process of formal or informal health care policy that
accentuates one or more of the following: the distribution of
physicians, the distribution of equipment and facilities, and the
control of patient movement within the system
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46. Cont…
 Regionalization refers to the creation of an intermediary
administrative and governance structure.
 Referred to as a regional health authority or board) that
assumes responsibility for organizing and delivering health
care services to a defined population.
 The main goals of regionalization are :
o to improve responsiveness to and accountability for
population health needs, and
o to increase public participation in health care decision-
making
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47. Types of hospitals
According to ownership:-
 Government hospital:- public health hospital
 They are owned, administered and controlled
by the government
 Private hospital:
 Privately owned or controlled by an
individual or group of physicians or citizens or
by private organization
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48. Privates and Government hospital
Private hospital
 Private hospitals are
hospitals that are owned
by an individual or a
group of people.
 Private hospitals provide
the best healthcare
facilities.
 Have a short period of
waiting time
 Private hospitals are not
easily affordable
 Doctor-patient ratio is
high
Government Hospital
 Public Hospitals are
hospitals owned and
funded by the government.
 Public hospitals offer
healthcare services but the
quality is not up to the
mark.
 Have longer waiting
periods.
 Public hospitals are
affordable
 Low doctor-patient ratio 48
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49. Types of Hospital…
According to Level of Care:
 Primary Care Hospital
 Primary care is the day-to-day health care given by a
health care provider.
 Provides mostly basic health care. Eg. District Hospital
 Secondary health care:
 This level of services are provided in
General hospitals.
 Tertiary level:
 This level deals with highly specialized services provided
at regional or central level hospitals
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50. Types of Hospital Cont…
According to services of Hospitals
 General Hospital
o They provide wide-range of various types of healthcare, but with limited
capacity.
o They care for patients with various-disease conditions for both sexes to all
ages
 Specialized hospital
o They limit their service to a particular condition, orthopedics,
maternity, paediatrics, geriatrics, oncology etc
 Teaching hospital
o College is attached for medical/ nursing/ dental/ pharmacy education.
o Main objective is to provide medical care, teaching and research purpose
 District hospital
o District hospital is a hospital responsible for a district of a defined
geographical area containing a defined population. 50
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51. Functions of hospitals
 Patient care
 Education services
 Research function
 Public health care
 Training center
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52. Common structure of hospital
 Administrative services
 Informational service
 Therapeutic service
 Diagnostic services
 Support services
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53. Hospital service
 Line service in hospital are the care which
is directly related to patient treatment’
 Emergency services
 Out patient services
 Inpatient services(wards)
 Intensive care unit
 Operation theatre
 NICU
 Labour ward
 Other Services
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54. Hospital layout
Layout planning aims at arranging
organizational units inside a building such
that the available area is used optimally
and total distances are minimized.
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55. Hospital layout…
Selection of site
Needs of community
 Easy of accessibility
Range of services offered
 Requirement of the staff and services
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56. Development of Community health service
 A community is a collection of people who share some
important feature of their lives.
 A collection of people who interact with one another
and whose common interests or characteristics form the
basis for a sense of unity or belonging.
 It can be a society of people holding common rights and
privileges (eg, citizens of a town),
 sharing common interests (eg, a community of farmers),
 living under the same laws and regulations (eg, a prison
community).
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57. The role of NGO’s in health system
 Providing goods and services
 Assisting the government achieve its
development
 Helping citizens to voice their aspirations,
concerns and alternatives for consideration by
policy makers
 Helping to enhance the accountability and
transparency of government and local
government programs and of officials 57
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58. Role of NGO…
 Women's issues (women's and child health care, rights, counseling,
literacy issues)
 Maintaining the international health relations
 Conducting and funding the medical and public health research for
improvement of health service
 To maintain the intersectoral coordination in health care delivery
system
 Technical assistance and training for health care delivery
 Advocacy for and with the government programmed of health care
from partners and advisors as well as sponsors
 Can provide valuable resources in promoting health care
 Implementing the mutually agreed programmed of collaboration
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59. Organizing emergency and support services
I. Laboratory services
 It also assists in teaching programmes
for doctors, nurses and laboratory technologists.
 It carries out urgent tests at any part of day or night.
Functional divisions:
 Hematology
 Microbiology
 Clinical chemistry/ biochemistry
 Histopathologye. Urine and stool analysis
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60. II. Planning and organization of laundry services
Location
 It should be in the same building as the hospital,
and
should have separate entrance and exit areas.
Space requirements:
 The requirement for any laundry services has bee
n workedout to be approx. 10-15 sq.ft./bed?
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61. 2. Laundry management:
Linen distribution system:
 Topping up
 Clean for dirty exchange
 Exchange trolley system
 Quality control of laundry services
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62. 2. Laundry management…
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63. 3. Blood Bank
 Blood banking is the process that takes place in the
lab to make sure that donated blood, or blood
product
 Using the laboratory information system to achieve
strategic advantage over the competitors of
hospital-based clinical laboratories.
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64. Blood bank…
The term "blood bank" typically refers to a division
of a hospital where the storage of blood product
occurs and where proper testing is performed (to
reduce the risk of transfusion related adverse
events). However, it sometimes refers to a
collection center, and some hospitals also perform
collection
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65. 4. Bio-medical waste
 Means any solid and/or liquid waste including its container and any
intermediate product, which is generated during the diagnosis, treatment or
immunization of human beings or animals or in research pertaining thereto
or in the production or testing.
Bio-medical waste:
Segregated storage at source in colored plastic bags (according to
the rules) which are inside sturdy covered containers.
For collection, dedicated wheel-barrows are to be used for carrying
the containers directly to the storage area.
For transportation, covered vans are to be used.
for treatment and disposal, the bio-medical waste should be
taken to a common treatment and disposal facility having
incineration facility
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66. References
• Nursing leadership and management lecture notes
• Gillies, Ann Dee (1994). Nursing Management. A
Systems Approach, 3rd. ed. W. B. Saunders Company,
Philadelphia.
• Hermann SJ. (1978). Becoming Assertive, A Guide for
Nurses. New York, NY: D. Van Nostrand, Co. 27
• Kotter, I.P., and L.A. Schlesinger (1979). "Choosing
Strategies for Change", HarvardBusiness Review. Vol 57 (March
- April)
• Lovell, R. (1994). Managing Change in the New Public
Sector. London: Longman in
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67. THANK YOU!!!
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