By Hatim Jaber MD MPH JBCM PhD 18+20 - 12- 2017 Faculty of Medicine Introduction to Community Medicine Course (31505201) Introduction to Healthcare Management and Health Planning By Hatim Jaber MD MPH JBCM PhD 18+20 - 12- 2017

Post midterm management Causation Week 8 Unit 6: Demography and Data Week 9  Midterm assessment (Exams.) 15-11-2017 Week 10 Unit 8 Introduction to Epidemiology. Week 11 Unit 9: Prevention and Control of Diseases Causation Week 12 Unit 10: Communication and Health Education Week 13 Unit 11: Public Health Surveillance and Screening Week 14 Unit 12: Health Administration and healthcare management Week 15 Unit 13: Revision and Health Research Week 16 Final assessment (Exams.) 4-1-2018

Presentation outline Introduction and Definitions 08:00 to 08:15 Time Introduction and Definitions 08:00 to 08:15 Health Care System and its components 08:15 to 08:30 Levels of Health care 08:30 to 08:45 Approaches to health care provision Resources, and Financing 08:45 to 09:00 Quality and Health 09:00 to 09:15

Health Policy International health policy Health policy reform Health systems Quality of healthcare Health management and administration Management functions Management principles Planning Cycle Types and levels of planning Team work Supervision and monitoring Evaluation

Management: The organization and coordination of the activities of a business in order to achieve defined objectives. The act of directing people towards accomplishing a goal. Administration: the activities that relate to running a company, school, or other organization Health administration, a field relating to leadership, management and administration of public health systems, hospitals and hospital networks Policy: set of ideas or plans that is used as a basis for making decisions, especially in politics, economics, or business.

Health Policy Defined Health policies are public policies or authoritative decisions that pertain to health or influence the pursuit of health Health policies affect or influence groups or classes of individuals or organizations

Public vs. Private Policymaking Public Policy Policy that is established by the federal, state, and local levels of government Private Policy Policy that is established by private organizations Public Policies are authoritative decisions made in the legislative, executive, or judicial branches of government intended to direct or influence the actions, behaviors, or decisions of others Health Policy the aggregate principles, stated or unstated that characterize the distribution of resources, services, and political influences that impact on the health of the population

The Policy Cycle The formation and implementation of health policy occurs in a policy cycle comprising five components: 1.) issue raising 2.) policy design 3.) public support building 4.) legislative decision making and policy support building 5) legislative decision making and policy implementation

The Policy Cycle Stages

The policy cycle Sound health financing policy planning, implementation, management, and analysis requires a good knowledge of health financing issues, contextual constraints and opportunities. It also requires adequate tools to support a systematic approach to the issues.

Forms of Health Policies There are five main forms of health policies Laws Rules/Regulations Operational Decisions Judicial Decisions Macro Policies

Categories of Public Health Policies Public health policies are grouped into two categories Allocative Regulatory

Historical Development of Term Public Health: Developed as a discipline in the mid 19th century in UK, Europe and US. Concerned more with national issues. Data and evidence to support action, focus on populations, social justice and equity, emphasis on preventions vs cure. International Health: Developed during past decades, came to be more concerned with the diseases (e.g. tropical diseases) and conditions (war, natural disasters) of middle and low income countries. Tended to denote a one way flow of ‘good ideas’. Global Health: More recent in its origin and emphasises a greater scope of health problems and solutions that transcend national boundaries requiring greater inter-disciplinary approach

From individual to Global Health International Health Public Health Health problems know no boundary Health in the interconnected context, globalization, extends beyond problem on and capability of one country Problem and/or concern beyond frontier Focuses on solving health problem in developing countries Health problem within national boundary aims to promote health of the population through prevention and health promotion including sanitation Individual Health << Family Health << Community Health Source: J P Koplan et al. Towards a common definition of global health Lancet 2009; 373: 1993–95

Quality Carrying out interventions correctly according to pre-established standards and procedures, with an aim of satisfying the customers of the health system and maximizing results without generating health risks or unnecessary costs.

Dimensions of Quality Technical competence Access to service Effectiveness Efficiency Amenities Interpersonal relations Continuity Safety

What Is Health Care Quality? “The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.” -- Institute of Medicine

Key Components of High Quality Health Care Safe Effective Patient-centered Timely Efficient Equitable -- Institute of Medicine, 2001

Quality Controls These regulations are intended to ensure that health services providers adhere to acceptable levels of quality in the services they provide and that producers of health-related products meet safety and efficacy standards

Quality Control The process Variable characteristics Quality control in health care organization refers to activities that evaluate, monitor or regulate services rendered to consumers. Observe The process Identify Variable characteristics Track Variables through statistical methods

What is a Health Care System? What is a System? System: “a set or arrangement of things connected or related to form a unity or organic whole”. System: “a collection of components organized to accomplish a specific function or a set of functions”. The parts of a system can be referred to as its elements or components The environment of the system is defined as all of the factors that affect the system and are affected by it.

What is a Health Care System? A Health Care System: “the complete network of agencies, facilities, and all providers of health care in a specified geographic area.” (Mosby's Medical Dictionary, 8th edition. © 2009, Elsevier.) : “an organized plan of health services.” Every country has a health care system, however fragmented it may be among different organizations .

Health Care Systems Health care systems are designed to meet the health care needs of target populations. In some countries, the health care system has evolved and has not been planned, whereas in others efforts have been made by: governments, trade unions, charities, religious, or other coordinated bodies to deliver planned health care services targeted to the populations they serve.

Goals of a Health Care System The goals for health systems, according to the World Health Report (WHO, 2000), are: Good health for the population Responsiveness to the needs and expectations of the population Fair financial contribution to the health care system Efficient to achieve the best outcomes possible given available resources and circumstances

What is a Health Care Delivery System? Three major components that make up the Health Care Delivery System are: Facilities Practitioners Entities

Facilities Hospitals: acute and sub-acute care, primary care, and tertiary care (medical education and complex cases) Health Centers or Ambulatory Surgery (out-patient) Physician offices (GP,s and specialists) Skilled Nursing Facilities Home Health Agencies: nursing care at home Freestanding Substance Abuse Facilities: inpatient Hospice: care for terminally ill patients End-stage Renal Disease Centers

Practitioners Physicians Medical Doctors (MD’s) Nurses Nurse Practitioners Registered Nurse (RN) Physician Assistants (Pas) Therapists Physiotherapist (PT) Occupational therapist (OT) Speech therapist (ST)

Entities Provide the financial and regulatory functions for the facilities and practitioners, e.g. government. Governmental Health Care Functions: Direct Services (hospitals, health care centers) Financing Information Policy Setting

Health Care Delivery System

Elements of a health care system One way to look at the HCS is by identifying elements of a health care system that embrace the following: Personal health care services for individuals and families, available at hospitals, clinics, neighborhood centers, and in physicians' offices, etc…… . Public health services needed to maintain a healthy environment, such as control of water and food supplies, regulation of drugs, and safety regulations. Teaching and research activities related to the prevention, detection, and treatment of disease. Third party (health insurance, pharmaceutical companies) of system services.

Key components of a well functioning health system Health System Building Blocks The building blocks alone do not constitute a system, any more than a pile of bricks constitutes a functioning building. It is the multiple relationships and interactions (integration) among the blocks – how one affects and influences the others, and is in turn affected by them – that convert these blocks into a system.

Health system In Jordan Health system governance in Jordan has been characterized by a stable political system which seeks to identify and allocate responsibilities between the public and private sectors. The government is responsible for supervising, monitoring and enacting laws for the protection of public rights and justice between the citizens.

The health sector in Jordan The health sector in Jordan consists of: Service providers (public, private, international and charity sectors) and councils and institutions working on the development of health policy. The public sector includes the: Ministry of Health, the Royal Medical Services and university hospitals (University of Jordan Hospital, King Abdullah University hospital) and the centre for diabetes and Endocrinology and Genetics. The private sector includes private hospitals and diagnostic and therapeutic centers in addition to hundreds of private clinics.

The international sector and charitable sectors provide services through: UNRWA clinics for Palestinian refugees and the UNHCR and King Hussein Cancer Center and charity association clinics. Drawing the general policy for health sector in Jordan is done mainly through: the Higher Health Council pursuant to law No. 9 of 1999. It is noted that there are other institutions in the health sector involved in health policy, such as the Jordanian Medical Council, the Supreme Council of the population, the Jordanian Nursing Council, the National Council for Family Affairs, Jordan Food and Drug Administration and the Joint procurement Department

Major components of health sector in Jordan

Presentation outline 2 Time Introduction to Management in health care organizations 08:00 to 08:15 The Four Functions of Management 08:15 to 08:30 Planning, Organizing, Leading and Controlling. 08:30 to 08:45 The planning cycle 08:45 to 09:00 Health Systems Planning Health Policy 09:00 to 09:15

International health policy Health policy reform Health systems Quality of healthcare Health management and administration Management functions Management principles Planning Cycle Types and levels of planning Team work Supervision and monitoring Evaluation

Management Management is the operational part of administration. It is defined as: “ It is a set of interactive processes through which the utilization of resources results in the accomplishment of organization objectives.” It is through “management” that the objectives of the health care organization are achieved by gathering and positioning of resources. It is a “conversion mechanism”.

Definitions and concepts MANAGEMENT is both a SCIENCE and ART As a SCIENCE, management has basic rules and principles. As an ART, successful managers learn through experience, they follow flexible, adaptive, innovative approaches to fulfill objectives.

Definitions Management is getting things effectively done to achieve desired objectives through proper planning, efficient implementation and evaluation to identify the needs for re-planning. Management is thus a dynamic process.

Effectiveness is the degree to which a stated objective is being achieved. Efficiency is the optimized (balanced) use of resources (Human resources, equipment, supplies, money, space, time & information).

Definitions Management is a decision making process translating the policies into plans, implementing those plans, and evaluate the plans and the interventions to re-plan to achieve better results

Good Management Highlights priorities Adapts services to needs and to changing situations (dynamic) Makes most of limited resources Improves the standard and quality of services Maintains high staff morale

PRINCIPLES OF MANAGEMENT Management by objectives: Setting targets (goals and objectives) Learning from experience Teamwork Proper use of resources Putting priorities

Management Process I. Planning II. Implementation: III. Evaluation Organizing Staffing Leading/Directing Controlling /Monitoring III. Evaluation

A systems view of management Process Outputs Inputs Conversion mechanism Human resources Non-human resources Objectives achievement

Management Skills Technical skills Technical skills Mainly firs level Human / interpersonal skills All levels Conceptual skills Mainly top level Technical skills Human skills Conceptual skills + Political skills

Health Administration Sound administration is essential for the success of any public health program whether on the national, intermediate or the local level.

Definition of Administration We can define sound administration as: “ The process of achieving defined goals at a defined time through the guidance, leadership, and control of the efforts of a group of individuals and the efficient utilization of non-human resources bearing in mind adequacy, speed, and economy to the utmost possible level.”

Another definition “Administration is the art and science of guidance, leadership, and control of the efforts of a group of individuals towards some common goal.”

Administration There are several elements for administration. In practice all these elements are interrelated to one another. There are also 3 levels of administration.

Elements of Administration: Planning Organization Staffing Directing Coordinating Reporting Budgeting Supervising Evaluation

Levels of Administration Central level Ministry of health Intermediate level directorates of health e.g. health office, Hospital, health care unit Local Level

Every program must have an overall (general) goal which confirms with that of the nation’s policy, and various objectives to be achieved according to a definite plan.

Goals versus Objectives A GOAL: is a long range specified state of accomplishment towards the activity it is directed. Goals are not constrained by time or existing resources. Example: the goal of public health services is to attain optimum health for all the people this may be accomplished through many objectives like provision for safe water for all villages within so many years ,

is a measurable state of accomplishment aimed towards the goal. AN OBJECTIVE: is a measurable state of accomplishment aimed towards the goal. The objective should include a description of “what” outcome is desired, “when” it is expected, and “where” it will take place. Example: objectives like raising the covering of vaccination to 100% after 2 years in a specific cit

Setting Objectives Should be SMART Specific Measurable Attainable /Achievable Relevant Time-specific

Planning and management *Planning is for tomorrow. *Management is for today.

Planning Planning is considered the most important element of the administrative process. The higher the level of administration, the more the involvement and time devoting to planning. A good plan is the basis of any successful program. Sufficient time should be given to the process of planning. More than one plan should be available to choose from to meet the existing plan.

Definition of Planning “Planning is a projected or predetermined course of action designed to achieve a specific goal or objective.” Planning determines What? When? Where? How? Why? And by whom? Things will be done. It involves “decision making for future events”.

Process of systemic planning 1. Establishing goals and objectives 2. Designing alternative courses of action 3. Analyzing and predicting the consequences 4. Selecting the best course of action 5. Implementing the selected plan and performing periodic evaluation to assure success of plan

Principles of planning Being an intellectual activity it needs knowledge, experience, foresight, reasoning and the mastering of special skills and techniques. Examples of different techniques of planning are: PPBS: Planning/Programming/Budgeting system PERT: Performance/Evaluation/Review technique CPM: Critical Path Method

Planning is a dynamic (non-static) process It is a continuous circular process Planning Evaluation Execution (implementation) Futuristic Decision making process Dynamic Flexible

How to stay here Where I want to be Objectives How Where I am now Situation analysis

Participative planning is sharing the program planning with other people, staff and agencies concerned with the program. Participative planning have advantages and disadvantages.

Planning of a program is based on: Needs and demands of the public Available resources Attitude of the public

Establishing priorities are essential in planning Constraints (intervening factors) to a plan may be social, economical or political, and they may be related to either: External environment (community) Internal environment (the organization) Establishing priorities are essential in planning (What are these priorities???)

The planning function includes 1. Situation analysis. 2. Problem identification and priority setting. 3. Objective setting. 4. Selection of alternative solutions/interventions. 5. Planning for resources. 6. Planning for monitoring and evaluation. 7. Planning for sustainability.

Organization Definitions: “ Organization is any collection of persons, materials, procedures, ideas or facts arranged and ordered that the combination of parts makes a meaningful whole that works towards achieving organizational objectives.” “The process of organization implies to the arrangement of human and non-human resources in an orderly fashion to make a meaningful whole that accomplishes organizational objectives.”

Human& Non human resources Organization Human& Non human resources Arranged & ordered Meaningful whole Achieve objectives

Organization Organization of health services It means any collection of persons ,materials, procedures, ideas or facts so arranged & ordered that each case the combination of parts makes a meaningful whole that works at achieving organizational objectives

The organizational process is classified into: Structural organization Functional organization

Principles of organization Departmentation Acquisition of human and non-human resources Specialization and division of labor Coordination Authority and responsibility Centralization and de-centralization Unity of command Line and staff

Staffing It is the process of “personnelizing” the organization, by hiring the right type and adequate number of workers to each unit for the time required for the program, through the following steps: Identifying the type and number of personnel Recruitment Selection and appointment Orientation Job analysis Job description Job specification

Financial administration Financial administration consists of a series activities were funds are made available for certain people in the organization under procedures that will ensure their efficient use. The main activities are: Budgeting Accounting Auditing Purchasing

Budgeting: It is the allocation of financial resources in support for programs or projects for a special period of time. A budget is defined as “a balanced estimate of expenditures and receipts for a given period of time”.

Accounting: “It is recording assembly and summarization of financial effects of executive action. a harmonious relationship between budget and account is important to current comparisons, between goals set in and accomplished.”

Auditing: “It is the investigation and report on the fidelity and legality of all financial transactions”.

Purchasing: “It is the acquisition of the property and materials needed in administration”.

Supervision Supervision refers to the day-to-day relationship between an executive and his immediate subordinates. Supervision aims at satisfying both: Work Workers

Supervision Motivation is defined as: “an externally induced behavior which occurs in order to bring about or maintain need fulfillment”. The following conditions if present build high levels of motivation: Achievement Recognition Advancement Working conditions Responsibility Technical supervision Interpersonal relations Organizational policy Salary and compensations Job security

Supervision Styles of leader authority: Autocratic Consultative Participative Democratic Free rein

Supervision Factors affecting style of supervision: Condition present Type of work Subordinates characteristics Personal characteristic of manager

Evaluation Definition: “systemic collection of information about the activities, characteristics and outcomes of programs, personnel, and products for use by specific people to reduce uncertainties, improve effectiveness and make decision with regard to what those programs, personnel or products are doing and affecting.”

Types of Evaluation Process Outcome /impact Structure

Types of Evaluation Structure evaluation Facilities/ Equipment/ Manpower/ organization Program planning Program Implementation Performance of staff/ way procedures are done Program impact Measurable Indicators + Health related impacts Process or Formative evaluation Impact or summative Evaluation

Elements of Evaluation Relevance Adequacy Accessibility Acceptability Effectiveness Efficiency Impact

Evaluation is an ongoing process. Steps of Evaluation Describe the program in terms of objectives expected. specify the evaluation design. gather credible evidence (information Analysis and justification of results Taking action 6) Re-evaluation Evaluation is an ongoing process.

Teamwork Together Each of us Achieves More Whenever achievement of a common goal needs more than one individual to function together, then we need a teamwork. Together Each of us Achieves More

TEAMWORK Everybody, Somebody, Anybody, and Nobody. There are four people named Everybody, Somebody, Anybody, and Nobody. There was an important job to be done. Everybody was asked to do it. Everybody was sure Somebody would do it, but Nobody did it. Somebody got angry about that, because it was Everybody's job. Everybody thought Anybody could do it but Nobody realized that Everybody wouldn't do it. It ended up that Everybody blamed Somebody when Nobody did what Anybody could have done.

Thank you