1. By Hatim Jaber MD MPH JBCM PhD 20+22- 12--2016
Faculty of Medicine Introduction to Community Medicine Course ( ) Introduction to Healthcare Management and Health Planning By
Hatim Jaber
MD MPH JBCM PhD

3. Presentation outline Introduction and Definitions 12:00 to 12:10
Time
Introduction and Definitions
12:00 to 12:10
Health Care System and its components
12:10 to 12:20
Levels of Health care, and the main approaches to health care provision, in addition to Resources, and Financing
12:20 to 12:50
Introduction to Management in health care organizations
Next Lecture
The Four Functions of Management: Planning, Organizing, Leading and Controlling.
The planning cycle and Health Systems Planning Health Policy

4. 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

5. 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

6. 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

7. 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

8. 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.

9. The Policy Cycle Stages

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

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

13. 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

14. From individual to Global Health
Health problems know no boundary
Health in the interconnected context, globalization, extends beyond problem on and capability of one country
International Health
Problem and/or concern beyond frontier
Focuses on solving health problem in developing countries
Public Health
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 4

15. 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.

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

17. 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

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

19. 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

20. Quality Control
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

21. 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.

22. 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 or however

23. 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.

24. 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

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

26. 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

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

28. 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

29. Health Care Delivery System

31. 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.

32. 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.

33. 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.

34. 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.

35. 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

36. Major components of health sector in Jordan

43. Presentation outline Introduction and Definitions 12:00 to 12:10
Time
Introduction and Definitions
12:00 to 12:10
Health Care System and its components
12:10 to 12:20
Levels of Health care, and the main approaches to health care provision, in addition to Resources, and Financing
12:20 to 12:50
Introduction to Management in health care organizations
The Four Functions of Management: Planning, Organizing, Leading and Controlling.
The planning cycle and Health Systems Planning Health Policy

44. 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

45. 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”.

46. 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.

47. 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.

48. 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).

49. 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

50. 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

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

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

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

54. 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

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

56. 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.”

57. 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.”

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

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

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

63. 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.

64. 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 ,

65. 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

66. Setting Objectives Should be SMART Specific Measurable
Attainable /Achievable
Relevant
Time-specific
Specific: spell-out clear statement of what to be attained
Measurable: to facilitate monitoring and evaluation of achieving the objective
Attainable/achievable: The community has the capacity/resources to achieve
Relevant: Should be focused towards the intended outcome
Time specific: give clear time period within which the stated objective has to be achieved.

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

68. 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.

69. 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”.

70. 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

71. 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

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

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

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

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

76. 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???)

77. 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.

78. 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.”

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

80. 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

81. The organizational process is classified into:
Structural organization
Functional organization

82. 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

83. 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

84. 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

85. 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”.

86. 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.”

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

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

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

90. 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

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

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

93. 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.”

94. Types of Evaluation
Process
Outcome /impact
Structure

95. 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

96. Elements of Evaluation
Relevance
Adequacy
Accessibility
Acceptability
Effectiveness
Efficiency
Impact

97. 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.

98. 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

99. 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.

100. Thank you