Transcript Models and Systems of Health Services Organization

PA 574: Health Systems Organization
Session 2 – April 10, 2013

Six Aims
 Safe
 Effective
 Patient-centered
 Timely
 Efficient
 Equitable

Ten Rules for System Redesign…
1.
Care is based on continuous healing relationships;
2.
Care is customized according to patient needs/values;
3.
The patient is the source of control;
4.
Knowledge is shared and information flows freely;
5.
Decision making is evidence-based;
6.
Safety is a system property;
7.
Transparency is necessary;
8.
Needs are anticipated;
9.
Waste is continuously decreased; and,
10.
Cooperation among clinicians is a priority.
 Level
1: Patient and Community
• Experience of patients
 Level
2: Microsystem
• Functioning of small units of care delivery
 Level
3: Organization
• Functioning of organizations that house
microsystems
 Level
4: Environment
• Policy, payment, regulation, accreditation
• Shapes behavior, interests and opportunities of
Level 3 organizations
 Medical
Model Health defined by lack of
presence of illness or disease (health
defined by non-health)
• Illness defined by person – Disease by medical
professional
 Sociological
(Parsons) – Health is state of
optimum capacity to fulfill social roles
• Defined disease/illness not needed
• But can be “ill” and still perform(?)
 Society
for Academic Emergency
Medicine – Health is a state of physical
&mental Well-being that facilitates the
achievement of individual and social
goals.
 WHO – Health is a complete sate of
physical, mental &social well-being, and
not merely the absence of disease and
infirmity.
 Holistic
Health – encompasses physical,
mental, social and spiritual aspects of
well-being.
 Two “indirect” views:
• Acute, subacute & chronic conditions
• Primary, secondary & tertiary prevention?

Last but not least..Public health –
• “societies interest in assuring conditions in
which people can be healthy”.
• Population health
 ..And the Community Health Model:
• Add care, prevention, health promotion & health
education to attain holistic health
 So
what makes the most sense…Are
these all “functional” definitions:
• Are they feasible/doable?
• Do they delineate reasonable boundaries for a
health system?
• How do we decide????
 Health
Determinants:
• Lifestyle (personal?)
• Environmental (social?)
• Heredity
• Care

Justice
• Market – health/health care is individual good
• Social – health/health care is social good
 How
do/should these combine to
determine health system goals:
• Definition of health
• Health determinants
• Health/Healthcare as a individual or social good
Brainstorm:
What has transformed health services
delivery over past few decades?
 Professional
sovereignty
 Urbanization
 Science and technology
 Growth of institutions
 Dependency
 Cohesion among medical professionals
 Licensing and regulation
 Health professions education
 Growth
in public health
 Consumer advocacy
 Increase in chronic conditions and
longevity
 Services to special interest groups
(veterans, disease, racial/ethnic)
 New forms of coverage
Science & Technology
Mid 18th to late 19th
Late 19th to late 20th
Consumer
Sovereignty
Professional
Dominance
Late 20th to 21st
Corporate
Dominance
Beliefs and Values
Social, Economic & Political Constraints
Shi & Singh: Figure 3.1; p. 113