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 18 th to late 19 th Late 19 th to late 20 th Late 20 th to 21 st Consumer Professional Corporate Sovereignty Dominance Dominance Beliefs and Values Social, Economic & Political Constraints Shi & Singh: Figure 3.1; p. 113