Addressing key health challenges such as changes in disease burden and population dynamics, in governance and funding mechanisms, and in technology and clinical management practice required a high performing health system. While primary care providers hold the responsibility for the health of a defined population and act as the primary entry point to the health system hospitals form part of health care networks to fill the availability gap of complementary referral care. Significant investment has been made by many countries in strengthening the primary care level including the development of home-based care programmes and yet hospitals remain essential for the delivery of complex acute specialized care. Hospitals form an important part of health spending and play an important role in shaping public perception of the performance of countries’ health systems, and, thus, their political visibility.
Providing care at different levels in the context of challenges
Due attention must be given to all levels of care as well as the integration and coordination of functions and care mechanisms to meet the challenges. Pressure for change emerges from changing demographics and the burden of disease, supply issues linked to technology and workforce against financial pressures, increasing expectations of service quality and safety. These pressures need to be balanced against enabling people to live longer and healthier lives and participate in society, ensuring fair and equitable access to treatment and technologies, involvement in health care decision-making, being treated with respect and dignity, and enjoying the benefits of effective and efficient services.
The long-term nature of many chronic diseases, and in particular multiple conditions, calls for a comprehensive health system response that brings together a trained workforce with appropriate skills, affordable technologies, reliable supply of medicines, referral systems, and active engagement of people with chronic health problems to manage their own care, all acting over a sustained period of time. It important to note that to effectively address the multiple challenges arising from a change in the disease burden along with resource constraints requires short-term action as it relates to resource use and long-term, transformative change to reform the delivery system. Achieving the long-term, transformative change requires an overall vision, or systems perspective on population health management along the continuum of care, balancing public health and health service interventions.
Human resources represent a substantial proportion of expenditure in the health sector. There is a need to invest in people and the environment to enable them to do their job. Consideration needs to be made as to where should the health workforce work, what are the right numbers, what are right skills and skill mixes, how can improvement be made in the validity of workforce data and how can health workers be successfully retained. The question on skill mix concerns but not limited to the professions, patients and their care givers in relation to preventive, diagnostic, therapeutic, psychological, psycho-social, administrative, communicative, and managerial skills.
Data for health workforce planning, and horizon scanning (forecasting future health workforce needs) are necessary so that quantity of health care workers is complemented by a simultaneous focus on quality. Thus, there is a need to rethink the type of professional needed for the future whose skills would be more suited to meeting the needs for this with multiple chronic health problems.
Quality of services
With rising customers’ expectations, patient care becoming more complex, and because of continuing shrinkage of resources, hospitals are finding that traditional approaches to defining, organizing, and staffing quality assurance functions are no longer adequate. It is becoming more convinced that improving quality requires a broad, whole-hospital consensus about what quality means, who is responsible for it, and how key actors should communicate with one another about quality issues. A common philosophy of quality management is that it aims to help organizations of all kinds improve performance through eliminating poor quality during production or delivery of the product or service rather than through trying to fix the results after the product has been made or the service given. In brief, it amounts to a call for top management commitment to constant organizational self evaluation and innovation. Central to the approach are such techniques as setting specifications for a process, monitoring performance against specifications, determining the causes of inappropriate variation, eliminating that variation, and starting over at a higher level of expectation. Emphasis is placed on the role of top management in developing specifications and achieving continuous improvement against them. Management is responsible if quality is not good or employees are not productive—not “poor job performance” or “poor morale”. Management needs to establish a total organizational climate that builds a team approach and breaks down barriers to quality and productivity improvement.
Quality has two main components—content and delivery. Content quality is concerned with the medical outcome that is achieved. Although patients and payers are playing an increasingly active role in evaluating medical content quality, it has traditionally been the domain of physicians and other health care professionals. Delivery quality reflects an individual customer’s interaction with the health care system. For a patient his/her concern will center around cleanliness of the hospital attitude- caring and informative-of the nurses, timely delivery of services, and understanding of the patient’s individual needs and preferences.
Myanmar health system is still to be well equipped for providing this comprehensive response, transforming from a tradition of an acute, episodic model of care. Experiences from various countries and regions of the world can be used to initiate a review of the place, role and function of hospitals within changing health systems, in the challenging process to remodel the hospitals appropriately and to build capacity to support health care delivery reform. The country needs to review the current situation in relation to hospital and health system reforms including the patient choice perspective and identify priority areas for future work. This is to be undertaken in the backdrop of key challenges the country health system is facing like:
• Ageing and the rising burden of (multiple) chronic conditions
• Unequal distribution of health across the country
• Financial burden raising concerns of affordability and sustainability
• Access to technological advances and medicines
http://www.euro.who.int/en/health-topics/Health-systems/public-health services/publications/2012/modern-health-care-delivery-systems,-care-coordination-and-the-role-of-hospitals accessed 5 March 2017