health system responsiveness

Health System Responsiveness Dr. Ahmed-Refat AG Refat www.SlideShare.Net/AhmedRefat 18-12-2012

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Health System Responsiveness

يحصلا ماظنلا ءادا رشؤمك ةباجتسالا

"اإلعزاز و اإلحسان"

Dr.

Ahmed-Refat AG Refat


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Contents Dimension and objectives of health system

Definition of responsiveness

Legitimate expectation

Patients vs customer

Elements of responsiveness

Dignity

Autonomy

Confidentiality

Prompt attention

Quality of amnesties

Access to social support

Choice of Care Provider


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The World Health Organisation’s new

framework for health system

performance assessment has

health improvement, responsiveness

and fairness of financing


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as the three goals of the health

system


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Functional Form for Overall Health

System Attainment

The general form of the overall

measure of health system attainment

is simply:

Composite = f (H,HI,R, RI,FF)

Health system attainment is simply:


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Composite = f (H,HI,R, RI,FF)

Where

H is the level of health,

HI is health inequality,

R is responsiveness,

RI is responsiveness inequality

and FF is fairness of financial contribution.


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What is

Responsiveness Response to individuals’ legitimate

expectations regarding the non-health

enhancing aspects of the health

system.


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Why Responsiveness

Patient satisfaction with non-medical

aspects of care, is often associated

with better compliance with

treatment instructions, prompt

seeking of care and a better

understanding and retention of

medical information .


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WHAT IS Health System

RESPONSIVENESS? Responsiveness in the context of a system can be

defined as:

the outcome that can be achieved when

institutions and institutional relationships are

designed in such a way that they are respond

appropriately to the universally legitimate

expectations of individuals.


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Responsiveness can be viewed from two angles.

Firstly

The user of the health care system is often

portrayed as a consumer, with greater

responsiveness being perceived as a means of

attracting consumers.


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Secondly,

Responsiveness is related to the safeguarding of

rights of patients to adequate and timely

care.

“treat those who use health services as

consumers within a market

based and people centred system”.


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Patient or

Client /Customer/Consumer ???

Patient Vs Customer


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The use of the word patients is considered to

underrate the status of the individual, as it crates

a hierarchy.

The patient should be defined as a consumer, a

rationale that originates from the emphasis on

the market mechanism.


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Patient Vs Customer

The term consumer dignifies the

professional/patient relationship in a way that the

traditional term patient with its association of

powerlessness against the medical

establishment does not.


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Patient Vs Customer

Using the word client, customer or service user

similarly moves away from the idea of the user of

medical services being passive and dependent.


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Patient Vs Customer

The seven principles should relate to consumers: 1. access,

2. choice,

3. information,

4. redress,

5. safety,

6. value for money

7. and equity


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Responsiveness Vs SATISFACTION

(1) Scope: patient satisfaction focuses on clinical

interaction in specific health care settings whereas responsiveness evaluates the health system as a whole;

(2) Range: patient satisfaction generally covers both

medical and non-medical aspects of care while responsiveness focuses only on the non-health enhancing aspects of the health

system;

(3) Rationale: patient satisfaction represents a

complex mixture of perceived need, individually determined expectations and experience of care.


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Legitimate EXPECTATIONS

a- Expectations

Expectations are often simply defined

as individual’s beliefs regarding

desired outcomes.


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Four types of expectations:

- Ideal:

similar to aspirations, desires or preferred outcomes

- Predicted

realistic, practical or anticipated outcomes that result from personal experiences, reported

experiences of others and sources of knowledge such as the media


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Four types of expectations:

- Normative

expectations that are based on what should or ought to happen

- Unformed

– the situation that occurs when individuals are unable or

unwilling for various reasons to articulate their expectations, which may either be because they do not have expectations,

have difficulty expressing their expectations or do not wish to reveal their expectations due to fear, anxiety or conforming to

social norms.


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Legitimate EXPECTATIONS

b- Legitimate

can be defined as conforming to

recognised principles or accepted

rules and standards. Ethical norms can be set in most instances without

much debate

as to the optimal desired behavioural process


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Elements of

Responsiveness


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1 Dignity The right of a care seeker to be

treated as a person in their own right

rather than merely as a patient


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Dignity includes:

♦ the safeguarding of human rights

such as the liberty to free movement

even for individuals who have

leprosy, tuberculosis or are HIV+

♦ treatment with respect by health

care staff;


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♦ the right to ask questions and

provide information during

consultations and treatment;

♦ privacy during examination and

treatment

Patients satisfaction levels are increased by doctors taking time to make conversation with the patient, such

as make comments that are not related to health or crack a joke.


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Assessment of dignity


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2-Autonomy

Autonomy is self-directing freedom.


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The Four rights of individual

♦ The right of an individual to

information on his/her disease and

alternative treatment options (this

facilitates informed choice)


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♦ The right to be consulted about

treatment


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♦ Informed consent in the context of

testing and treatment


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♦ The right of patients of sound mind

to refuse treatment


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Models of Autonomy.

1- The first the paternalistic model

has the health care provider making

all

decisions on behalf of the patient,

since the provider is considered to be

better informed this is considered to

be optimal.


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2- The second model termed the

informed decision making model,

imposes the need for information

dissemination on the

provider and the responsibility of

decision making on the patient.


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3- The professional agent model,

has the patient willingly foregoing

the right to decision making, though

well informed, through voluntarily

and explicitly transferring the

decision making

task to the provider.


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4- The final model termed the shared

decision making model

focuses on the sharing of both

information and decision making

between the patient

and the provider, including the

determination of preferences.


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Assessment of Autonomy


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3- Confidentiality

Information relating to the patient

and his illness should not be divulged

during the course of care, except in

specific contexts, without the prior

permission of the patient.


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Assessment of Confidentiality


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4- Prompt

Attention Prompt attention is consist of three

characteristics:

♦ Patients should be entitled to rapid

care in emergencies, and


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♦ Patients should be entitled to care

within reasonable time periods

even in the case of non-emergency

health care problems or surgery..

♦ Patients seeking care at healthcare

units should not face long

waiting times for consultations and

treatment.


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Assessment of Prompt attention


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5- Qualities of

clean amenities This aspect relates to the provision of

physical infrastructure and a

conducive care environment. The

study defines basic amenities in the

following manner:


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♦ clean surroundings

♦ regular procedures for cleaning and

maintenance of hospital buildings .

♦ adequate furniture

♦ sufficient ventilation

♦ clean water

♦ clean toilets

♦ clean linen

♦ healthy and edible food


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Assessment of the qualities of clean amenities


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6 -Access to social

support networks

during care The patient welfare is best served if

the individual has access to support

networks during care.


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The procedures in the provision of

inpatient health care should allow

♦ regular visits by relatives and friends ♦ provision of food and other consumables by relatives and friends, if not provided by the hospital ♦ religious practices that do not prove a hindrance to hospital activities or hurt the sensibilities of other individuals


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Assessment of Social Support Network


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7- Choice of Care

Provider The ability to choose between care

providers .


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Assessment


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Cited References

Amala de Silva. A FRAMEWORK FOR MEASURING RESPONSIVENESS .GPE Discussion Paper Series: No. 32 EIP/GPE/EBD. World Health Organization

Christopher JL Murray,Jeremy Lauer,Ajay Tandon,Julio Frenk. OVERALL HEALTH SYSTEM

ACHIEVEMENT FOR 191 COUNTRIES Discussion Paper Series: No. 28 EIP/GPE

World Health Organization

Ana-Lucia Ristea1, Ion Steg_roiu2, Valeriu Ioan-Franc3 and Vasile Dinu4 Responsiveness of Health Systems: a

Barometer of the Quality of Health Services. Amfiteatru Economic Vol XI • Nr. 26 • June 2009

WHO- World Health report 2000. http://www.who.int/whr/2000/en/whr00_en.pdf

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