POHCLP802

Apply contemporary public oral health frameworks to review service delivery within the local context

Module 1

Public oral health

Learner Guide

2019

Table of Contents:

Welcome

The Health System

Social Determinants of Health

Population Health

Environmental Scanning

Conclusion

References

Appendix A: PESTLE Analysis: Sample Template: Part A - Factor Identification

Appendix B: PESTLE Analysis: Sample Template: Part B - Analysis Grid: Impact, Implication & Importance

Welcome

Welcome to the module The Australian Health Care System

“The way we work in public health is, we make the best recommendations and decisions based on the best available data.”~ Tom Frieden

Learning outcomes:

This module is an opportunity for you to refresh your understanding of the Australian health system and the influencers of public oral health care. It provides the ‘big picture’ context for situating public oral health in Victoria

In this module you will be addressing the first learning outcome element of the unit POHCLP802: Apply contemporary public oral health frameworks to review service delivery within the local context.

In demonstrating this element you will engage in activities that require you to: identify the major components of the public oral health care system identify the interrelationships between public oral health system: inputs; activities

and outputs; quality dimensions; and outcomes identify current public oral health issues impacting policies and systems analyse the political, economic, social, technological, legislative and ecological

factors that influence public oral health care

This module is primarily delivered as self-managed learning, allowing you to engage with the activities at a time and place that suits you. As this is a foundation module, you are expected to have completed the activities prior to workshop 1 so that you are able to fully engage in discussions.

At Workshop 1 you will be presenting the outcomes of Activity 1.10 Conducting a PESTLE Analysis, which is the final activity for this module. The details for this presentation are included in the Unit Guide for POHCLP802.

Topic: The Health System

“Of all the forms of inequality, injustice in health is the most shocking and inhumane.”~ Dr Martin Luther King Jr

The World Health Organisation (WHO) describes heath systems as “all organisations, people and actions whose primary intent is to promote, restore or maintain health”. (WHO. 2007 p.2).

Components of a Well Functioning Health System

The WHO (2010) suggests a well-functioning health system responds in a balanced way to a population’s needs and expectations by:

improving the health status of individuals, families and communities defending the population against what threatens its health protecting people against the financial consequences of ill-health providing equitable access to people-centred care making it possible for people to participate in decisions affecting their health and

health system.

WHO (2007; 2010) also identifies the following as the 6 building blocks for an effective health system:

Leadership and Governance Health Information Systems Health Financing Health Workforce Essential Medical Products and Technologies Service delivery

Activity 1.1 Health Systems Overview

The following article while focusing on the role and actions for the World Health Organisation, provides insight to principles and concepts that apply to health systems more broadly.

Read: World Health Organisation. 2007. Everybody’s business: strengthening health systems to improve health outcomes: WHO’s framework for action. pp. 1 – 11. https://www.who.int/healthsystems/strategy/everybodys_business.pdf

Key questions to guide your reading: What does the WHO define as overall health system goals? What are the attributes of each of the health system building

blocks? What is the Alma Ata Declaration? What is primary health care? What are some of the challenges common across health systems?

Reflection: How does what you have considered above, impact in terms of Australia’s health system and the public oral health system more specifically? What were your key ‘take aways’ from this reflection?

Australia’s Health System

Australia’s health system may best be understood as a network of health systems, rather than a single system. (AIHW. 2018)

Activity 1.2 Australian Health System Overview

Read: Australian Institute of Health and Welfare. 2018. Chapter 2. “Australia’s Health System?’ Australia’s Health 2018. Australian Government. https://www.aihw.gov.au/reports-data/health-welfare-overview/australias-health/reports

Key questions to guide your reading: What are the components in delivery of health services? What is the main role of each of the 3 levels of government in

Australia’s health system? How does system funding work and where is expenditure

occurring? Note:

health expenditure on dental services by fund source; health expenditure per person by Indigenous status for

dental services How is system regulation and consumer protection managed? Who comprises the health workforce? What are the trends and issues for digital health and the secondary

use of health information? What are the key challenges for the system?

Reflection: Building on your reflection from the activity 1.1 what further insights have you gained about the Australia’s health system and the public oral health system more specifically? How are the health system building blocks being addressed? What were your key ‘take aways’ from this reflection?

The Australian Health Performance Framework (AHPF), adopted by state and territory Ministers in 2017, provides a way to assess the Australian health care system and its inputs processes and outcomes. The AHPF comprises a health system conceptual framework and a performance logic model.

Activity 1.3 Australian Health System Conceptual Framework

Read: National Health Information and Performance Principal Committee. 2017. The Australian Health Performance Framework. COAG Health Council. pp 4 - 6

https://www.coaghealthcouncil.gov.au/Portals/0/OOS318_Attachment%201.pdf

Review Figure 1: Australian Health Conceptual Framework

Reflection: Thinking about the public oral health system as part of the health system network how do each of the key domains of the conceptual framework apply?

Activity 1.4 Australian Health System Performance Logic Model

We will be discussing Performance Logic Models in more detail in the unit Apply evidence to improve clinical practice and will be exploring criteria for effective indicators in the next module of this unit. At this stage you are asked to get acquainted with the AHFP Health System Performance Logic Model as a foundation for these future discussions.

Read: National Health Information and Performance Principal Committee. 2017. The Australian Health Performance Framework. COAG Health Council. pp 7 - 8https://www.coaghealthcouncil.gov.au/Portals/0/OOS318_Attachment%201.pdf

Review Figure 2: AHFP Health System Performance Logic Model

Reflection: Thinking about the performance logic model in relation to the public oral health system: how would you describe the interrelationships between health

system: inputs; activities and outputs; quality; and outcomes? how do these interrelationships ‘play out’ at the State level and in

your local context?

Topic: Social Determinants of Health

“Inequities in power, money and resources give rise to inequities in the conditions of daily life, which in turn lead to inequities in health.”~ Sir Michael Marmot

The World Health Organisation identifies the social determinants of health as “the conditions in which people are born, grow, work, live and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies and political systems.”

Activity 1.5:

Watch: Social Determinants of Health: An Introductionhttps://www.youtube.com/watch?v=8PH4JYfF4Ns

Read: AIHW. 2016. “Determinants of Health”. Australia’s Health 2016. https://www.aihw.gov.au/reports/australias-health/australias-health-2016/contents/chapter-4-determinants-of-health

The reading above provides a fuller description of the social determinants than the one below so is a better place to start.

AIHW. 2018. ‘Social Determinants of Health”. Australia’s Health 2018.https://www.aihw.gov.au/getmedia/746ded57-183a-40e9-8bdb-828e21203175/aihw-aus-221-chapter-4-2.pdf.aspx

Reflect:

1. What are the social determinants of health?2. Reflect on how social determinants impact the health of your community?3. Why do we have to consider determinants in our approach to care?4. How do social determinants give rise to oral health inequalities in communities?

Activity 1.6:

The following video is a keynote address by Don Berwick at an IHI forum. In this presentation he discusses the social determinants and provides examples of action being taken to address them. He also reflects on the work of Michael Marmot noting the conditions of daily life that matter

Watch: “Start Here: Getting Real About Social Determinants of Health.” http://www.ihi.org/resources/Pages/AudioandVideo/Don-Berwick-National-Forum-Keynote-2018.aspx

Note if you are new to the IHI site, you will be asked to register to access the materials. Registration is free.

Reflect:

1. What were the key messages you took from the presentation?2. Did you adjust your thinking or was it validated, from the last activity about social

determinants in health and how they impact in your community and/or challenges and opportunities for action in relation to improving oral health outcomes? In what way?

Activity 1.7: MyHealthyCommunitiesThe MyHealthyCommunities is an interactive website which lets you see how your local health area is performing in relation to key areas of health and welfare.

Visit the MyHealthy Communities website at: https://www.myhealthycommunities.gov.au

Explore the data relating to the local community in which you work.

Use the functionality available in the Reports section of the site to create a custom report in relation to factors important for you to understand your local community.

Topic: Population Health

“We need to think upstream and differently so we can improve health, rather than just improving the problems that were created in our society by not investing.”

~ Dr Donald Schwarz

Population health has been defined as “the health outcomes of a group of individuals, including the distribution of such outcomes within the group.” (Kindig & Stoddart. 2003). These population groups may or may not be based on geography, but may also be other groups such as particular age cohorts, priority groups, or specific diagnoses.

It is “an approach that focuses on interrelated conditions and factors that influence the health of populations over the life course, identifies systematic variations in their patterns of occurrence, and applies the resulting knowledge to develop and implement policies and actions to improve the health and well-being of those populations”. (Dunn and Hayes. 1999)

Activity 1.8: Oral Health PlanAustralia’s National Oral Health Plan 2015 – 2024 describes population health as “the health of the population, measured by health status indicators. It is influenced by physical, biological, social and economic factors in the environment, by personal health behaviour, health care services etc. Also, the prevailing or aspired level of health in the population of a specified country or region, or in a defined subset of that population.”

Read: Healthy Mouths, Healthy Lives: Australia’s National Oral Health Plan 2015 - 2024 https://www.mah.se/PageFiles/1541119092/Australias-National-Oral-Health-Plan-2015-2024_uploaded-170216.pdf

The National Oral Health Plan 2015 – 2025 provides the current population health strategic direction for improving oral health in Australia.

Key questions to guide your reading: What are the national oral health goals? Population health is one of the guiding principles of the plan, what

are the other 3? What are the 6 foundation (focus) areas of the plan? Consider the

goals, strategies and indicators for each area. Who are the priority populations? Consider the goals, strategies and

indicators for each priority group.

DHSV Strategic Plan 2016 - 2021 https://www.dhsv.org.au/__data/assets/pdf_file/0010/63289/2016-Strategic-Plan-web.pdf

In line with the National Oral Health Plan, the DHSV Strategic Plan adopts a life course approach reflecting the need to tailor interventions at different life stages to deliver improved health outcomes. The plan is built around 4 strategic themes with accompanying goals, strategies and indicators.

Key questions to guide your reading: What are the life course groups and the strategies identified for each

group to improve health outcomes? What are the strategic themes and their goals, strategies and

indicators? What are the 6 foundation (focus) areas of the plan? Consider the

goals, strategies and indicators for each area. Who are the priority populations? Consider the goals, strategies and

indicators for each priority group.

Visit the https://www2.health.vic.gov.au website to identify: population groups identified for targeted health care and services in Victoria population groups eligible for public dental care in Victoria population groups with priority access to public dental services in Victoria

Reflection: How does what you have considered above, align with the:

Kindig and Stoddart definition of population health? Dunn and Hayes description of the population health approach?

Consider the National Oral Health Plan and DHSV Strategic Plan. To what extent do they align? Are there any gaps or conflicts in alignment? What parts of the oral health system, the health system more

broadly, or other agencies/systems, need to engage with the plans to enable achievement of the goals? How can this be achieved?

Are there other federal, state or local drivers/influencers that may support and/or hinder achievement of the goals of the plans?

Which of the priority groups are represented in the community in which you are a care provider? What strategies/interventions are you currently implementing to

address the needs of these groups? How did you determine these needs?

What are the challenges in providing care for these groups? What may you be able to do differently?

You may find it useful to discuss this reflection with your mentor.

Activity 1.9: Access to public dental services in Victoria

In 2016 the Victorian Auditor-General conducted an audit to assess: the extent to which people eligible for Victorian public dental services have access to

oral health care that effectively meets their needs; whether public dental services are accessible in a timely manner; and whether agencies effectively facilitate timely access.

The audit considered the broad continuum of care (ie prevention, early detection and intervention, treatment and oral health promotion) provided by Victorian community dental agencies.

Read: Greaves, A. 2016. Access to Public Dental Services in Victoria. Victorian Auditor-General.https://www.audit.vic.gov.au/report/access-public-dental-services-victoria?section=

Key questions to guide your reading: What is the policy and legislative framework that informs public oral

health in Victoria? How is responsibility for Victorian public dental services organised

and what are the specific responsibilities of the key parties? How are Victorian public dental services funded? What key population health strengths, initiatives, weaknesses,

challenges, and opportunities does the report identify for Victorian dental public health in improving health outcomes?

What learning can be taken from the report to inform revision to the Victorian public oral health model of care and the development of appropriate programs and service interventions?

Reflection: What insights did you gain from this report about the oral health

programs and services in your local community? What learning can be taken from the report to inform revision to the

Victorian public oral health model of care and the development of appropriate programs and service interventions? What did you identify as the critical issues? What are the challenges and opportunities in your local

community?

You may find it useful to discuss this reflection with your mentor.

Topic: Environmental Scanning

Every organisation has an internal and external environment.

Figure 1: Components of a Business Environment (toppr)

It is important for an organisation or service to scan its environment regularly to assess its developments and understand factors that can contribute to its success. Environmental scanning is a process used by organisations to monitor their external and internal environments.

The major assessment work for the Course in Clinical Leadership in Public Oral Health Practice is a workplace project that asks you to make a strategic decision to identify and address an improvement opportunity relevant to your organisation’s provision of public oral health programs and services. One part of the decision making process is to collect information regarding the environment in which your service operates and analyse it to forecast the impact of changes in the environment. Once these are identified you can use this information to create a strategy that helps in maximising the opportunities and minimising the threats.

The 4 important factors of environmental scanning are (toppr): Events: specific occurrences which take place in the different

environmental sectors of the business which can be observed and tracked.

Trends: general courses of action or tendencies along which events occur – groups of similar or related events which tend to move in a specific direction.

Issues: concerns that can arise flowing from events or trends which may require corrective measures.

Expectations: arise where interested groups/stakeholders have demands based on their concern for issues.

There are a range of tools, which will introduce throughout the course, that can be used to assist you to scan the environment. In this section we will introduce the PESTLE Analysis.

PESTLE Analysis

The PESTLE Analysis is a framework to analyse and monitor the macro-environmental factors that may have a significant impact on the business environment, in this case how public oral health programs and services and provided. PESTLE is an acronym that stands for the following domains of environmental analysis: political, economic, social, technological, legislative and ecological. Figure 2. below provides a brief descriptor of each of these factors and prompts of aspects you might consider as part of your scan. These prompts are just a guide, you can of course consider other questions or prompts relevant to the subject/issue or situation for which you are conducting the scan.

Figure 2: PESTLE Analysis Prompts by Factor

Factor Descriptor PromptsPolitical These factors reflect how and to

what degree government(s) intervene in or influence public oral health care.

It includes both big and small ‘p’ political forces and influences that may affect the performance of, or options open to your organisation.

government policies government type and stability employment regulations health regulations/standards clinical safety - accreditation registration bureaucracy

Economic These factors reflect the determinants of the economy’s performance and availability of financial resources which may impact public oral health.

economic growth employment/unemployment

rates labour supply structure of workforce – skill –

mix enterprise agreements labour costs financial resourcing likely changes in the economic

environment

Social These factors reflect the demographic characteristics and trends in the way people live, work and think (eg norms, customs, and values) within the population in which you provide public oral health programs and services.

population growth rate and age profile

population education attainment population health and health

consciousness population employment patterns media attitudes, public opinion,

social attitudes and social taboos

lifestyle choices and attitudes socio-cultural changes professional influence on health

care public & government attitudes to

health care workforce

Factor Descriptor PromptsTechnological These factors reflect

innovations in technology that support new approaches to doing new and old things, and tackling new and old problems that may affect your delivery of public oral health programs and services.

They do not necessarily involve technical equipment – they can be novel ways of thinking and or organising

changes in digital or mobile technology

recent technological developments in materials and equipment

emerging technologies eg AI rate of technology diffusion client and/or business

information management and accessibility

social technologies/platforms impact on cost structure impact on value chain opportunities for flexible/remote

working

Legislative These factors reflect specific laws, regulations, that impact your delivery of public oral health programs and services.

While there is some cross-over with political factors, the key difference is that political factors are led by government policy.

legislation and regulations in relation to health

health & safety law employment law data protection consumer rights/protection

Ecological These factors include ecological and environmental aspects of the delivery of public oral health care.

They reflect the wider ecological system of which the organisation is a part and consideration of how the organisation interacts with it.

harmful chemicals waste management water consumption infrastructure transportation parking sustainable materials

PESTLE Analysis Process (Markwell & Leigh Hunt. 2016)

1. Clearly identify the subject of the PESTLE Analysis. If you blur the focus of the analysis you will produce a blurred picture of the environment.

2. Decide how the information is to be collected and by whom. Often a team approach is more powerful.

3. Identify appropriate sources of information

4. Gather the information. It is useful to use a template to help in exploring the facts and recording the information. A sample template is included in Appendix A.

5. Transfer issues to the Analysis Grid in Appendix B and make an assessment of the potential impact, implications and importance of the issue.

6. Analyse the findings:

a. Identify the most important issues

b. Identify strategic options

c. Document and disseminate the findings

d. Decide which trends should be monitored on an ongoing basis

Note: In the context of health care it is important to assess whether there are any disproportionate impacts on particular population groups and actively seek to reduce them.

Activity 1.10: Using the PESTLE Analysis FrameworkAs you have moved through the activities in this module you have had the opportunity to reflect on the context of public oral health within the broader health system. This activity asks you to complete a deeper analysis (using the PESTLE framework) of the macro-environment influencing provision of public oral health programs and services.

The link in the readings below will provide additional support in understanding and applying the PESTLE Analysis.

Read: Morrison, M. 2007. The Environment Scan – Environmental Organisational Scanning. RAPIDBI. https://rapidbi.com/the-PESTLE-analysis-tool/

You may also find it useful to review the following to see a worked example of factors identified in a PESTLE Analysis for the Pharmaceutical industry.

Shaw, A. 2011. A PESTLE Analysis for the Pharmaceutical Industry. Strategic Planet. http://www.strategic-planet.com/2011/01/a-pestle-analysis-for-the-pharmaceutical-industry/

Task:

Undertake a PESTLE Analysis to explore how the macro-environment may influence/impact your organisation’s provision of public oral health programs and services.

Using the template in Appendix A:

identify the key national, state and local political, economic, social, technological, legislative and ecological factors

review each of the factors to identify the issue they present.

You may wish to brainstorm these factors and issues with colleagues and/or your mentor.

Using the template in Appendix B:

transfer the issues to the Analysis Grid

consider each issue and rate its potential impact, implication and importance using the criteria provided on the template.

As with the factor identification phase, you may find it useful to gain the perspectives of colleagues and/or your mentor in conducting your analysis.

In your journal record the findings from this activity including:

your identification of current and emerging factors influencing public oral health policies and systems

your assessment of the most important issues influencing public oral health at the state/local level

your preliminary consideration of strategic options to address the issues (either mitigate or capitalise upon them) and your perspective on the role of the clinical leader in championing these options

any trends you have identified should be monitored on an ongoing basis

You will be presenting your PESTLE analysis in workshop 1 with other course participants. See the Overview of Assessment section in the Unit Guide for details on the requirements for your presentation.

ConclusionWith this last activity completed you have clarified the macro-environment, policies and systems that are informing the strategic context for public oral health care.

Your next module in this unit is Public Oral Health Model of Care. In this module you will be taking a deeper dive into the:

drivers informing the public oral health model of care; strategic directions, objectives, guiding principles and components of the model of

care framework; clinical guidelines and clinical pathways informed by the framework; and evidence based metrics to measure oral health programs and interventions

informed by the model of care framework.

References:

Appuhamy, R. 2017. An Introduction to Health Promotion and the Ottawa Charter. Let’s Learn Public Health. Retrieved 8 March 2019 from: https://www.youtube.com/watch?v=G2quVLcJVBk

Appuhamy, R. 2017. What is Public Health? Let’s Learn Public Health. Retrieved 8 March 2019 from: https://www.youtube.com/watch?v=t_eWESXTnic

Appuhamy, R. 2017. Social Determinants of Health – an introduction. Let’s Learn Public Health. Retrieved 8 March 2019 from: https://www.youtube.com/watch?v=8PH4JYfF4Ns

Australian Institute of Health and Welfare. 2017. Australia’s Welfare 2017. Australian Government. Retrieved 8 March 2019 from: https://www.aihw.gov.au/reports-data/health-welfare-overview/australias-welfare/reports

Australian Institute of Health and Welfare. 2016. Australia’s Health 2016. Retrieved 9 March 2019 from: https://www.aihw.gov.au/reports/australias-health/australias-health-2016/contents/summary

Australian Institute of Health and Welfare. 2018. Australia’s Health 2018. Australian Government. Retrieved 8 March 2019 from: https://www.aihw.gov.au/reports-data/health-welfare-overview/australias-health/reports

Berwick, D.M. 2018. Start Here: Getting Real About Social Determinants of Health. Institute for Healthcare Improvement. Retrieved 9 March 2019 from: http://www.ihi.org/resources/Pages/AudioandVideo/Don-Berwick-National-Forum-Keynote-2018.aspx

Bishai, D. 2017. From 6 Building Blocks to Public Health. Retrieved 8 March 2019 from: https://www.youtube.com/watch?v=x6RT72ioR0Y

COAG Health Council. 2015. Healthy Mouths, Healthy Lives: Australia’s national Oral Health Plan 2015 – 2024. Australian Government. Retrieved 9 March 2019 from: https://www.mah.se/PageFiles/1541119092/Australias-National-Oral-Health-Plan-2015-2024_uploaded-170216.pdf

DHSV. 2016. DHSV Strategic Plan 2016 – 2021. Dental Health Services Victoria. Retrieved from: https://www.dhsv.org.au/__data/assets/pdf_file/0010/63289/2016-Strategic-Plan-web.pdf

Dunn JR, Hayes MV. ‘Toward a lexicon of population health’. Can J Public Health. 1999;90(suppl 1):S7–S10. Retrieved 20 April 2019 from:https://www.researchgate.net/publication/12628301_Toward_a_lexicon_of_population_health

Graham, P. Evitts, T. and Thomas-MacLean, R> 2008. Environmental Scans: How useful are they for primary care research? Can Fam Physician. 2008. Jul; 54(7); 1022 – 1023. Retrieved on 21 April 2019 from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2464800/

Kindig, D. and Stoddart, G. 2002. “What is Population Health?” American Journal of Public Health. March. 2003. Retrieved 8 March 2019 from: https://ajph.aphapublications.org/doi/full/10.2105/AJPH.93.3.380

Koo, D. 2016. The Difference Between Population Health and Public Health. The practical Playbook. Retrieved 13 April 2019 from: https://www.youtube.com/watch?v=GDWDb_G7Hvs

Lazarus, J.V. and France, T. 2014. A new era for the WHO Health System Building Blocks. Health Systems Global. Retrieved 8 March 2019 from: https://www.healthsystemsglobal.org/blog/9/A-new-era-for-the-WHO-health-system-building-blocks-.html

Markwell, S. and Leigh-Hunt, N. 2016. The impact of political, economic, socio-cultural, environmental and other external influences. Public Health Action Support team (PHAST). Buckinghamshire. Retrieved 20 April 2019 from: https://www.healthknowledge.org.uk/public-health-textbook/organisation-management/5b-understanding-ofs/assessing-impact-external-influences

Morrison, M. 2007. The Environmental Scan – Environmental Organisational Scanning. RAPIDBI. Retrieved 21 April 2019 from: https://rapidbi.com/the-PESTLE-analysis-tool/

National Health Information and Performance Principle Committee. 2017. The Australian Health Performance Framework. COAG Health Council. Retrieved 24 March 2019 from: http://www.coaghealthcouncil.gov.au/Portals/0/OOS318_Attachment%201.pdf

Oral Health Monitoring Group. 2015. Healthy Mouths Healthy Lives: Australia’s National Oral Health Plan 2015 – 2024. Australian Government. Retrieved 24 March 2019 from: http://www.coaghealthcouncil.gov.au/Portals/0/Australia%27s%20National%20Oral%20Health%20Plan%202015-2024_uploaded%20170216.pdf

Public Health Association of Australia. 2017. PHAA Policy Statement on: Oral Health Policy Statement. PHAA. Deakin. ACT. Retrieved 24 March 2019 from: https://www.phaa.net.au/documents/item/2484

Rogers JG. 2011. Evidence-based oral health promotion resource. Prevention and Population Health Branch, Government of Victoria,Department of Health, Melbourne. Retrieved 22 April 2019 from: http://www.health.vic.gov.au/healthpromotion/evidence_res/evidence_index.htm

Shaw, A. 2011. A PESTLE Analysis for the Pharmaceutical Industry. Strategic Planet. Retrieved 21 April 2019 from: http://www.strategic-planet.com/2011/01/a-pestle-analysis-for-the-pharmaceutical-industry/

World Health Organisation. Social Determinants of Health. Retrieved 9 March 2019 from: https://www.who.int/social_determinants/en/

World Health Organisation. 2007. Everybody’s business: strengthening health systems to improve health outcomes: WHO’s framework for action. WHO. Geneva. Retrieved 10 March 2019 from: https://www.who.int/healthsystems/strategy/everybodys_business.pdf

World Health Organisation. 2017. ‘The WHO Health Systems Framework’. World Health Organisation, Asia Pacific Region, Retrieved 27 Oct. 2017 from:http://www.wpro.who.int/health_services/health_systems_framework/en/

World Health Organisation. 2010. Key Components of a well functioning health system. WHO. Retrieved 27 October 2017 from: https://www.who.int/healthsystems/EN_HSSkeycomponents.pdf

Appendix APESTLE Analysis: Sample Template: Part A – Factor Identification

(Adapted from: Morrison, M. 2007. & Shaw. A. 2011)

Subject: Date of Analysis:

Factor Issue for BusinessUsing the 6 domains as a framework, list the factors in the macro-environment which may impact on the subject you are exploring

How might the factors listed on the left impact your business?

Polit

ical

Econ

omic

Soci

alTe

chno

logi

cal

Legi

slat

ive

Ecol

ogic

al

Appendix BPESTLE Analysis: Sample Template: Part B – Analysis Grid: Impact, Implication & Importance

(Adapted from: Morrison, M. 2007)Subject: PESTLE Analysis on Date of Analysis:

Factor Issue

Potential Impact Timeframe Type Impact Relative Importance

High

Med

ium

Low

Unde

term

ine

d 0 –

6 m

ths

6 –

12 m

thss

12 –

24

mth

s

24+

mth

s

Posi

tive

Nega

tive

Unkn

own

Incr

easi

ng

Unch

ange

d

Decr

easi

ng

Unkn

own

Criti

cal

Impo

rtant

Unim

porta

nt

Unkn

own

Political

Economic

Social

Technological

Legislative

Ecological

Appendix BPESTLE Analysis: Sample Template: Part B – Analysis Grid: Impact, Implication & Importance

(Adapted from: Morrison, M. 2007)