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Abstract

The World Health Organization defines healthcare policy as the set of “decisions, plans, and actions that are undertaken to achieve specific healthcare goals within a society”. The healthcare delivery system is the system which provides health care to every person, and is made available by dedicated health personnel. Each and every individual involved in healthcare, from the personnel who provide it to person who receives it become health’s stakeholders. In spite of the best efforts taken by the system in providing efficient healthcare to all, a large number of individuals are found not to avail any benefits from the healthcare system. This calls for an urgent need for framing a healthcare policy to promote and educate healthcare among the community. This essay deals with the strategies needed to be used in framing a healthcare policy and the steps to its implementation on increasing patient awareness towards healthcare and increasing patient compliance

Table of Content

• Abstract
• Identification of the Need of a Policy
• The Strategies to frame a Policy
• The Implementation of the Policy
  • Identifying the factors
  • Assigning the tasks
  • Budgeting
  • Risk Management
• Conclusion
• References

Introduction

The World Health Organization defines Health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity”  (World Health Organization, 2008). The Healthcare delivery system is the system which provides health care to every person, and is made available by dedicated health personnel. Each and every individual involved in healthcare, from the personnel who provide it to person who receives it become health’s stakeholders. Even though it is highly essential that healthcare must be made available to all, it is chiefly determined by many factors such as social, economic, political, demographic, and regional factors, including the management of the facilities providing healthcare. Management of one’s health issues is usually availed at the concerned facilities at primary, secondary, tertiary and quaternary levels; and at community and home-based healthcare at the primary level (Kongstvedt, 2012).

The perspective of the healthcare system is quite flexible, and there are a lot of areas that need to claim their deserved importance. To put it simply, there is always an opportunity for further growth and development. One of the main factors determining any health intervention to be noted by the healthcare management is a proper healthcare policy. This is an issue with planning, which directly and indirectly affects the entire delivery system. A healthcare policy is the set of “decisions, plans, and actions that are undertaken to achieve specific healthcare goals within a society” (World Health Organization, 2008). It is essential to have a dedicated healthcare policy in order to produce efficient results, as health is a physical, psychological component of the society, and not a virtual substance.

The aim of this report is to deliberate on the need healthcare policies, how it would improve the healthcare delivery, the planning and strategic management involved, the possible risks and the resources needed to accomplish the task, and the effect of the policies on the healthcare delivery system and its stakeholders.

Identification of the Need of a Policy

 Close to 50% of the people availing healthcare facilities are referred for follow up to ensure the continuity of the treatment, early detection of any misdiagnosis, identification of any side effects of management programs, and the optimal management of complications. Having a regular follow up also makes sure that the efficacy of a treatment protocol is maintained in the future. Article 25 of the United Declaration of Human Rights (UDHR) of the United Nations states that “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, illness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.” (United Nations, 2016)

Unfortunately, there only 40% attendance is seen in most healthcare facilities, (Demetrios N Kyriacou, 2005) which mostly consist of reports of poor treatment, exacerbations, recurrences, or further complications. This results in poorer overall health in the community, a higher rate of delayed admissions, increased mortality of the patient and decreased satisfaction of the patient, despite the best efforts taken to assure adequate healthcare. To focus on this issue, one needs to take adequate measures in improving the overall healthcare status of the society. The following parts of the essay shall deal with the strategies needed to be used in framing a healthcare policy on increasing patient awareness towards healthcare and increasing patient compliance.

The Strategies to frame a Policy

The proposed policy in the healthcare delivery system is to strengthen the patient awareness and compliance by utilizing and implementing suitable resources. Once the need is made clear, different ideas in which the proposed change can be brought about and how much difference would it make in the huge healthcare system, has to be planned documented, and implemented. In order to make the process easy, we can use Kurt Lewin’s model of organizational change (Burnes B., 2013), where should ideally be three phases in the process – Unfreezing, Changing and Refreezing. Each phase must have a major goal, revolving around which any decisions for planning can be made.

In the Unfreezing phase, the major goal would be to provide general and public awareness of the present and running status of the healthcare delivery system. The decisions made would be a detailed analysis of the present system, the loopholes and lacunae in it, the factors influencing poor patient turn-around, the urgent steps that must be taken in order to look into the issue, and the optimal resources needed to enhance patient compliance.

In the Changing phase, the major goal would be to implement the decisions made. The major work done would be making adequate budget allocations, assigning of relevant portfolio to the new staff that are appointed, sharing of the additional workload is divided with the existing staff, making a reach-out to the patients is via community visits and/or media communications. Whatever is done is documented, and updated regularly. To provide a framework to this most important and highly challenging phase, we can follow the Kotter’s 8-step change model (Steven H. Appelbaum, 2012).

Step 1 – Creating a sense of urgency: The significance of poor patient healthcare compliance and its influence on the system must be explained, and the urgent need for instant and prompt action must be reiterated.

Step 2 – Building a guiding coalition: A group of efficient staff who can shoulder the responsibility to bring about the change (ideally the of hospital administrators) must join hands to work on the issue.

Step 3 – Form a strategic vision and initiatives: A vision statement of what does the idea really aim to achieve in improving healthcare compliance, and its significance must be documented.

Step 4 – Enlist a volunteer army: The most suitable individuals to work on the task would be the students, interns, and healthcare volunteers, who are guided by the senior nursing and administrative staff, as they have a wide range of patient interaction experience.

Step 5 – Enable action by removing barriers: A detailed literature review must be performed, and the factors responsible for poor patient compliance must be identified and modified.

Step 6 – Generate short-term wins: A pilot project of the initiative must be conducted in order to gain a grounded idea on the issue; the process must be re-examined for its efficacy based on its results.

Step 7 – Sustain Acceleration: The obtained short term success must be used to encourage other projects, which would help the implementation of the plan in all sectors.

Step 8 – Institute the Change – Implement the change as a procedure to be followed.

Last comes the Refreezing phase, where the major goal would be to manintain the changes made. Reflecting this in the new protocol of documentation is very important to ensure that there is no rollback of the change made.

Following such structured models will enable the proposed policies and plans to be more concrete and less abstract, ensuring its success.

The Implementation of the Policy

Once a protocol is formed, how does it bring about change in the patient follow-up system? How can it be implemented and how does it work? This chapter discusses the answers to the above questions.

Identifying the factors

One of the tasks is to identify the areas in which patient compliance in healthcare is known to fail. According to the various sources literature, a few of the reasons attributed to poor patient compliance could be both hospital-oriented and patient-oriented factors. (CDC, 2014)

Step 1 – Identifying the hospital oriented factors such as dissatisfaction of treatment provided, improper instructions and infrastructure, poor facilities, etc. Upon identifying the factors, the management has to assess the concerned areas and bring about immediate changes in improving the treatment quality, providing proper instructions, etc.

Step 2 – Identifying the patient oriented factors such as poor healthcare awareness and disinterest, poor economic conditions that stop them from availing healthcare services, etc and bringing it to the immediate notice of the nursing staff, and the public relation officers. Upon identifying the factors, the main goal of the staff is to clearly educate to the patients the ideal purpose of healthcare (Keith Tones, 2013) in the healthcare setup. Issues pertaining to transportation, and the management of time must be dealt with alternate methods management, such as healthcare personnel’s visit to the community; it would go a long way in enhancing patient healthcare compliance. The grand success of the Directly Observed Treatment – Short Course (DOTS) as a part of Tuberculosis management in India (Azhar, 2012), can be taken as an excellent example. In this program, the community health staff would go to the patient’s place in their particular community and make him/her intake the TB medicine under their direct observation. Programs like this can be made possible by employing new staff exclusively for field duty, or by adding extra portfolio to the existing staff.

Step 3 – Documenting the policies once the strategies and plans are implemented. Upon accomplishing this, regular follow-up is to be performed, in order to ensure the sustenance of the policy.

Step 4 – Constant monitoring of the policy that has been implemented is essential In order to ensure the success of the plan.

Assigning the tasks

Each and every stakeholder of healthcare, from its provider to recipient is responsible in managing any issue with the system. However, the balance slightly tilts more towards the providers, as their deeds are more influential in the system.

The administrative staff would be accountable for the budgeting, that is allocating the essential funds for the implementation of health programs in the healthcare budget. Additionally, they would also take over the necessary steps to be ensured in the inpatient/outpatient care and the setting up of posters and displays for health awareness within the hospital/facility to improve public awareness. The ideal time that must be taken for this process from the the commencement of the project would be 60 days.

The responsibility of the medical staff would be identify the basic issues and ailments that need medical care but are usually ignored, and make it mandatory to include them in the awareness program. In the department while consulting, the medical staff must advise the patients on the significance of adhering to healthcare protocols. It is essential to ensure that all backlogs are cleared within 3 months, and after 3 months every patient attending the department is well educated and informed of his condition and management schedule.

The responsibility of the nursing and the community healthcare workers is pivotal in the improvement of patient healthcare. They begin by conducting regular community visits and creating awareness in the people on why regular health check-ups and follow ups are necessary. As encompassing the community is a very challenging affair, the community in-charge team would be split, and an optimal time of 15 days will be provided to each team, in order to cyclically cover a specific area under the control of a primary health centre.

The major responsibility in the success of this healthcare policy lies with the patient and his caregivers, by actually adhering to the healthcare appointments, and by providing ready compliance for the betterment of healthcare. It must be noted that this program is mandated for the betterment of the patient. An optimal time 15 days would be given from the date of the community visit to the consultation, wherein he is expected to visit a specialist for consultation. Here, the duty of the community worker is to monitor the patient on his compliance.

If all the members of the healthcare team work together in complying with the policies, then there would be no hindrance in achieving the aim of health for all.

Budgeting

Healthcare budgeting can be analogized to the mirror reflecting the resource need of the healthcare provider. A specific management protocol costs a specific cost to the healthcare provider; it will be analysed whether the protocol is quality and cost effective, whether it has a record of positive responses from the consumer (patient), how beneficial it is to the patient, etc. While drafting the healthcare budget, one must keep in mind that minimizing of cost is not compromising on quality, and in no case must quality be substituted for cost.

The overall estimated budget for the Healthcare awareness policy (Peter S. Hussey, 2013) would be 8 lakh USD, which would have to seek approval by the health budget. (CMS, 2012) This budget is inclusive of the costs of providing healthcare and medical consultations at a low/subsidized/ free of cost at the discretion of the hospital management; the costs of paperwork used in updating record forms, follow up appointment forms etc; the training costs, the salaries and bonuses to the staff who are a part of the program; transportation and food charges of the community visits; the health education material provided to the patients such as billboards, handouts and posters to convey the importance of regular medical check-ups,  etc. The documentation can be digitized, in order to avoid unnecessary red tape and to save paper.

The money that is used in this project must be completely utilized for the healthcare development policy, in order to see positive results.

Risk Management

Risks are a part of every initiative. In the healthcare industry, the major risks include improper response from the patient, a sudden outbreak of an epidemic throwing all the work done in retrograde, a genuine medical error which leads to legal interventions, scope for malpractices, failure to document the data leading to loss of track and rights over the management, etc. (Sadgrove, 2014) In most government facilities, the general outpatient consultations are performed by interns/ residents who work on rotatory shifts. Here, there is a chance of two different physicians treating the patient, with two different opinions. This might lead to misdiagnosis or mistreatment, though not always. In order to prevent this risk, care must be taken that the patient is reviewed by the same physician who has treated him earlier, or a referral slip from the first specialist in legible handwriting be provided to the patient, so that the latter has the total data of the patient and his prognosis. (Zapka, 2010)

Other risks include monetary losses in the budget  (CMS, 2012), safety of the community healthcare worker  (Bride, 2015), etc.

Conclusion

Every single new initiative has to be evaluated, assessed, and monitored, for its effective working. This patient health-awareness initiative also has to be periodically evaluated for any flaws, so as to set them right as early as possible.  (David McKenzie, 2014). Upon evaluation, any bugs within the system, such as potential inefficiencies, requirements that are still unmet, financial discrepancies, and any improper implementation of the policy would be exposed, which can be rectified immediately. Evaluation also helps to periodically quality test the program for its stakeholders, which allows for periodic re-statement and renewal of the goals and aims of the program. The true success of the healthcare delivery system is in assuring complete and a long term health for the society. This can only be achieved by the genuine co-ordination of all the people involved in the healthcare delivery system. The onus lies on all the stakeholders of health, and all have the responsibility to create a healthy society.

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