� Discuss and critique two methodologies that can be used in developing a health service plan. One of the methodologies must be population-based planning.
Maximum of 2,000 words
Marking Criteria
1. Incorporates relevant concepts and theories – Weighting 60%
� Addresses the subject and the issues raised in the question
� Demonstrates an appropriate level of understanding of the theoretical principles and concepts.
� Relevant principles and concepts are used with appropriate application to support argument.
2. Use of resources – Weighting 20%
� Evidence of an appropriate level of research regarding the various concepts.
� Evidence of a range of relevant resources are used and integrated into the discussion.
3. Communication – Weighting 20%
� Ideas are clearly articulated and coherently structured.
� The paper is presented in an acceptable academic format.
� The paper is structured logically and clearly with an appropriate conclusion.
Health service planning
Health service planning is aimed at improving health service delivery and/or system performance to better meet the needs of a population. It encompasses the process of aligning existing health service delivery arrangements with changing patterns of need, making the most effective use of available and future resources (Crawford et al., 2002). Health service planning is usually based on the future and it adopts a period of between ten to fifteen years perspective supporting organizations to respond to:
- New policy initiatives and directions
- Increasing or changing service demand
- Targeted population health improvement
- Emerging trends in service delivery
- Improved service delivery models
Importance of health service planning
Health service planning occurs in rapidly changing environment, with changing community expectations, government priorities and technological advances (Crawford et al., 2002). This occurs whenever there are increasing pressures and demands on the public health system due to a constrained budgetary system (Baskin, Abd, & Ilowite, 1990). Hospitalization rates for various health conditions are predicted to continue rising for over the next ten years. In future there will be pressure on the health system as a result of the aging population and other causes such as the increasing prevalence of chronic diseases (Manaf, Samah, & Zukki 2009). In these situations, it is essential to have well planned services with the capability to respond to evolving changes in order to meet the community needs (Wennberg & Gittelsohn, 1973).
There are several factors that indicate the importance of planning health services and they include: changing populations, health status of populations, providing safe and sustainable services, improving service efficiency, projecting future service needs, and prioritizing allocation of resources (Baskin, Abd, & Ilowite1990). In the promotion of quality health care, one needs to identify the various categories of health need in a population. The categories of health need are as follows;
- “Well population” which refers to people who are generally healthy and able to live independent lives.
- People at risk of developing a health condition, that is, people with a probability of an adverse health outcome, or a factor that raises this probability
- Early identification and intervention which refers to people experiencing the early effects of ill health and who, without intervention are at a risk of developing acute or chronic consequences from their condition.
- People with acute consequences and conditions and these are people that are in need of treatment.
- People with chronic consequences and conditions and this refers to people with conditions that are persistent and long lasting and/or leave residual disability.
- “End of life” which refers to people with fatal conditions and those who are dying from the condition.
Health care requirements at any point of these stages may involve a wide range of services, providers and settings such as hospitals, in a community based health centre, sub-acute facilities, general practice hospitals, and home based settings (Obermann et al., 2006). An effective health service plan provides clear direction for service development and resource investment across all areas of the health system (Wennberg & Gittelsohn, 1973).
The different types of health service plans include: planning for a particular geographical catchment, planning for a particular population group, and planning for clinical or service streams. Planning for a particular geographical catchment relates to health services planning for a defined population. The key service areas include prevention, promotion and protection, primary health care, ambulatory care, acute care, sub-acute care, mental health and aged care. Planning for a particular population group relates to planning a health issue that exists in a specific population (Wennberg & Gittelsohn, 1973). This type of planning could also target a population in a particular geographical catchment. Planning for clinical or service stream relates to planning for a particular clinical stream or services to provide evidence based safe high quality and appropriate clinical services. This type of planning could also be targeting a population or geographical catchment (Obermann et al., 2006).
Planning for a Particular Geographical Catchment
Before we discuss about the planning based on a particular geographical catchment, let us look at the key components of the planning process. The health service planning process consists of several elements (Yun et al., 2007). They include; scope and planning activity in which you define the planning parameters and identify desired output. The second element is to understand the population and service environment-scan the environment, profile the population, profile and understand the health status of the population, profile the geographical context, profile the health status, profile current service arrangements, profile service activity, and profile service activity. The third element is, identify the health service needs-identify health issues, identify health service issues (current and projected), and develop an approach to categorize and analyze needs (Wennberg & Gittelsohn, 1973).
The forth element is, prioritize the health service needs-determine prioritization criteria, and apply the prioritization process. The fifth element is, identify the service directions-come up with possible service directions, and determine the criteria for success. The sixth element is, identify service options-develop service options, come up with preferred service options, consider opportunities for innovations, that is, research service models, carry out an analysis of feasibility, and identify the indicative resource implications (Wennberg & Gittelsohn, 1973). The seventh element is, develop objectives and strategies for carrying out the plan-develop objectives and strategies, understand future service change, and establish final resource implications (Renne 1996).
Planning for a particular geographical catchment is related to planning for a particular population in one way or the other. In the approach of this methodology, there is need to understand the population and service environment. This is because different geographical regions have different environments and populations different from other geographical regions. This understanding is important to create a good understanding of the current situation of health service users, their health status, their status and the services they access and what services they are not able to access (Wennberg & Gittelsohn, 1973).
It is necessary to understand the specific population and how adequately the available health services serve them. This method of developing a health plan can be time-consuming and costly if not well managed. It involves extensive data collection, interpretation and data analysis. Doing a comprehensive data gathering and analysis helps to ensure that all relevant information informs the development of strategies to address the issues for which the planning activity is being undertaken (Manaf 2005).
Qualitative Data: This is the information captured that is not numerical in nature and generally constitutes data about needs, perception and preferences. This data in health service is usually collected through written documents, interviews, consultations and direct observations (Wennberg & Gittelsohn, 1973). These methods of data collection make it difficult to acquire data over a short period of time because much time is needed to collect data from large populations (Powell-Griner, Bolen, & Bland 1999).
Quantitative data: this refers to information that can be counted and expressed numerically. This data in the service planning falls under different categories; demographic data, epidemiology data which includes mortality and morbidity data, facility and health services activity data which constitutes of how the populations use the health services, health economic data which relates to costs and effectiveness of various health services in a particular population, and finally, data that provides evidence of the efficiency if the various types of health interventions (Wennberg & Gittelsohn, 1973).
In the planning of health services, we need to consider the sources of data that are available and we should be in a position to access information from databases which are supported by the highest level of rigor in the first instance. All the data associated with hospital admission should be available to determine the populations that are mostly affected by various public health issues so that the health service plan can emphasize on their needs.
A population profile population (demographic profile) is one of the main elements for informing the identification of health service needs (Jacobson, Resneck Jr, & Kimball 2004). This is necessary for coming up with a clear picture of the composition and characteristics of the population within scope (Briss et al., 2000). The state and national information data sources are necessary for proper analysis of population data (Abd Ghani et al., 2008). Some of the population profiling information that may be useful includes current estimated and projected population size, distribution and density, socio-economic status and social disadvantages of the compared to state averages (health determinants), significant trends for geographic catchments in planning an area, or among a particular age or ethnic groups, age breakdown which provides main characteristics of the population and how they may be changing, estimated culturally and linguistically diverse populations in terms of size, population share and distribution, and implication of population characteristics on health service needs (Peyre et al., 2009).
This information helps in making it possible to have an effective health service plan that ensures that all the populations are catered for in the plan (Briss et al., 2000). As we can see, the population-based health service plan goes hand in hand with the geographical context of the specific population (Statistical Service 2004).
The Geographical Context
The amount of information required for the geographical contexts depends on the scope of the planning activity. The analysis of the a specific geographical catchments provides information about challenges, limitations, risks and opportunities that the physical area presents in the delivery of health services that is important in the implementation of a health service plan to a particular population (Bowling, 2009).
The geographical challenges and limitations relevant to health service planning may include:
- Main economic, environmental and social factors that impact the health of the population
- Areas within the catchment area that may experience difficulties in accessing services because of distance, transport, and patient accommodation access and options.
- Geographical conditions or urban infrastructure that contributes to present difficulties for the delivery of health services.
- Degree of remoteness of the specific demographic area.
These factors may stand in the way for provision of health services in a particular population proving it difficult for a particular health plan to be implemented successfully (Briss et al., 2000).
Planning for Clinical or Service Streams
This planning ensures that patients are provided with high quality services. At this age, provision of high-quality, affordable health care services are becoming increasingly difficult Turnbull, A. P. (1995). This is as a result of the complexities that exist in the health care services and systems, investigating and interpreting the use, costs, quality, accessibility, delivery, organization, financing and outcomes of healthcare services which is key to informing government officials, insurers, providers, consumers and others who are involved in making decisions about health related issues (Briss et al., 2000).
Health Service Research
This source of information is relied upon by decision makers to be the primary source of information on how well health systems in many countries are working to cope with the challenge of provision of quality health care to individuals and populations (Crawford et al., 2002). This information is used in the provision of quality of health care provision in the health services. Health service researchers examine the access to care, health care costs and processes and the outcomes of the healthcare services to individuals and populations (Brandeau, Sainfort, & Pierskalla, 2004). The goals of health services and patient outcomes are to protect and improve the health of individuals and populations. These goals constitute six components: patient safety, effectiveness, timeliness, patient centered, efficiency and equity (Warheit, Bell, & Schwab 1977).
Evaluating the Quality of Health Care
Quality of health care is defined as the degree to which health care for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge (Vretveit 1998). The structure, quality and outcome dimension of quality of health care are influenced by both internal and external factors (Briss et al., 2000).
The service based method ensures that the model of care outlines best practice patient care delivery through the application of a set of service principles across identified clinical streams and patient flow continuums (Vretveit 1998). An overarching design or description of how care is managed organized and delivered within the system it takes care of hospitalization services ensuring that the total number of separations in hospitals that provide acute care services. These are ways of ensuring that the best services are provided to individuals and populations are provided with quality care across the different geographical regions (Crawford et al., 2002).
These methodologies help put up strategies that meet the current changes and challenges in the public health sector. These methodologies help in proper planning of the health services ensuring that all possible factors that may stand the way of proper provision of services and ensuring that these challenges are curbed (Baum 2003).
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