Community health nurses focus on both short and long-term care for disease prevention. Community health nurses also help keep community health problems under check. Their responsibilities range from control of spread of disease, especially those that are communicable to offering patient support programs to diabetes patients (diabetes control and self-management). Community health nurses are also charged with the responsibility of offering advice and treatment services to members of the local community while stationed at local community health centers (“What is a community health nurse?” 2019). In summary, community health nurses are tasked with the duties of delivering health care services. Community health nurses are therefore part of the health care delivery system. This raises an important question, what is a health care delivery system? According to the World Health Organization (WHO), health care delivery system refers to a system that does what it takes to maintain, restore and promote health. WHO further reveals that health care delivery systems are made up of institutions, organizations of people as well as resources that deliver health care services to address the health needs of a group of people (“Health systems service delivery,” 2019). The implication of the term health care delivery system raises further questions focusing on the future alongside the elements of an effective system in care delivery. Therefore, to help advance the said discussion, it is important to not only explore and address the prerequisites of an effective health care delivery system, but also the future of such systems.
Key Elements of an effective Health Care Delivery System
How do you tell when a health care delivery system is effective? Well, according to the World Health Organization, a well functioning health system responds in a balanced way to a target population’s expectations and health needs. It does so by:
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Defending the target population against what threatens its well-being.
Enhancing the health statuses of individuals, families and communities.
Offering equitable access to people-centered care.
Protecting and safeguarding the target population against the financial costs of ill-health (“Key components of a well-functioning health system,” 2010).
Having explored the contributions of a well functioning health care delivery system, it is now important that we venture into the key elements of a health care delivery system and that enables it to yield such benefits to its target community. Several scholars have had their say on this topic however; the following are the most important elements of an effective health care delivery system: comprehensive whole-person/ whole family care (patient-centered approaches), culture of resiliency and recovery, rapid and open access, high quality services, education, training and process improvement. Additionally, change and change management, information and information technology, clinical governance, leadership and leading, outcomes-based care (performance results), staff engagement and wellness (focus on staff), communication, and world class customer services are also essential for effective health care delivery. (Crossland, Janamian & Jackson, 2014, Fraizer & Stea, 2013, Berman, Pallas, Smith, Curry & Bradley, 2011, and Yong, Saunders & Olsen, 2010).
Outcomes-Based Care/ Performance Results
Fraizer and Stea (2013) had their say about this significant element of effective health care delivery systems. To begin with, the duo expressed that it is only possible to change something that is measurable. Therefore, a good health care delivery system is one that is focused on outcomes and these outcomes relate to practices, patient satisfaction, employee turnover, workplace violence prevention, as well as the use of seclusion and restraint. This derives sense from the definition of health care delivery system (it is earlier mentioned that it is a system comprising of people- health service providers and receivers, institutions, as well as resources). An effective health care delivery system is therefore one that is determined to improve patient satisfaction, reduce employee turnover, and eliminate instances of workplace violence. Crossland, Janamian, and Jackson (2014) also echoed the sentiments of Fraizer and Stea. The triplet publicized that performance results are one of the integral elements to high quality health practice performance. Crossland, Janamian, and Jackson revealed that performance results encompasses processes designed to support reporting of results of performance measures both internally and externally (benchmarking against the performance of other services) as a strategy to initiating improvement.
Comprehensive Whole-Person/ Whole Family Care (Patient-Centered Approaches)
This is the second element of an effective health care delivery system. According to Fraizer and Stea (2013), a good health service delivery system should be one that treats more than one aspect of an individual or community. The services offered by a health care system should cater for the health needs of all individuals within the target population for it to be termed as effective. In addition, Crossland, Janamian, and Jackson (2014) affirmed that an effective health care delivery system is one whose service delivery is tailored to address all the health requirements in the family context and even the broader local community. They also added that it is necessary for a health care delivery system to be culturally competent.
Rapid and Open Access
Ann Fraizer and Kendra Stea wrote about the need of health care facilities to be rapid and open in terms of accessibility. Health care facilities as part of the larger health care delivery system therefore need to be fast, open, and easy in terms of access to services at all hours of the day. Ann and Kendra however highlighted security threats as one of the main reasons as to why many healthcare centers are not accessible 24 hours a day. Even then though, the duo provided some of the solutions to addressing security threats so as to ensure open and rapid access to healthcare facilities. Setting up complex but quick search procedures, and equipping health facilities with metal detectors are some of the measures managements can resort into so as to protect rapid and open access (Fraizer & Stea, 2013).
Culture of Resiliency and Recovery
An effective health care delivery system is one that is designed to withstand pressures of service delivery and also able to recover from the latest setbacks. Additionally, an effective health care delivery system is one which attempts and gains control over their situation. To ensure that this happens, power struggles within the institutions should be avoided or addressed as soon as they emerge as they do not cultivate recovery and resiliency. It is necessary to equip staff within a delivery system with skillsets enabling them to collaborate and cooperate with persons in their care so as to create and environment in which they can learn additional productive proficiencies, and also foster an effective recovery process for them (Berman, Pallas, Smith, Curry & Bradley, 2011).
High Quality Services/ World Class Customer Services
Another key element of an effective health care delivery system according to Berman, Pallas, Smith, Curry, and Bradley (2011) is high quality patient care. In addition health care facilities as a key component of the health care delivery system should focus on safeguarding patient safety, welfare, and security, since only then can it be said that the health service delivery system they are part of is effectual.
Education, Training, and Process Improvement
Berman, Pallas, Smith, Curry, and Bradley (2011) also underscored education, training as well as process improvement as central essentials of an effective health care delivery system. According to the five authors, education and training are fundamental strategies to healthcare quality improvement. In addition, education and training relates to provision of, access to, apt training of staff, as part of extant obligations. They also narrated that education and training as an element of an effective health care delivery system includes lessons customized to address changes that occur within practice. Regarding process improvement, this is what they had to say. The five scholars are cited saying that this element relates to clinical processes of care, internal improvements to the practice, and even the systems implemented to monitor the process of practical healthcare delivery.
Change and Change Management
Crossland, Janamian, and Jackson (2014) wrote that this element of effective health care delivery systems incorporates institutional preparedness and commitment, flexibility and capacity to adjust to new procedures and standards. Change and management implies the ability and willingness of the practice staff (a component of the health care delivery system) to make, manage as well as sustain change. The three scholars also revealed that one can tell when a health care delivery system if it incorporates a practice with a reputable change history and that has been more often associated with improvement of performances.
Communication
Yong, Saunders, and Olsen (2010) cited good communication as an indicator of an effective health care delivery system. They went a step further to explain what good communication is as far as health care delivery systems are concerned. Young, Saunders, and Olsen introduced facts such as formal and informal processes of information internal to the practice, cultural and environmental factors that reinforce linkage and collaboration between the practice and outside services; methods of timely referral; and sharing of patient information. Communication also covers environmental dynamics that influence sharing of information between service providers and patients.
Staff Engagement and Wellness
Some individuals seek the caring profession because they are passionate about giving back to their societies, that is a higher calling or that they want to be part of something bigger than themselves. Many staff in the caring profession cannot uphold these expectations because of the failure of many employers to create favorable work conditions and environments thereby causing compassion fatigue (Fraizer & Stea, 2013). If the staff are made to worry about their own safety, providing safe and quality care to others becomes undermined. It is therefore necessary that employers invest in staff wellness alongside improving communication between them and staff to promote their safety, a key element of an effective health care delivery system.
Information and Information Technology
The use of information and information technology is another characteristic of organizational context that is integral to high performing practices. The use of information and information technology includes aspects such as effective collection and patient data, and efficient use of technology (clinical software). This requirement of effective healthcare delivery systems most importantly focuses on use of patient clinical information and to a lesser extent on the inclusion of data on practice finances and billing as well as information relating to human resource management (Yong, Saunders & Olsen, 2010).
Clinical governance, and Leadership and Leading
Closely associated with other elements of effective health care delivery systems such as communication and collaboration, Crossland, Janamian, and Jackson (2014) said that clinical governance relates to the formal structures and systems set in place to oversee clinical safety and effective care delivery. Examples of such strategies put in place to ensure clinical safety, risk management and effective care delivery include patient complaint procedures, medical alerts, and patient call-back processes. Leadership and leading on the other hand and according to Yong, Saunders, and Olsen (2010) includes the idea of knowledge of, and attitudes to, practice leaders in practice organisation, administration and clinical care. Leadership and leading also bears some resemblance with change and innovation.
Focus of Future Health Care Services
Norman Miller, through his post on The Telegraph narrated that present technology focuses a lot on keeping persons alive rather than keeping them healthy. Dr. Mark Aloia, the global head of health behavior change at Philips added that exercise, sanitation, nutrition, sleep as well as stress management are critical to living healthy and also longer. In the dying paragraphs of his post, Miller emphasizes that disease prevention through healthier lifestyles and practices could as well be the way forward to addressing human health-related issues in the future (Miller, 2016). Norman Miller’s sentiments were also echoed by the United Kingdom Department of Health and Social Care. According to the U.K. government department’s website, promotion of wellbeing as a strategy to preventing health complications is the future of health care services (“Care and support statutory guidance,” 2018). Advancing the argument further, White (2015) wrote that clinicians and health cared decision makers tend to overlook the reasons as to why people become ill and instead focus on patient care and financial challenges and the administrative costs of illness management. White then went a step further to reveal that even though often not credited much attention, establishment of the root causes of illnesses is of invaluable significance to disease management. One meaning can be drawn from the opinions aired by the three sources. That for sure, the focus of future health care services is to uphold models of prevention and promotion that especially invest in establishing the root causes of health problems. Additionally, the three sources also reveal that encouragement of prevention through promotion of wellbeing (healthy habits and practices) could as well be the basis of health care service provision in the near future due to its association with little financial and health risks.
Conclusion
An effective health care delivery system defends the target population against what threatens its well-being, enhancing the health statuses of individuals, offers equitable access to people-centered care, and protects the target population against the financial costs of ill-health. Some of the key elements of an effective health care delivery system include outcomes-based and whole family care, rapid and open access, culture of recovery and resiliency, high quality services, change and proper change management, and staff engagement as well as assurances of staff wellness. It is also important to state at this point that the focus of future health care services is encouragement of prevention through promotion of wellbeing and establishment of root causes of disease.
References
Berman, P., Pallas, S., Smith, A.L., Curry, L., & Bradley, E.H. (2011). Improving the delivery of health services: A guide to choosing strategies. World Bank. Retrieved February 12, 2019 from http://siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Resources/281627-1095698140167/ImprovingDeliveryofHealthServicesFINAL.pdf
Care and support statutory guidance. (2018). UK Department of Health and Social Care. Retrieved February 12, 2019 from https://www.gov.uk/government/publications/care-act-statutory-guidance/care-and-support-statutory-guidance
Crossland, L., Janamian, T., & Jackson, C.L. (2014). Key elements of high-quality practice organisation in primary health care: a systematic review. The Medical Journal of Australia, 201 (3), S47-S51. doi: 10.5694/mja14.00305
Fraizer, A., & Stea, K. (2013). 7 essential elements of healthcare excellence. Crisis Prevention Institute. Retrieved February 12, 2019 from https://www.crisisprevention.com/Blog/July-2013/7-Essential-Elements-of-Healthcare-Excellence
Health systems service delivery. (2019). World Health Organization. Retrieved February 12, 2019 from https://www.who.int/healthsystems/topics/delivery/en/
Miller, N. (2016). What is the 150 club and how might it change the future of healthcare? The Telegraph. Retrieved February 12, 2019 from https://www.telegraph.co.uk/wellbeing/future-health/welcome-to-the-150-club/
What is a community health nurse? (2019). EveryNurse. Retrieved February 12, 2019 from https://everynurse.org/careers/community-health-nurse/
White, F. (2015). Primary health care and public health: Foundations of universal health systems. Medical Principles and Practice, 24 (2), 1-69. doi: https://doi.org/10.1159/000370197
Yong, P.L., Saunders, R.S., & Olsen, L.A. (2010). The healthcare imperative: Lowering costs and improving outcomes: Workshop series summary. Washington (DC): National Academies Press.
