DHSM303 Managing Service Delivery In Health Care Sector

Health care service industry is one of the most developing industries in recent times. New Zealand has one of the most comprehensive health care system in the world which is basically developed on the inbuild need of the Kiwis to examine that every resident there gets a ‘fair go’ health providence in their life (Abdelhak, Grostick & Hanken, 2014). The core purpose of the report is to provide a holistic purview of the health care system in New Zealand. Heavy government subsidies provide great benefit of public health care services and service is either free of cost or of very low cost (Batalden et al., 2016). Government involvement is also emphasized in this report and how it provides funding for service care in health organizations is also explained.

There are main three sectional heads which provide a synopsis of prevalent health care system, governmental support, theories of health care, integrative care and revenue considerations. The final section includes explanation of various health professions, job descriptions and some issue that might be faced by the health practitioners in future. For the report work the primary healthcare service organization Stoddard Road Medical Centre is chosen. A brief introduction of the organization is provided in the next section.

The organization Stoddard Road Medical Centre (SRMC) emphasis on the words ‘you and your health’. Here best expertise on knowledge, skill and experience is used to impart the best service to the patients and to their families (Stoddard Road Medical Centre – General Practice in Mt Roskill, Auckland, 2019). It is the ultimate destination of quality health care and is pioneer in general health practices (GP services). And 365-day online health service accessibility is provided to patients to have a complete updated information about their health. The hospital is situated in Auckland one of the most popular town of New Zealand.  Expert nurse services are also available for health screening and vaccination services (Nurse Services – Stoddard Road Medical Centre, 2019). Other than health service check-up facility it also has its own pharmacy and laboratory for testing sample results. The organization has been awarded with the prestigious ProCare’s award of ‘Practice of the year’ in recent times.

In order to understand the position of SRMC in healthcare system it is important to understand the National Hierarchy in the country. Along with that the regional health system need to be understood as well. The National Hierarchical framework is shown in the diagram below.

In the National Hierarchy of health services first and foremost the annual work agreement is assigned by the Central Government to the Ministry of Health (MOH). The Health ministers then work as per the MOH guidelines (Baum, 2016). The policies are all set up to devise the quality health care services to the entire community and for that reason there are 20 District Health Boards under Minister of Health. Private health providers, NGOs and DBH providers work together to support the responsibilities of DHBs. The primary health care level includes private hospitals, laboratories, pharmacies, public hospitals for direct care providence, and other public health service providers as well (Betancourt et al., 2016). The organization Stoddard Road Medical Centre (SRMC) has direct contract with the Auckland District Health Board in providing quality health care to the patients. The position of SRMC is provided in the national hierarchy and it is one of the primary health care providers in the country.

In order to support the functions of the National Hierarchy the Regional health system is developed in the country. The regional health care system deals basically with the primary, secondary and tertiary service levels. The chosen organization SRMC is one of the best primary level service care providers in the country. Here quality care is provided to patients in areas of GP, online service care and nurse caring (Free et al., 2013). Registered nurses are only considered for providing support to patients in areas of vaccination and general health screenings. Report preparation and checking the same is another job of the nurses. Free checkup for children below 14 years is facilitated. Moreover the 365 days and 24*7 days online service help patients have the updated health information about their concerns (Drummond et al., 2015). The organization support secondary and tertiary health cares by system of referral and are referred to the Auckland City Hospital in emergency situations. Added to all these, SRMC has its own pharmacy and laboratory for on time delivery of medicines and diagnostic reports to the patients (Healthcare Services in New Zealand | New Zealand Now, 2019). The regional system of healthcare including SRMC is provided in the diagram below.

The four theories incorporated in this report are Bureaucratic theory, institutional theory, system theory and resource dependency theory. Each is elaborated below with supporting examples.

Max Weber the father of Bureaucracy, propounded this theory in the year 1905. In bureaucratic organizational structure rules, standard procedures, responsibility, division of labor, professional hierarchy and impersonal employee interaction are the main characteristic features. It supports large organizational having higher number of employees (Ginter, Duncan & Swayne, 2018). Organizational power can be of three types traditional, charismatic and legal. Principle of established jurisdiction is the underlying law and in such organizational staff selection and promotion is supported only on the basis of qualification. Here standard of quality care is maintained by controlled supervision and well-developed line of command (Hirshon et al., 2013). The top management provides a descending scale of functional operation and every employee need to abide by the set-up principles and procedures. Large organizations are benefitted by consistent employee behavior, reduced chance of conflicts and optimum human resource optimization by providing specialist job roles. The major characteristics of bureaucracy include,

• Simple division of labor
• Well defined tasks
• Clearly defined chain of command
• Clear and formal staff selection on basis of qualification and expertise
• Well defined set of rules and regulations
• Uniform application of rules irrespective of staff diversity
• Career orientation support to expert professionals like managers.

Supporting example

In SRMC every staff need to follow some pre-defined set of rules and regulations. Only expertise staffs are hired (registered nurses) so that quality are is provided to the patients (Nurse Services – Stoddard Road Medical Centre, 2019). Chain of command is well balanced where support workers follow the command of the nurses, the nurses in turn follow the command of the line managers and they in turn follow the top management guidelines.

Institutional theory

The main idea of this theory is that every organization follow the stakeholders’ guidelines and their operation is based on the hierarchical framework set up by the stakeholders. The organization that best fits the environment gains in productivity as well. Success factor is influenced largely by social environments (Kim, Farmer & Porter, 2013). In New Zealand almost all health service providers fulfil their stakeholders’ interests and also governmental rules and regulations to encourage easy funding and uphold the good market reputation.

Supporting example

In SRMC the governmental health guidelines are followed and health care is provided as per the requirements of the patients. It is very flexible to change needs and try to uphold its dignity and reputation in all situations. Hygiene is one of the major concerns here and patient safety is emphasized upon the most (Kringos et al., 2013). Qualified and experienced registered nurses and expert staffs work here to provide quality care and look after the patient safety needs at large.

System theory

This theory helps in illustrating the relationship in between the organization and the departments. All concerned departments are interdependent and work with each other to add to the ultimate success of the organization. Quality care in health organizations are provided by the interaction of three basic component support of input, process and output.

Open system- here changes in government rules and regulations, environment and technological changes directly affect the organization.

Closed system- here the outer changes cannot affect the organization and its functions remain unaltered.

Supporting example

SRMC is basically an open system organization where main departments like GP service, Nurse service and Online service are interdependent and work together to assure quality care providence to patients (Levesque, Harris & Russell, 2013). The organization is also flexible to policy changes in governmental health regulations and is updated to the latest health regulatory framework (Krumholz, 2014).

Resource dependency theory

This theory basically defines the importance of resources to an organization. No healthcare provider can survive on its own and requires resources to support its existence. Resources can be either financial funds or can be human resources and care providers (Mills, 2014). Organizations can also have strategic alliance with other similar organizations to control uncertainty and future contingencies. Reasons can be either resource instability and operational complexity.

Supporting example

SRMC is a primary health care provider and it has alliance with Auckland City Hospital to refer emergency cases when required. It is also dependent on governmental aids to support lower fee and free check-up programs for the patients.

INTEGRATED Care PROVIDANCE

To provide better and quality health care New Zealand government decided upon the idea of integrated care to all communities. Here primary, secondary and tertiary care providers are directly interlinked and have the same mission and vision statement for providing quality are and support overall patient wellness (Stoddard Road Medical Centre – General Practice in Mt Roskill, Auckland, 2019). Integration can be organizational, normative, systematic, functional, financial and clinical. In SRMC normative and clinical integration is predominant. Here health providers share same philosophy of providing quality care to patients and meet the safety needs and dignity of patients.

Both horizontal and vertical integration care is provided in SRMC.

Horizontal integration- Horizontal clinical integration is provided at SRMC where all GPs, nurses and support staffs work together for the same cause of patient care.

Vertical integration- SRMC is a primary care provider and it refers patients to Auckland City Hospital for secondary and tertiary treatment services.

Government plays an important role in tax collection and revenue generation in NZ. Major portion of health care sector is dependent on tax collection and statistics show that almost 25% of total revenue collected is spend on health care sectors (Stoddard Road Medical Centre – General Practice in Mt Roskill, Auckland, 2019). The DHBs distribute the money to the respective health organizations as per requirement.  

There are a number of reasons for government involvement in revenue collection in the country,

• To provide quality care treatment by involving third parties which in turn reduces financial burden on the common people
• Ensuring equality and equity in fund allocation and community service care
• Making optimum resource accessibility to rural and under privileged areas in areas of health care 

Communal health care service is provided by the concept of funding triangle comprising of people, care providers and third-party involvement. Two organizations play major role in revenue collection namely ACC and Ministry of Health. Appropriation budget planning is supported by PBFF method for equal distribution of funds. DHBs collect the funds and then money goes to primary, secondary and tertiary levels (Stoddart & Evans, 2017). NGOs and private fund providers also take part in service contribution. A number of insurance companies fund patient treatment coverage and support health care funding.

• The age and life style of people impact the revenue and cost generation in NZ. Most of the people are educated and have higher health consciousness. Aged people are more prone to health issues complications and need increased primary care. SRMC provide primary are and its online service help aged community to have an updated health information about their lives.
• Advancements in technology increase self-care and patients demand the best specialized treatment alternative available which is also costly in comparison to general treatment.
• The increased pay rate for health care staffs in the year 2007, forced health organizations to restructure the employees’ salary structures and this is another major drive for cost changes (Kim, Farmer & Porter, 2013).

Apart from these, general maintenance cost of water supply and electricity and laboratory costs for chemicals and apparatus equipment and also supplier demands change every year and this affects the overall organizational costing.

All Doctors of SRMC have special General Practice training. Specialty training and preventive care training is provided to them to take care of patients and solve complex health issues. Patients are encouraged to consult the same doctor for the issue so that consistency in treatment is maintained. The GPs provide services like urgent care, wound and injury care, suturing, driver medicals, insurance medicals, travel medicine, family planning, skin consultation, minor surgeries, Aclasta infusions, primary option for acute care (POAC), repeat prescriptions and home visits as well (GP Services – Stoddard Road Medical Centre, 2019).

Most of the nurses here are registered under the nursing policies. The major service provided by them include vaccination (both funded and non-funded), health screening, travel vaccine, diagnostic test results and other nurse services like ECG recording, ear syringing, blood pressure and cholesterol check, diet planning, diabetes advice, sexual health advice and other cardiovascular risk assessments (Nurse Services – Stoddard Road Medical Centre, 2019).

They support the nurses and doctors in their jobs like bookkeeping, data recording, equipment supplies etc. Moreover, the online service portal for patients called Health 365 also provide support to the main patient care providence by increased service accessibility (Stoddard Road Medical Centre – General Practice in Mt Roskill, Auckland, 2019).

The GPs are available all days except for Sunday which is a holiday. All GPs are available during the working hours from 8am to 6 pm (GP Services – Stoddard Road Medical Centre, 2019). Emergency facility is also supported as per patient need.

Registered nurses work in rotational shifts where the shift coordinator roaster their shifts. But their expertise area remains unchanged.

The support workers and health care assistants are few in number and so work in flexible job hours to reduce monotony of work and provide support during peak hours.

Job Design and SRMC

Here extra responsibility is added with the job role. The GPs along with their general practice sessions include motivating patients and supporting them in leading healthy life. They can prescribe diet chart if required which is not included in medication (Kim, Farmer & Porter, 2013). The nurses can provide free medical samples to motivate the patients to visit them in future. The support staffs can provide quality hospitality so that patients find the quality difference in health care.

The nurses and support staffs have job rotation and flexible shifts so that they remain active and provide their best quality care to the patients. Employee management becomes easy and cost effectiveness is increased in SRMC.

Nurses are provided with extra works to be done by the GPs to increase their expertise and knowledge of patients. This at times may cause conflicts among staffs.

Multitasking is supported SRMC and both GPs, nurses and support staffs are trained to improve their work efficiency so that limited number of employees can meet the situational demand when required. 

• Most of the nurses in NZ is aging and thus the increased need for new young and specialized nurse are required and hospitals in order to meet the demand are recruiting nurses lacking field knowledge and experiences. This will reduce the quality of care providence. Also, nurses are migrating to other countries to find more balanced job and their increased turnover is creating health care issues in NZ (Ginter, Duncan & Swayne, 2018).
• Support staffs are not expertise in their fields and this will hamper the quality care providence and improved technological effect will be seen in their work when they will lack knowledge of operating new equipment and care quality will reduce considerably.

Conclusion

It is evident that New Zealand Government is dedicated to provide quality care to the people and community of the country. A number of regulatory bodies are there to support the financial contingencies in health sector and every professional here try to deliver their best to impart quality health care to the patients. To sum up it could be said that the service delivery management in health sector in the country is well defined and health sector will show considerable growth in future times. 

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