Unit two: Health care delivery system

Governmental bodies responsible for national

health
• Governments, through ministries of health and other related ministries and agencies, play
an important role in health development, through strengthening health systems and
generation of human, financial and other resources.
• Goals of health systems:
 improving health
 reducing health inequalities
 securing equity in health care financing
 responding to population needs
• Improved health outcomes are not attributable to health systems alone, as evidence has
shown, but to social, economic, cultural, and environmental determinants also, as
reflected in the WHO conceptual framework of Health for All.
Health system governance in Jordan
• The government is responsible for supervising, monitoring and enacting laws for the
protection of public rights and justice between the citizens.

• The best proof for the adoption of the principle of partnership in health decision making
is the existence of a health committee in the parliament to provide consultation on the
revision of important laws and health issues in the best interest of the nation and citizens
as well as ensure the validation of government decisions and to reactivate the HHC, as a
governing body for all health sectors.
Cont.
• Ministry of health (MOH) roles (through the public health law No.47
2008) are to license, control, and regulate professions and health
institutions in Jordan with the cooperation of other health related
bodies in Jordan.

• Decentralization helps to solve lot of financial, technical, social, and

administrative problems facing health institutions.

• Therefore, the role of the peripheral departments in the governorates of

Jordan should be activated and delegation of powers to local levels
(decentralized decisions) should be expanded.
Cont.
• The health sector in Jordan consists of service providers:
Public sector
Private sector
International and charity sector
as well as councils and institutions working on the development of
health policy.
Health care institutions
• Institutions can be categorized in various ways such as in-patient
hospitals and out-patient hospitals.
• Hospitals traditionally have provided restorative care to the ill and
injure.
• Hospitals classified by services provided as:
A. General: patients admitted requiring services (medical, surgical,
ENT, orthopedic)
B. Specialty hospitals: offer only special services such as pediatric,
psychiatric.
Cont.
• Hospitals described as acute or chronic care:
A. Short-term care provide assistance to clients who are acutely ill,
hospitalization period is relatively short.
B. Long-term care described as chronic care, long term care hospitals
provide health services for long period.
• Long term care facilities:
A. Nursing homes: include extended care, intermediate care, and
personal care for those who chronically ill.
B. Retirement centers: resident; live relatively independently (nursing
care, meals, and social activities were provided)
Cont.
C. Rehabilitation centers: usually special units in hospitals, nurses
rehabilitates clients e.g. physical and mental
D. Hospice services: a place provide health care facility for the dying,
given to the terminally ill, their families and support persons.
Cont.
• Physician’s office
• Ambulatory care centers
• Industrial clinics
• Crisis centers
• Home health care agencies
• Community health agencies
• Day care centers
• Rural primary care hospitals
• Public health
Health care teams
• The providers of health care referred to as health care team are health
personnel from different disciplines who coordinate their skills to
assist clients.
• The goal of heath care team is to restore a client`s health and promote
wellness.
• Health team commonly include the personnel as follow:
A. Nurses: the role of the nurses varies with the needs of the clients.
• A registered nurse (RN) assess client`s health status, identifies health
problems, and develops, and coordinate care
• Licensed practical nurse (LPN) provide direct client care under
direction of RN.
Cont.
B. Physician: responsible for medical diagnosis and determining the
therapy required by person who has a disease or injury.
C. Physician`s assistance: perform certain tasks under direction of
physicians.
D. Dentists
E. Pharmacist
F. Dietitian
G. physiotherapist
H. Respiratory therapist
I. Paramedical technologies ( laboratory, radiologist)
J. Social workers
Quality of Health Services, health care
teams:
• A national accreditation committee was formed in 1987, but its work did not last
long due to the lack of a governing body under which various health sectors can be
involved.

• Quality control directorate was established in 1999. This directorate assumed the
responsibility to develop quality units and teams to control quality and patient
safety.

• Roles of quality control directorate:

Improve the quality of health services.
Raise the satisfaction of both providers and recipients of the service at all levels.
Safety and Quality Improvement in
Professional Nursing Practice
• Why is it important for nurses to be involved in quality improvement
efforts?
• The nurses have significant, direct contact with patients at the bedside. Because of this
closeness to clinical activity:
 Nurses recognize the need for change.
 See the effects when the best care is not provided,
 And see the effect of changes.
• More than ever before, quality improvement is considered a core responsibility of the
professional nurse.
The Role of the Nurse in Quality
1. Improvement:
• The role of the nurse in quality improvement builds on the ability of the nurse to
collect and analyze patient data.
• The novice nurse and the expert nurse alike participates in quality improvement
initiatives.
Novice nurse: data collection and will assist with improvement interventions .
Expert nurse: Leading the quality improvement initiative.
• Registered nurses at the bedside use quality improvement techniques that were
once employed only by quality assurance personnel.
Cont.
• Nurses actively monitor outcomes of patient care processes using spreadsheets,
flow diagrams, computer programs, and control charts to record and monitor data
when analyzing a clinical problem or situation.

• Trended data collected by nurses are provided by the risk management department
or performance improvement council and disseminated to the units.

• Nurses in addition to monitor and analyzing data are involved in the identification
of a problem outside of the routine data monitoring system.

• Who will initiate the process of quality improvement??

Cont.
• Nurses may initiate the process of quality improvement based on observations of clinical issues
in daily practice.
• These observations may lead to the conduct of health record audits to compare care provided to
standards or evidence-based clinical practice guidelines.
• Quality improvement is also tied into a nurse’s performance evaluation.
• Individual nurse and team goals for quality and safety are important components of each staff
member’s annual review.
• As nursing leadership and staff foster a culture of safety and quality, they emphasize reporting
near misses and unintended outcomes to identify and fix weak links in processes of care.
Cont.
• 2. Continuos quality improvement (CQI):
• is defined as a structured organizational process that involves personnel in planning
and implementing the continuous flow of improvements in the provision of high-
quality health care that meets or exceeds expectations.
• There are two typical pathways in the quality improvement process:
The first process occurs as data that are regularly collected are monitored. If the
data indicate that a problem exists, then an analysis is done to identify possible
causes and a process is initiated to pilot a change.
The second pathway involves the identification of a problem outside of the routine
data monitoring system.
Cont.
• There are several quality improvements tools that can assist in monitoring
measures:
Six Sigma is quality improvement methodology frequently used in health care.
• The goal of Six Sigma is to decrease the defects or errors from the current level
within an organization.
• Six Sigma uses an approach that “emphasizes the use of information and
statistical analysis to measure and improve an organization’s rigorously and
routinely performance, practices, and systems”.
• Approaches to Six Sigma vary by organization, but initiatives generally have five
elements in common. The common elements include intent, strategy,
methodology, tools, and measurements.
Cont.
• Several Six Sigma methodologies exist, but the most common one
used in health care is what is known as DMAIC (Define, Measure,
Analyze, Improve, Control).
• Define: Clearly identify and state the problem that is the focus of the quality
improvement initiative and outline the scope of the project.
• Measure: Review all available data, measure the extent of the quality problem,
and obtain baseline performance information.
• Analyze: Use tools (such as a fishbone diagram) to study the root cause of the
problem and to develop potential solution alternatives.
• Improve: Develop alternative processes to help achieve the desired outcomes.
• Control: Sustain improvements through ongoing measurement and by conducting
ongoing communication, reviews, and training
Evidence-Based Professional Nursing Practice
• Evidence-based practice is a mechanism that allows nurses to provide safe, high-
quality patient care based on evidence grounded in research and professional
expertise rather than on tradition, myths, hunches, advice from peers, outdated
textbooks, or even what the nurse learned in school 5, 10, or 15 years ago.
• Evidence-based practice provides a strategy to ensure that nursing care reflects the
most up-to-date knowledge available so that what we do in practice matches what
we know.
• Nurses are accountable for the interventions they provide to patients.
• Evidence-based practice provides a systematic approach for decision making and
offers a framework for the nurse to use to incorporate best nursing practices into
the clinical care of patients.
• Evidence-based practice is a framework used by nurses and other healthcare
professionals to deliver optimal health care through the integration of best
current evidence, clinical expertise, and patient/family values
Promoting Evidence-Based Practice
• Strategies that can be useful in the promotion of evidence in practice generally fall into
two categories:
• 1. strategies for individual nurses and organizational strategies.
• 2. Strategies for individual nurses include the following:
• Educate yourself about evidence-based practice through such avenues as websites original
research articles, evidence reports, conferences, and participation in professional
organizations that
• provide resources related to evidence-based practice
• Conduct face-to-face or online journal clubs that can be used to educate yourself about
the appraisal of evidence, share new research reports and guidelines with peers, and
provide support to other nurses.
• Share your results through posters, newsletters, unit meetings, or a published article to
support a culture of evidence-based nursing practice within the organization and the
profession.