Country Choice Final

CHAPTER 17

17.1 INTRODUCTION AND EVALUATION OF THE EIGHT FACTOR MODEL

This discussion brings us to the end of our book journey. It summarizes the importance of the information included in the book and offers concluding remarks about what one country might learn from another. It also explores future leadership considerations that might prove beneficial in moving healthcare delivery toward a brighter future, worldwide. The Eight Factor Model was introduced for the first time in Chapter 3 to familiarize the reader with all aspects of it. The learner is encouraged to review it in greater detail. This table highlights a few of the most striking observations made about the countries included in Chapters 4 – 14 of the book. The observations may be useful in evaluating the extent to which true access is being provided. Healthcare delivery activities, positive and negative, are important considerations in determining true access. For example, although France and Italy are considered to be among the best systems in the world and they are progressively moving in the direction of providing full health care to all its citizens, one might conclude that neither is providing true access . Health care in both countries is costly, there is no consistent plan to care for non-citizens, and Italy has regional disparities. Similarly, countries such as Canada, Ghana, and India are challenged by a greater demand for services than can be provided because of a loss of physicians and nurses to other countries with better compensation packages. Planning and execution of interventions vary widely among countries as does

funding for health care. Both affect the extent to which patients get their healthcare needs met even if they experience no difficulty accessing care.

Table 17-1 Eight Factor Model for true access.

17.2 LESSONS LEARNED In regard to what lessons can be learned from the information discussed throughout the book, much can be said about embracing change with a new mindset. It is apparent that most healthcare systems would benefit from better collaboration and planning about how to maximize their current workforces. They would also benefit from planning new and creative ways to balance the supply of health professionals according to the demand for services. Another consideration is that a strengthbased approach to administering health care might prove beneficial. The obvious response from a larger, more powerful country might be, what can we learn from a developing country? However, by closely examining the strengths of even a relatively poor country, much can be learned. Replicating the country’s successful practices will likely result in better outcomes despite the size or characteristics of the country.

France, a developed nation, is admired as a healthcare leader. Yet, it is looking to other countries for answers in reducing their healthcare costs. In considering the success of France’s health system, lessons might be learned from the less costly United Kingdom system that achieves good outcomes without the extraordinarily higher expenditures.

Interestingly, the United States and Cuba demonstrate the same top three causes of death. A closer examination of the reasons for this might be helpful. The value of international collaboration on healthcare issues could provide insightful information on preventing future illness, and significantly improving health outcomes. Government officials must be transparent about the issues. They must also keep an open mind, and willingly negotiate for practice innovations that first and foremost address the needs of the people. Initiatives must include due diligence toward reforming what is clearly in need of changing in current systems, while retaining the best of what a system has to offer. It is also essential that there be more closely scrutinized bottom lines. That is, the sustainability of government financing of health care can only be made possible if there are serious efforts made to achieve system efficiency and effectiveness.

Another lesson learned is the importance of healthcare systems placing more attention on balancing health promotion, disease prevention, and interventions. Maximizing efforts at boosting preventive measures to keep people healthy, active, and more fully functioning while introducing interventions as early as possible to prevent complications, is essential. The ability to replicate the Cuban model where physician–nurse primary care partnerships are strategically entrenched in communities among the population masses could prove beneficial in that it assists people to remain in their homes and out of the hospitals. Joint crossdisciplinary efforts at improving true access is consistent with a major Healthy People 2010 goal. Providing access to quality services and service equality is of paramount importance in achieving the goal of eliminating healthcare disparities.

17.3 IMPLICATIONS FOR THE 21ST CENTURY LEADER If healthcare delivery systems are to be transformed, it will require an entrepreneurial type leadership that is unapologetically refreshing, risk-taking, motivating, cutting edge, embracing of new ideas and strategies for accomplishing goals, and pro inter-collaboration. The 21st century leader working in health care could emphasize the following seven strategic elements:

• The importance of planning for a stabilized workforce reflecting adequate numbers of well-educated health professionals at every level needed requires some level of risk-taking. We need to ask, are we inviting people who think differently? Are we creating learning organizations in which people feel comfortable expressing their ideas although different from others’? Do we reward people for thinking differently?

• Planning for creating and maintaining a retention oriented environment that thrives for high patient and staff satisfaction. Do we promote a fair and equitable distribution of the workload? Do we promote transparency in the data that are reported? Is the mission of the organization clearly communicated at every level of the organization?

• The need to identify and eliminate unnecessary costs. We need to determine the redundancy in our practices and ask what are the essential services to provide quality outcomes? We also need to ask, what strategies do we have to evaluate our efficiency and effectiveness?

• Ways in which opportunities for continuing education and training can be expanded. We need to ask how we can utilize research to enhance the quality of care through evidence based practice.

• Improving strategies to maximize efforts in providing true access to care. In what way do we continuously assess progress toward the achievement of organizational goals?

• Opportunities to engage in collaborative decision-making. Are industrialized countries open to best practices of developing and vice versa?

• Striving for improved standards. Are our ways of thinking outdated? Or do we look for new ways to improve the delivery of health care?

Each of these elements is important for the effective leader who is focused on moving the healthcare organization well into the 21st century. In the words of Patton (2001), “good practices are only as good as the evidence that supports them and their definition and applicability typically evolves in time and space” (p. ii12).

SUMMARY There is a strong argument in support of needing future healthcare leaders with vision. These leaders must be prepared to change environments. They must also establish better ways to improve effectiveness in approaches to preventing, diagnosing, and treating diseases. With increasing diversity more attention must be given to how we engage patients in their treatment and care. The effects of an aging society and the chronicity of illness and disability make strategic planning a priority. Heightened consumer expectations and demands, including their increased interest in using complementary/alternative medicine (CAM) require that providers be more sensitive to patient needs. Escalation in healthcare costs and budgetary pressures creates new challenges for providing coordinated high quality care.