• The four sub-components within Facility Organization and Management (team-based care organization, facility management capabilities and leadership, information systems use, and performance measurement and management) are diverse, addressing elements of workforce, infrastructure, and individual competencies. Consequently, strategies to improve service delivery within facility organization and management are far-reaching, and the best fit for any given context may be highly contingent upon pre-existing structures, systems, and capacities. For instance, improvements in team-based care organization may require the education and integration of a new cadre of providers in one context, while in a second context training for existing team members in respectful teamwork may be needed. Thus, the order in which health systems address sub-components of facility organization and management is dependent upon initial assessments, the magnitude of change needed, and contextual feasibility. The following sequencing of domains is intended to show the interconnectedness of these elements rather than imply a specific pathway that must be followed.

    Information systems use underlies many aspects of facility organization and management. Planning services, allocating resources, accessing patient information, and evaluating performance or management of a health facility and its staff all require robust facility data originating from information systems that are well integrated into the facility and are easy to use. Building on the inputs to establish these information systems, more efficient use of information systems can be championed by facility leaders and managers. Making use of information systems and relevant data, facility leaders – whose skill sets and responsibilities are encompassed by facility management capability and leadership – can enact necessary reforms or changes in service delivery, monitor change, and foster a facility culture and learning system which values data use for continual improvement. Data on the size and needs of the population should inform the composition and size of care teams while the culture, goals, and responsibilities within the teams should be guided and facilitated by leadership. Finally, well-designed performance measurement and management systems should be used to monitor the functioning of all aspects of a facility, including team-based care, information systems, and facility leadership, highlighting gaps and subsequently opportunities for continued improvement. Facility managers should have the necessary training and capability to use data to guide improvement.

View case studies for:

Facility Organization and Management Costa Rica

Costa Rica's primary health care system is supported by robust care teams that provide community-based care to a clearly defined group of patients.

Facility Organization and Management Ethiopia

Ethiopia has implemented a series of reforms over the last several decades intended to improve service delivery and specifically improve care through stronger hospital management practices.

Facility Organization and Management Alaska, United States

The Southcentral Foundation in Alaska, United States, has developed a system where patients are co-owners of the health system and are involved in all aspects of decision-making. 

Suggested citation: “Facility Organization and Management.” Improvement Strategies. Primary Health Care Performance Initiative, 2018, https://improvingphc.org/facility-organization-and-management. Accessed [insert date].

References:

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  3. Tsai TC, Jha AK, Gawande AA, Huckman RS, Bloom N, Sadun R. Hospital board and management practices are strongly related to hospital performance on clinical quality metrics. Health Aff. 2015;34(8):1304–11.
  4. Boyatzis RE. The Competent Manager: A Model for Effective Performance [Internet]. Wiley; 1982. Available from: http://www.wiley.com/WileyCDA/WileyTitle/productCd-047109031X.html