Facility Organization and Management

Team-based care organization
Team-based care organization refers to groups of providers with diverse training, education, and capabilities.(1) Working together and leveraging their distinct expertise, these teams are designed to provide comprehensive, coordinated, and efficient primary health care to patients.(2) Effective team-based care involves two central components: comprehensive team composition to meet population health needs and strong team culture focused on communication, respect, and trust between team members.
Facility management capability and leadership
Facility management capability and leadership refers to the capabilities of managers and leaders within a facility. Leaders should have relevant skills related to coordination of operations, external/consumer relations, target setting, and human resources.(3) Strong leaders must have or develop particular competencies and personality traits to engage the workforce and manage effectively. Competencies can be defined as the combination of motive, trait, skill, self-image, social role, and body of relevant knowledge.(4) Managers should be properly equipped with the tools, systems, and skills to productively assess the health workforce within a facility and provide supportive supervision.
Information systems use
Information systems use is the effective utilization of existing information systems and the data they produce at the facility level to coordinate care, monitor performance, and drive management. Effective information systems use can support a variety of purposes ranging from priority setting to clinical tasks and education. Information systems should be easy to use with clear expectations of use and systems for monitoring and evaluation and should provide easily accessible information to those who use them.
Performance measurement and management
Performance measurement and management includes both supportive and continuous supervision of staff as well as the routine establishment of performance targets, monitoring of progress towards these targets, and implementation of quality improvement (QI) initiatives to address identified gaps. These measurement systems should be designed with feedback loops to target results to the end users of the data and should be ensconced in larger continuous QI systems.

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:

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.

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.

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.

Relevant resources

Many tools and resources focused on facility organization and management strategies have been created over the last decade. Below is an interactive resource that provides the most useful documents within the context of our defined scope of facility management capability and leadership, information systems use, performance measurement and management, and team-based care organization.

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PHCPI is a partnership dedicated to transforming the global state of primary health care, beginning with better measurement. While the content on this website represents the position of the partnership a whole, it does not necessarily reflect the official policy or position of any partner organization.

References:

Bitton A, Pesec M, Benotti E, Ratcliffe H, Lewis T, Hirschhorn L, et al. Shaping tiered health care delivery system in accordance with People-Centered Integrated Care Model. In: Deepening Health Reform in China : Building High-Quality and Value-Based Service Delivery. World Bank Group; 2016.
Schottenfeld, L; Petersen D; Peikes, D; Ricciardi, R; Burak, H; McNellis R; Genevro J. Creating Patient-Centered Team-Based Primary Care. Ahrq. 2016;
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.
Boyatzis RE. The Competent Manager: A Model for Effective Performance [Internet]. Wiley; 1982. Available from: http://www.wiley.com/WileyCDA/WileyTitle/productCd-047109031X.html

Facility Organization and Management

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