• 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. 

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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  • Information systems use
  • Team-based care organization
  • NCDs and mental health
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  • Supportive supervision
  • Monitoring and evaluation
  • Infectious disease
  • Responsiveness to people
  • Quality improvement
  • Performance based financing

Barriers and facilitators to health information exchange in LMICS Akhlaq et al., 2016

This systematic review investigates the barriers and facilitators to the implementation and adoption of HIE in LMICs...strong leadership and clear policy direction coupled with the financial support to acquire essential technology, improve the communication network, and provide training for staff all helped to promote implementation."
Tags: Information systems use

Common Barriers and Strategies to Support Effective Health Care Teams for Integrated Behavioral Health Safety Net Medical Home Initiative, 2013

This technical table summarizes common challenges faced in building effective integrated behavioral health care teams and strategies for addressing these challenges. The core principles identified are shared goals, clear roles, mutual trust, effective communication, and measurable processes and outcomes.
Tags: Team-based care organization, NCDs and mental health

Continuous and Team-Based Healing Relationships: Improving Patient Care Through Teams Safety Net Medical Home Initiative, 2013

This implementation guide addresses "why care teams are important for improving patient care and ways to build an effective care team that meet patients’ needs and expectations." It identifies "four principles that should guide any effort to provide continuous, team-based care, and presents detailed steps on how to implement continuous, team-based care."
Tags: Team-based care organization

Creating Patient-Centered Team-Based Primary Care AHRQ, 2016

This resource provides a proposed conceptual blueprint for patient-centered team-based care and strategies for providing patient-centered team-based care, of particular relevance in the midst of increasing emphasis on delivering high-quality primary care.
Tags: Team-based care organization

Easing the Data Collection Burden on Healthcare Providers by Strengthening Health Information Systems USAID and MEASURE Evaluation, 2017

"This paper...explores how to improve HIS to address the burden of data collection that falls to healthcare providers. The aim is to discover ways to help providers collect good-quality data without compromising the care they give to their clients. It provides a series of recommendations for data collection and HIS."
Tags: Information systems use

Engaged Leadership: Strategies for Guiding PCMH Transformation Safety Net Medical Home Initiative, 2013

This implementation guide outlines strategies for guiding organizational transformation, centering on the importance of visable and sustained engagement of leadership along with time and resource allotcation for innovation, and creating a supportive environment for staff.
Tags: Facility management capability and leadership, Resource management

Framework for Action on Interprofessional Education & Collaborative Practice WHO, 2010

This framework "highlights the current status of interprofessional collaboration around the world, identifies the mechanisms that shape successful collaborative teamwork and outlines a series of action items that policy-makers can apply within their local health system," which is of relevance at a time when the world is facing a shortage of health workers.
Tags: Team-based care organization

Guidelines to implement supportive supervision PATH, 2003

These guidelines "focus on supportive supervision, a process that promotes sustainable and efficient program management by encouraging effective two-way communication, as well as performance planning and monitoring." They include case studies and available tools to understand context, incorporate supervisors in the training process, maintain motivation and build sustainability.
Tags: Performance measurement and management, Supportive supervision, Monitoring and evaluation

Health Facility Guidelines and Management Benchmarks The Population Council, 2015

"This document is a set of voluntary heath and management guidelines for corporations and their supply chains to promote continual improvement and application of good practices, better access to...health services, and more effective use of health resources at workplaces in the developing world."
Tags: Facility management capability and leadership, Resource management

Holding Health Workers Accountable: Governance Approaches to Reducing Absenteeism USAID, 2012

This technical brief serves as a guide for quantifying absenteeism, understanding the issues impacting absenteeism, and methods to reduce absenteeism.
Tags: Performance measurement and management

Management of health services delivery: Supportive supervision of staff WHO

This website centralizes management materials for all levels of managers working on health services delivery. Of particular relevance are the resources on supportive supervision of staff.
Tags: Performance measurement and management, Supportive supervision

Means, Motives and Opportunity: determinants of community health worker performance John et al., 2019

"This article presents a framework to help practitioners and researchers diagnose the constraints to performance of CHWs and guide programmatic and policy responses...It is based on three interdependent and interacting domains: means (whether an individual is capable of performing), motives (whether an individual wants to perform) and opportunity (whether the individual has the chance to perform)."
Tags: Performance measurement and management, Supportive supervision

Operations Manual for Delivery of HIV Prevention, Care and Treatment at Primary Health Centres in High-Prevalence, Resource-Constrained Settings: Chapter 10 Leadership and Management and Chapter 11: Quality Improvement WHO, 2008

This manual is "intended for use in countries with high HIV prevalence and provides operational guidance on delivering HIV services at health centres." The chapters on Leadership and Management and Quality Improvement outline clear guidance for best management practices.
Tags: Facility management capability and leadership, Infectious disease, Responsiveness to people

Performance Measurement for Health System Improvement WHO, 2011

The conclusion of this book underlines the twofold approach of performance measurement: promoting accountability and improving the performance of the health system. It draws out the most important lessons for policymakers, including: conceptual frameworks, selecting measures, statistical issues, incentives, policitics and stewardship.
Tags: Performance measurement and management

Quality Improvement Strategy Pt 1: Tools to Make and Measure Improvement Safety Net Medical Home Initiative, 2013

This implementation guide addresses how to choose and use a formal QI model, establish and monitor metrics to evaluate efforts and outcomes, and ensure that patients/families/providers and care teams are involved in QI activitites.
Tags: Performance measurement and management, Monitoring and evaluation, Quality improvement

Quality Improvement Strategy Pt 2: Optimizing Health Information Technology for Patient-Centered Medical Homes Safety Net Medical Home Initiative, 2013

This implementation guide addresses the optimization of health information technology (HIT) to meet criteria for meaningful use.
Tags: Information systems use, Quality improvement

Sub-national and district management: Primary Health Care WHO

This resource hub centralizes materials for frontline managers, including toolkits for being in a leadership role, implementing PHC, PHC financing and costs, quality in PHC, PHC indicators, and country experiences.
Tags: Facility management capability and leadership

Supportive Supervision A Guide for Design and Implementation of Strong and Effective Supervision Systems NASTAD, 2016

This guide provides a standardized reference for the design and scale methods of ensuring supportive supervision in the health workforce.
Tags: Performance measurement and management, Performance based financing

The courage to improve data quality IHI, 2020

This blog post highlights the approach and frameworks a monitoring and evaluation team in Ethiopia used to understand and illuminate potential solutions for their low data quality scores.
Tags: Information systems use, Monitoring and evaluation

The health manager's website WHO

This website centralizes resources for managers, or their supporters, working in settings with limited resources who make decisions on staff/budgets/drugs and other resources.
Tags: Facility management capability and leadership, Resource management

Training for mid-level managers (MLM) Module 4: Supportive supervision WHO, 2008

"These modules have been designed to provide immunization managers with up-to-date technical information and explain how to recognize management and technical problems and to take corrective action and how to make the best use of resources."
Tags: Performance measurement and management, Supportive supervision

Exemplars in Global Health - Community Health Workers Exemplars in Global Health, 2020

Exemplars in Global Health aims to help public health decision-makers around the world identify and analyze countries that have made extraordinary progress in important health outcomes and disseminate the key takeaways. The lessons and topics contained in this growing list of Exemplar narratives will be a resource to leaders committed to improving health and achieving success in their countries, including via Community Health Workers. Users can learn more about Community Health Workers and Community Health Worker exemplars on the Exemplars in Global Health webpage.
Tags: Responsiveness to people, Team-based care organization

SCORE for Health Data Technical Package WHO, 2020

"The new SCORE for Health Data Technical Package forms the cornerstone of WHO’s efforts to strengthen health information systems worldwide, and countries’ capacity to generate, analyse and use health data (i.e. health status and health intervention). The package is published during one of the most data-strained public health crisis responses ever – that of the COVID-19 pandemic2 – which is placing a huge burden on already overstretched health and health-related data systems worldwide. The SCORE for Health Data Technical Package can guide countries to take action by providing a one-stop shop for best technical practices that strengthen health information systems, using universally accepted standards and tools."
Tags: Performance measurement and management, Information systems use, Monitoring and evaluation

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:

  1.  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.
  2. Schottenfeld, L; Petersen D; Peikes, D; Ricciardi, R; Burak, H; McNellis R; Genevro J. Creating Patient-Centered Team-Based Primary Care. Ahrq. 2016;
  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