Skip to 0 minutes and 5 secondsThis week we're going to look at the organisational context of healthcare improvement. We think it's important to understand a bigger picture, the way in which organisations, the way they're managed and funded frames the kind of health improvement initiatives that are possible within organisations such as hospitals. To make sense of this, we're going to look at three levels of analysis. The macro, the meso, and the micro. But broadly speaking, what I mean by that is we're going to look firstly at the big picture, the macro level of analysis of health systems and how they're funded, and the key actors, governments, professions, commercial firms that are involved in that process.
Skip to 0 minutes and 47 secondsThe meso level, we're going to look at the sort of organisational population of a health system, its architecture, and how health systems are organised. For example, are they managed for a bureaucracy? Or do they have markets and competition, or networks as a means of coordinating things? At that level, we'll also look at what's called a New Public Management, an attempt to reform health systems, make them less bureaucratic and more flexible. Lastly, we'll focus in on the specific organisational context of hospitals and community centres. These context are very specific, and are sometimes described as professional bureaucracies with particular challenges for management and challenges for change in health systems.
Skip to 1 minute and 35 secondsIn this week, you'll be hearing mainly from me, but also we'll be including examples from around the world. So for example, you'll look at the case of primary care reforms in China, an emerging health system. We'll also look at networks in the case of Australia. And other examples too from the United States and the NHS.
Welcome to understanding the organisational context of healthcare improvement
Welcome to Week 2. In this second week we will look at the organisational context of healthcare and how this context may generate both constraints and opportunities for quality improvement.
To make sense of this, week two contains three blocks, each relating to a separate level of analysis: macro, meso and micro. As you might expect, the ‘macro’ level relates to the level of the whole health system in each country. Important here are the relationships between different actors involved in funding and delivering health care, including governments, insurance providers, professions and commercial firms. These relationships, which differ between countries, determine the overall shape of healthcare systems, available resources and who has access to services.
In the second block we turn to the ‘meso’ level. Crudely this relates to a middle level of analysis, focusing on the organisational architecture of each health system and how decisions about the allocation of resources and services are made. We also look here at current reforms associated with the New Public Management’ (NPM) and how these are aimed at changing the organisational architecture to make health systems less bureaucratic and more commercially focused.
Lastly, we will introduce you to the ‘micro’ level of analysis. Here we focus on the specific organisations, such as hospitals or community centres, where health care improvement initiatives are implemented at the coalface. You will see how these organisations adopt distinctive characteristics of ‘professional bureaucracy’ which generate very significant challenges for managers and clinicians keen to bring about change.
By looking at these three levels (macro, meso and micro) this week highlights the complex nature of the organisations in which healthcare improvement takes place and an understanding of why the same policies and practices may work better in some contexts more than others. To develop these insights, week two includes reading materials, short lectures and examples from a range of international health systems, including China, Australia, the UK and the USA.
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