Policy Making Process in Healthcare

AMANDO TAGUINOD III

a. PROBLEM IDENTIFICATION AND AGENDA SETTING

Problem identification the word itself identification, the first thing to be done is to identify what is the issue. After which is the organization and gathering of information on how to solve the problem and further working for solutions. Agenda setting, prioritizing the problem that needs a special attention down to the simple issues. Those under the salient issues are the once discussed and thoughts, ideas and solutions are organized in an agenda.

Policy Formation

After gathering salient issues. Policy makers under the legislative and bureaucracy adhere to the issue and develop a regulatory strategies on how to address the problem. Effective formulation and acceptable formulation will be made. In effective formulation, the policy makers identify whether the policy is implementable and efficient. If not, policy analyst will identify some alternatives. In Acceptable formulation the law makers will decide whether it will be implemented or rejected. It depends on the decision of the majority.

Policy Adoption

The third phase of policy development process. The policy is ready to be adopted by the Government for the future implementation for the solution of the problem and bring about a change in the state.

Policy Implementation

Implement the adopted policy. The policy will be implemented and distributed from the top (president) down to the officials of the local government and the different government agencies and other private agencies involved. Policy will then become rules and regulations and it will be applied

Policy evaluation

Is a critical thinking approach to assess the implemented policy and its outcomes. According to my reading upon assessment, statistical data and verbal data is made in order to produce a subjective and reliable outcome. It is the final process wherein all policy makers, legislators and officials determine whether the policy achieved its goals and find out if there are revisions and changes.

Politics, Laws and budgets

Workplace. Almost all of the establishments requires a nurse, 2 and more. The environment in these establishments are political ones. Such establishments are: big Hospitals, clinics, firms, schools, agencies under the government or private, Home care, and other health agencies. Policies are guidelines to many health facilities. The presence of a nurse in the different facilities is very important in the determinant of health of all the people involved inside the facility considering the available resources and be an influence and an advocate and make a recommendations to the upper level of the facility in order to maintain and to provide adequate resources in the organization.

Government. As a Heath care provider, the policies and actions from the government extremely affects the lives of the people especially the underprivileged ones. According to my readings and research middle class countries such as the Philippines, its government finance most of the programs including health in the different sectors. Such funded programs are prenatal care, food safety, public highways, operates schools and some health care facilities. Bureau of fire protection, assistance to the poor and old ones. Federal government in the Philippines deciding who will be provided special attention and benefits depending on the kind of care needed examples are giving vaccines in community/adopted barangays, giving first aid to the people affected by typhoon and earthquakes and other calamities. We Nurses are influential in our respective fields and not just in Nursing but including all the aspects of health. We must be upgraded and well updated. We are responsible and competent enough to show the government our desires to bring about improvement in the health to our locality and to the national level through membership with Nursing Associations and active leader in other connected health associations, participates in debates and we will become powerful and influential in the policy implemented.

Professional Organizations. I am an Orthopaedic Operating theatre nurse for 7 years in the Philippines and in Libya. We have developed organizations that helps in influencing the Operating Theater Nursing practice in the Philippines. One of the examples are ORNAP (OPERATING ROOM NURSES ASSOCIATION IN THE PHILIPPINES). As an active member, one of our goals is to become the leading advocate for Orthopaedic Operating Theatre Nurse based from quality practice from the developed countries like United States and Dubai. We disseminate updates, trends and trainings to our fellow Operating Theatre Nurse to the local government and some private and government secondary Hospitals or tertiary Hospitals. We have a contingency plan if calamity arise. We pledged and are held responsible to adhere to the needs of affected individuals, offering our support and totally practice our specialized profession based from trainings, continuous education and workshops offered by the government. For the operating theatre nurse and other health care professionals from the other associations, we can work as a team to effectively practice our advocacy to help every individual, family, and community share the available resources offered by the government. When Nursing Organizations joined forces it creates a big influence to the whole society.

Community. As per definition, a community is a group that share something in common and an interaction within the group or with one another committed to share for the productivity and betterment of their living. We nurses can be an advocate by searching issues and influence interested people inside the community to be an active participant in mobilizing support and influence change. Furthermore, nurses can be a big help by gathering data’s and facts about the present health situation and identify what remedies or plan of action can be made to at least alleviate, reduce or eradicate the source of problem by implementing independent Nursing actions such as health education and evaluate it and further reporting to the local government. The target budget and resources will be given according to the reported scarcity. Such issues prevalent in the community is the outbreak of some communicable diseases.

Decision – Making

A.1 Rational model

The structure, steps an focus of the model

It is the process of logically identify the problem wherein all the members of the group must have a common identified problem. Each individual will be confronted with alternatives. The group will establish, evaluate and create alternatives, and must be ready with the consequences and finally implement and monitor the effectiveness and progress of the alternatives decided.

The first step is verifying, defining and gathering information. In this stage each member will contribute in giving ideas, inspirations and inputs. Brainstorming is very important. The second step is to initially implement the solutions. Each member has its own ideas and contribution to explore alternatives through brainstorming if problem exist for it is best to work as a theme. Third step is objective assessment. In this stage, the theme will determine if the alternatives is successful or not. If not, other solutions and options to the underlying consequences must be ready. Choosing the best solution is the next step and secondary implement it. And finally implement the alternatives and monitoring the results and outcomes of the alternatives. This stage takes very long time.

Advantages of using the Model

The problem is done as a theme, brainstorming of each members to attain good alternatives is obtained. This approach is based on scientifically obtained data that helps in reduction of errors, assumptions and all causes of poor judgements. This approach also uses logic and a process and deliberating the possible consequences on the initial implementation of the alternatives to arrive a good and best outcome or final decision.

Disadvantages or limitations of using the model

This decision making process is unsuitable for quick – decisions. It requires a deliberation and a careful assessment of the alternative it takes time for this. It is used just for long-term decisions not for short term. It requires many information from the members. It also assumed an accurate, good knowledge of the alternatives and options.

A.2 Garbage can model

The structure, steps and focus of the model

The model takes place when there is a disorder and uncertainties inside the organization because of the absence of a ruler or government control, fast turnover of positions in an organization and there is an unclear understanding of technology. The members of the organizations are not clear in understanding of the processes or the preferences of the decision makers. Members most of the time are not involved in the decision making. Garbage can models focus on giving many solutions but oftentimes useless because there is no appropriate problems identified. Sometimes there are problems arise and the solutions made is fitting to the problem.

By resolution. I worked as a staff nurse in one of the private hospitals in our town. We have fast turnover of our chief nurse. The problems from the past chief nurse is still existing and endorsed it to the new chief nurse. The solutions made by the past is gradually implemented and waiting until the entire problem will be solved which is now passed to the present chief nurse. The problems and solutions made by the past is successfully solved even in the absence of the one who made the choices after period of working on them.

By Oversight, For instance, The New Chief Nurse is not well versed with the activities or the kind of work environment he is into. He assumes that the choice made by the past Chief Nurse has an attached problems so he made another choice in a minimum span of time and energy.

By flight.After having made the choices, the problems has not been solved because of the underlying problems attached to other choices. By flight, it delays the choices made by waiting until other problems attached to the choices solved by itself in time. If the problems leave the choice, it is the time to make the decision.

Advantages using the model

There is no brain storming with the members. It is applied for quick decisions in urgent situations because of the immediate leaving or absence of the (experienced) decision maker, ruler or the leader.

Disadvantages using the model

You can’t see the big picture of the problem and solutions if it will be successful or not. The lack of urgency in dealing with the situation is lost. The budget is limited. There is also a lack of coordination with other members. Conflict of interest arise.

B. Explanations of the processes involved in each of the following types of decision-making processes and the levels within a healthcare organization they can be used and its examples.

Structured decision

Structured decisions are decisions wherein solutions are already identified and established (programmed). The manager is already used in solving this problem because the task is routine. The knowledge of solving the problem is readily available. An example is hiring nurses in the healthcare facility. The manager already planned a solution to the problem of the facility.

Unstructured decisions

Unstructured decisions are decisions in case of emergent situation. The solution is not planned that makes the situation uncertain. It is a trial and error approach that needs an immediate solution and brainstorming trying to solve the problem in a very short time. An example is the outbreak of an unknown disease that cause an abrupt number of casualties in a healthcare facility or fire break and the manager makes a decision that is unplanned.

Strategic decisions

The concern is deciding the organization’s objectives and to meet its objectives by identifying sources and then attain policies and finally disposition of the resources.

In a Healthcare setting, one of its committees is responsible for the allocation of budget. In this stage, after structuring the facility’s fund strategic decision is applied. Assessing if the programme performs well with regards to structured decisions of reduction of the budget and staffs in the facility and providing other resources but maintaining its operations good performance. When objectives are met setting standards for operation will follow

Operational decisions

At this stage, the concern is on the effectiveness and efficiency of the specific task of employees according to the available resources, standards and scheduling of employees.

Example is the monitoring of the operations activities daily.