Integration in health system
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Conceptualization of Functional Integration in Health system
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Integration in health system
- 1. Education as an Integrated Function in Ministry of Health and Medical Education Dr. Shahram Yazdani
- 2. Over the past two decades, significant steps were taken to improve the quality of health care delivery in Iran. One major step was the stepwise integration of medical education into health services.
- 3. Early Years after Islamic Revolution In early years after Islamic revolution, the need for greater medical workforce was critically felt because in some area there was only one physician per 18,000 population, and that was why foreign doctors were on the ground to render medical services. In addition, medical students were trained in specialized hospitals with no affiliation to the health care ministry and society.
- 4. The 1985 Reform In 1985 The Parliament of the I.R.Iran approved of the law integrating medical and health education with the health services forming the Ministry of Health and Medical Education Within this context, the main mission of the Ministry of Health, Treatment and Medical Education, set out in 1985, has been to upgrade the quality of the health care system of the country in the areas of health, treatment, education and research.
- 5. The 1985 Reform In terms of health, the aim was to improve the overall health index. In terms of education, the aim was to have an increase in medical and paramedical student enrolment in the universities to provide the necessary health manpower. It also included the revision of the curriculum of undergraduate and postgraduate courses, based on community needs. In terms of treatment, there had to be an upgrade in the quality of medical care services as well as a better distribution of medical services over the country.
- 6. The 1993 Reform In 1993 The Supreme Council of Government Administration declared the integration of all Provincial Health Organizations into the Universities of Medical Sciences present in the province and the outcome was the Province University of Medical Sciences and Health Services
- 7. The 1993 Reform In 1995 a ministerial decree approved that in each province the existing university of Medical Sciences take over all educational, research and health services activities
- 8. Objectives of Integration To improve the quality of community oriented medical education To improve the quality of health care services To decentralize To utilize the resources of the provinces for establishing new teaching bases To support newly established universities To increase the patient capacity of hospitals To unify management and decision-making. To expand research activities.
- 9. Organizational Changes In organizational terms the integration is expressed at the central level in the dual role of the Minister and then the existence of Deputy Ministers for both Education and University Affairs and Health. At the provincial level it is the role of the Chancellor of the Universities of Medical Sciences and Health Services to integrate the two functions.
- 10. Organizational Changes It should be said that in international terms, such functional integration is far from being common. Medical universities and faculties are usually under a formal relationship with the Ministry of Education but enjoy a special relationship with the government health services.
- 11. Universities of Medical Sciences and Health Services As an important point, Article 29 of the Constitution of the Islamic Republic of Iran emphasizes that every Iranian has the right to enjoy the highest attainable level of health. The Ministry of Health and Medical Education is mandated to fulfill this goal through designing and implementing a national-level health policy. Yet, the Ministry of Health and Medical Education delegates its implementation to medical universities across the country.
- 12. Universities of Medical Sciences and Health Services There is at least one medical university in every province. The president of a medical university is the highest health authority in the province who reports to the Minister of Health and Medical Education. The president of the medical university is in charge of public health, health care provision in public facilities, and medical education. Health care and public health services are provided through a nation-wide network
- 14. Functional Integration in Health System through Cross-boundary Process Management
- 15. Main Functions of Health System Provision Stewardship Finance Resource Creation
- 17. Sub-functions of Provision Provision Clinical Care Health Risk Factor Management Social Determinants of Health Stewardship Finance Resource Creation
- 19. Sub-functions of Resource Creation Provision Stewardship Finance Resource Creation Research Innovation & Industry Education
- 20. Different Levels for Each Sub-system Clinical Services Public Health Education Innovation Policy Policy Policy Policy Policy Administration Administration Administration Administration Administration Operation Operation Operation Operation Operation Research
- 21. Operation Operation Operation Operation Operation Administration Administration Administration Administration Administration Vertical Integration within Each Sub-system Clinical Services Public Health Education Innovation Policy Policy Policy Policy Policy Research Vertical Integration Policy Regulatory Standard Performance Monitoring Governing Levers Aligned Operation
- 22. Horizontal Integration Between Sub-systems Operation Administration Education Policy Horizontal Integration Communication Cooperation Coordination Collaboration Structural Integration Operation Administration Public Health Policy Operation Administration Policy Research Operation Administration Clinical Services Policy Operation Administration Innovation Policy
- 23. Horizontal Integration Between Sub-systems Horizontal Integration Operation Administration Education Policy Communication Cooperation Coordination Collaboration Structural Integration Operation Administration Public Health Policy Operation Administration Policy Research Operation Administration Clinical Services Policy Operation Administration Innovation Policy Throughout The Cross-organizational or Cross-boundary Processes
- 27. Project Steps Listing Main Processes in MOHME & UMS (more than 500 processes) Selecting Main Cross-organizational and Cross-boundary processes (more than 150 CO&CB Processes
- 28. Research Sub-system: CO&CB Process Feedback of health system to academy about research needs Involvement of health system in the process of research priority setting in academy Research on policies of health system in academy Research on management (administration) of health system in academy Funding of academic research by health system Joint research projects and corporate R&D by academy and health system Knowledge management (appraisal, synthesis and customization) by academy for health system usage Utilization of new academically generated knowledge by health system
- 29. Innovation & Industry Sub-system: CO&CB Process Role of academy in protecting intellectual property (e.g. patent office) Venture nurturing activities and units in academy (Searching for ideas that can be commercialized, creating fertile ground for spin-off activity, protecting the technology base, business coaching, and facility management) Science and technology parks, business parks University consultancy and contracting services Knowledge brokering in academy Knowledge purveyering in Academy Supply of scientific and technical services to third parties (business sector and public administration) Diffusion of information, knowledge and technology towards economic and public operators acting at the interface between suppliers and users. (Innovation centers and liaison units at universities) Technology Policy making (technology assessment offices) Diffusion of scientific culture through science museums, science centers
- 30. Education Sub-system: CO&CB Process Involvement of academy in community needs assessment Involvement of academy in workforce planning Involvement of academy in service gap analysis Defining and approving new educational programs according to community needs Community orientation (alignment of objectives and content with community needs) in academic educational programs Community based (authentic educational settings) in academic educational programs Continuous education of providers or producers by academy Continuous professional development of providers or producers by academy
- 31. Provision Sub-system: CO&CB Process Academy role in Setting standards and norms of services Academy role in Licensure and certification of providers Academy role in Distribution of workforce Academy role in Monitoring and control of service performance or quality Academy role in Coordination of services
- 32. Project Steps Listing Main Processes in MOHME & UMS (more than 500 processes) Selecting Main Cross-organizational and Cross-boundary processes (more than 150 CO&CB Processes Identifying main interventions to improve integrity of Cross-organizational and Cross-boundary processes (more than 300 interventions)