Discuss and critique the two main planning methodologies (Population and Institutional) that can be used in developing a health services plan.
Institutional and Population-Based planning used in Developing Health Service Plan
Health service planning involves the procedures that evaluate the entire health needs of a population and determine the best way to meet the needs identified. The key goal of health service planning is to improve the quality of the health services of the targeted population with the adequate utilization of the available resources. The institutional based and population-based planning attains the goal following different approaches. In the population-based approach, the planner develops interventions after analyzing the risk factors and aspects affecting the present status of population health. On the other hand, the institutional-based planning aim at improving the provision of quality healthcare services by first establishing the current health status through the situation analysis (Day & Leggat, 2015). The institutional-based planning adopts the top-down approach whereas the population-based approach utilizes the bottom-up approach in attaining the planned objectives.
The main goal of any health service plan is to ensure that the services provided are following the needs of the population and makes efficient use of existing resources. Population-based planning, therefore, helps to achieve the above aims. The planning involves a methodical and mutual assessment of the needs of the population (Keller et al., 2004). It lays emphasis on the recognition of the prevailing health status, risk factors, as well as the determinants of the health problems of the population. More so, population-based planning is linked to output. The data used in population-based planning is mainly holistic (Studnicki, Berndt & Fisher, 2008). The needs of the population are assessed using surveys. Moreover, the interests of the community and the society are the key ingredients of the population-based planning.
The population-based planning meets the needs of the population fully. Population-based planning lays emphasis on different values that include equity, accessibility, quality, as well as effectiveness. According to Keller et al. (2004), the first step in a population-based planning involves a consideration of health needs of the society. The choice of the correct conditions and needs determine the attainment of the planned objectives. The health demands of the society should meet certain criteria. For example, the health problems must be encountered a big population and associated with a significant cost. The criteria allow the health care providers to identify unique subsets related to the condition (Studnicki, Berndt & Fisher, 2008). Once the medical condition is selected, the next step is usually to spot the patients who have the condition and require the health care service. In this case, a target population is defined with factors such as age and gender among others.
To identify the patients with the chosen condition, the method could use questionnaires filled out by the targeted population. Once the patients with the condition are identified, the planner selects the outcomes linked to the guidelines. The chosen outcomes determine the success of the population based plan (Keller et al., 2004). Besides, the reasonableness of the outcomes is determined by variables such as the targeted condition as well as the amount of effort that can be expended. The final step in the population-based planning involves the adoption of a system that can be regularly used to measure and improve the chosen outcomes. The approach in population-based planning needs both the authority and the ability of the planners if the cross-boundary cooperation is to be achieved.
One of the greatest strengths of population-based planning is that it is based on a social determinants health model. In that case, the needs of the community are addressed without bias. As provided by Turnok (2015), the cost of healthcare has been on the increase over the years, and the available resources for health care have become limited. The need for addressing the health needs of the community has hence become vital. Also, the expectations that the members of the community have increases the concerns for the quality of the services provided to them. The population-based planning in the health service comes to address such issues. This method uses both qualitative and quantitative to identify the health issues addressing a population. Such activity allows achievement of better results. Moreover, it relies on sufficient evidence provided in the literature to decide on the best strategy to address an issue. Such evidence gives a direction to the general health planning.
According to the World Health Organization (2013), the health inequities are attributed to the social determinants of health. Again, it is difficult to assess the health status and risk levels of a population correctly. Also, the population-based planning is only successful when the health sectors collaborate. The method can take a long period to complete and can be slowed down by politics. Therefore, the planners have to counter the problem of conflicts between coherent planning and the political realities. Population-based planning also faces financial constraints as it lays prominence on preventative health presenting major challenges in fund allocation.
Institutional-based planning follows a top-down approach to solving health issues. The planning mostly focuses on a single organization or groups of organizations that aim to maximize their profits from the resources that have been invested (Thomas, 2003). Moreover, the planning lays emphasis on the degree to which an impact is made on the actual and the potential receivers of the services. This method does not consider those people who are not covered by the services. There is a limitation to the services received by the overall population. Most of the health organizations rely on institutional-based planning to promote efficiency and reduce the related cost.
The planning aims at the provision of services rather than the needs of a given population (On, Bennett & Whittaker, 2012). Through the application and understanding of the information regarding the provision of current services, the needs of a population are identified. In the development of a service plan, output data acts as a major source of information. Besides, normative planning guidelines are used. In institutionally based planning the beginning step is usually to conduct a situational analysis of the targeted population. The key goal of the step is to understand the service environment and the population at large. Certain procedures must be followed to plan effectively.
On, Bennett and Whittaker (2012) states that the first step involves scanning the environment. Both the external and internal environmental factors need to be scanned. The planner addresses the effect of the external environmental factors such as national and state policies. More so, the planner analyzes the predicted competition from other stakeholders in the health sector. The health institutions also consider the market available for the services the institution plans to provide the services. Nevertheless, internal environmental factors that could affect the success of the planning must be addressed. For instance, the ability to satisfy both the current and future health needs of the population is an important factor to consider. Also, evaluation of the efficiency of the provided services is vital. In that case, the planners should look for performance indicators in the process of the planning.
Once the environment has been scanned, the next step in institutional-based planning is to understand the geographic catchment. First, the availability and the cost of the public transport to ensure that access to the health facilities are considered. Also, the degree of remoteness of the areas that are nearest to the major cities should be put into consideration (Koontz & Koehler, 2011). Besides, communication and the different channels of communication is an important factor to consider.
With adequate information about the geographic catchment, then the assessment of the population profile can be done. One vital factor in profiling the population is demography. In this case, factors such as the size of the population, composition, housing, and education standards are considered. Also, social factors and health conducts such as alcohol consumption, smoking, and obesity rates should be addressed. The planners should address the relationship between the social factors and similar catchment areas to identify any variation and the reason for the variation.
The other step in the planning involves profiling the health status of the population. The planners address the mortality rate of the then population. Thereafter, a comparison is made between the trends in morbidity rate of the targeted population with that of the overall state or nation.
Next, the planner describes the current service arrangements. The issues to address in this case are private and public bed numbers, occupancy levels, the average length of stay per group, and the number of surgical operations among others (Eagar, Garrett & Lin, 2001). Also, the type of community services and the occasions of such services should be considered. With the completion of the above procedures, the final step is to perform service utilization and projections. With that, the planner will attain the aims and objectives of the planning process.
The use of the institutional-based planning makes it possible to anticipate the future demand for the hospital services based on the current usage as well as the standards of care. The use of the current data and structure enables the institutions to plan for the future at a low cost. Also, a link between the future medical problems is easily made by considering the current facts (In Ferguson, 2014). It is easy to predict conditions from the known to the unknown. The hospitals improve the quality of services by reviewing the status of the services they offer. The hospitals can effectively predict their costs and have the ability to motivate their employees effectively. Also, the information on the occupancy rates in a hospital helps to plan effectively for the future of the hospital. Besides, consideration of the appropriate standards during the planning ensures quality and equity on the services delivery. More so, the standards enable the planners to calculate the number of beds required by a particular hospital. Institutional-based planning allows for the best use of the available resources and plays a vital role in planning for the requirements of staff.
The institutional-based planning does not address the health problems adequately. The needs of the populations are predicted from the current health services conditions and only focus on a small percentage of the population. There is the assumption that clinical practice remains the same. The health sector is dynamic, and the clinical practice keeps on changing as time moves. In the health sector, new dynamics arises which emerge with new challenges. Ozcan (2008) observed that new medical challenges emerge daily, and the managers and the health workers have to plan continuously. In fact, the medical problems become complicated daily, and new approaches have to be adopted. Also, the assumption that the health of the population does not change is false. Health factors of the population change almost on a daily basis. Further, the rate of private health insurance does not remain the same as is assumed by the planners.
The institutional-based planning and population-based planning aim for the same goal of attaining the well-being of the society. The population-based planning proves to be more expensive but adequate in covering the needs of the society. It is a fact that the medical personnel should collaborate with the members of the society to improve their health care. The health professions should meet the health needs of the society.
The institutional-based planning addresses the quality of the services provided by the respective institutions. It does not have a major concern for the society. It is difficult to understand the actual problems facing the people in the society. Thus, the institutional-based planning partially solves the needs of the community.
The populations-based planning is preferred despite being costly than the institutional-based planning. The aim of the planning is to solve the health needs fully. It is difficult to solve the health needs of the society without adequate consultation. The members of the populations adequately understand the difficulties they face. Health professions interpret the problems and solve them in a professional approach.
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