health care management project presentation .pptx

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1. Evaluation of Public Sector Health Care Management and Patients' Satisfaction: A Case Study of LAKKI MARWAT (KPK) and MIAWALI (PUNJAB) Sub-Theme: Evaluation of Public and Private Sector Health Delivery System: Management, Financing, Infrastructure, Regulations, Medical Facilities, and Affordability RASTA ID # 05-184 Theme: HEALTHCARE MANAGEMENT & SERVICES

2. Team Composition Mr Asifullah Khan (Principal Investigator) Ph.D Fellow, Applied Economics Research Centre, AERC, University of Karachi. Pakistan Dr. Syed Ammad Ali(Advisor/Co-Principal Investigator) Assistant Professor, Applied Economics Research Centre, AERC, University of Karachi. Pakistan

3. Motivation of the Study The rising costs and increasing demand in healthcare are putting pressure on healthcare providers to prioritize productivity and quality. To meet these challenges, hospitals must optimize their resources and improve the quantity and quality of their services. The shortage of healthcare resources is more severe in developing nations, where poor health conditions hinder economic growth and well-being. As a result, hospitals in these countries must focus on utilizing their resources effectively and improving their operations to provide better care. Recent studies have emphasized the importance of enhancing efficiency and quality in hospitals to achieve crucial goals for hospital administrators. Efficiency in healthcare involves the careful and efficient utilization of resources to minimize waste and maximize the quality of output. According to Kirigia et al (2008)

4. Cont …. FULLY IMMUNIZED MALE FEMALE TOTAL Population PAKISTAN 70 71 70 207800000 PUNJAB 81 81 81 109990000 Khyber Pakhtunkhwa 68 69 69 35,501,964 MIANWALI 87 96 91 1543000 LAKKI MARWAT 41 48 43 902,138 Source: Data from Development Statistics (KPK, PUN) and PSLM (2019-20) Table 2: PERCENTAGE OF FULLY IMMUNIZED CHILDREN AGED 12-23 MONTHS: BASED ON RECORD

5. Problem Statement This study aims to address the limited understanding of the relationship between efficiency, quality, and patient satisfaction in healthcare services. While these variables are critical in determining the performance of health services, there has been a lack of research that integrates quality measures and efficiency while considering their impact on patient satisfaction. The study focuses on investigating the relationships between hospital efficiency, structural quality, and patient satisfaction in the districts of LAKKIMARWAT (KPK) and MIANWALI (PUNJAB), which present an interesting case as the two districts are nearly identical in socio-economic conditions, except for their different provinces.

6. Objectives of the Study: This study aims to investigate the following objectives: Compare the efficiency of healthcare services in the two neighbouring districts LAKKI MARWAT (KPK) and MIANWALI (PUNJAB) – Through DEA Patient satisfaction between these two districts . (Using PLS-SEM and Satisfaction Index) Compare the health department management system, decision making process and autonomy between two provinces i.e. Punjab and KPK (Through Key Informant Interviews such as medical superintendent, Doctors, Paramedic staff ) Compare the health department Financial management system, budgetary allocations between two provinces i.e. Punjab and KPK (Through Financial reports)

7. Significance of the study

8. Hypothesis / Research question The research questions include: What similarities or differences exist in the quality of healthcare services in the two districts of KPK and PUNJAB namely Lakki Marwat and Mianwali ? How do healthcare consumers in the two districts evaluate the quality of services in their respective district hospitals? What is the management hierarchy and decision making process among these two districts What are the major management conflicts What is the disbursement procedure and issues related to budgetary allocated funds

9. Methodology DATA ENVELOPMENT ANALYSIS (DEA) DEA is the most prevalent technique used to assess efficiency in the healthcare sector. DEA is a non-parametric method that employs linear programming to evaluate the relative efficiencies of Decision Making Units (DMUs) based on several inputs and outputs. INPUT OUTPUT Total number of Hospital Beds Bed utilization rate Number of specialist Physicians Total surgical operations Number of non-specialist Physicians Number of births   Total outpatient visits   Average facility inpatient days   Number of discharge

10. Health care Management System Key informant interviews will be conducted in each selected hospital and health care unit and district management (DHO) Healthcare Financial Management System Review of Budgetary allocation, utilization and public sector development programs(PSDP) related to health

11. Patient Satisfaction Index Patient Satisfaction will be measure through the questionnaire “P atient Satisfaction Questionnaire developed by the Rheumatism Research Unit at the University of Leeds ” This questionnaire comprises on 45 questions; which can be further divided into five dimensions A – General satisfaction B – Giving of information C – Empathy with the patient D – Technical quality and competence E – Attitude towards the patient F - Access and continuity An index will be generated through the responses of all likert scale (1-5 where 1 is strongly agree and 5 is strongly disagree) question, using the mean value of all questions.

12. Determinants of Patient Satisfaction The statistical relationship among the general satisfaction and various aspects of hospital performance will be examined through PLS-SEM. Giving of information Empathy with the patient Technical quality and competence Attitude towards the patient Access and continuity General satisfaction

13. There are some things about my care in the clinic which could be improved. General satisfaction I’m satisfied with the care I receive in the clinic. The care I receive in the clinic is just about perfect Breakup of outer model

14. The person I see in clinic takes an interest in my family Visiting the clinic is not a stressful occasion. I find it difficult to talk about things that concern me when I’m in the clinic. Empathy with the patient Visiting the clinic is not a stressful occasion. The person I see in clinic seems to know how it feels to have arthritis. The person I see in clinic has no interest in the effect my disease has on my family. I’m rarely asked which treatments I would prefer. The person I see in clinic doesn’t understand what its like to have arthritis. My feelings about my treatment are taken into consideration.

15. I feel that I’m in good hands when I come to the clinic The person I see in clinic sometimes appears uncertain about what they are doing. Technical quality and competence The person I see in clinic really knows what he/she is talking about. If I had a medical problem I feel sure it would be checked out when I came to the clinic. The person I see in the clinic is not as thorough as he/she should be. The person I see in clinic appears skilful at their job. I’ve no confidence in the person who is treating me. The person I see in clinic does not always talk sense.

16. No matter how long you have to wait in clinic, it’s worth it. I feel that I’m treated as a person rather than a disease. Attitude towards the patient I’m given as much time as I need for my consultation. Sometimes the person I see in clinic is too busy to spend enough time with me. I’m usually kept waiting a long time in the waiting area. They don’t seem to listen to anything I tell them during my consultation

17. There’s no one to get in touch with at the clinic if I have a problem. If I had a problem it would be difficult to get someone to speak to over the phone. Access and continuity It’s easy to get an appointment if I need to come back to the clinic. I hardly ever see the same person when I come for my appointment. If I had a problem with my arthritis I would find it easy to get advice over the phone. It’s hard to get an appointment if I need it quickly. I’m encouraged to contact the person I see in clinic if I have a problem with my arthritis. I see the same person nearly every time I come to clinic. I see the same person nearly every time I come to clinic. I’m usually kept waiting a long time in the waiting area.

18. Sample Technique and Data A purposive sample technique will be followed on the basis of available population information. The proposed sample size is . District/Tehsil Hospitals Population of Dispensaries BHUs Selected Sample size LakkiDistt: 5 19 30 5+4+6=15 Lakki 4 19 20 SeraiNaurang 1 10 MianwaliDistt . 5 22 42 5+5+8=18 IsaKhel 2 2 10 Mianwali 2 12 22 Piplan 1 8 10 SAMPLE PER POPULATION 10 QUESTIONARE PER POPULATION 20% FROM Dispensaries 20% FROM BHUs 33 Source: Data from Development Statitics (KPK, PUN) and PSLM 2019-20

19. This study will calculate the efficiency of the public health care system directly by quantifying the outcomes and indirectly by end user satisfaction. The results of data envelope analysis will identify which District hospitals are most efficient in terms of input/output ratio and the consumer survey will highlight the public satisfaction regarding the services of all big public hospitals situated in these districts. This public survey will also highlight the public problems which will be helpful for the policy makers. More specifically Policy Recommendation:

20. The study finding will highlight the relative performance of two districts working under different provincial managements. The results will be helpful to increase the performance of low performer The improved health facility will increase health, quality of life and human capital Policy makers can improve hospital management by removing managerial conflicts and hurdles The comparison of financial management system will identify which province has better financial management and what are the bottleneck related to finances Policy Recommendation: