By Hatim Jaber MD MPH JBCM PhD 15 + 17 - 04 - 2019

1. Faculty of Medicine Health Economics and Policies (31505391)Human resources in Healthcare delivery By HatimJaber MD MPH JBCM PhD 15 + 17 - 04 - 2019

2. Week 12 • Human Resource and Management • Regulations of health care delivery physicians, • The Supply of Physician and other Health Professional Services: Workforce Dynamics • The Physicians Services Market • Do physicians make too much money? • Do market forces shape physician incomes? • Role of the market in analyzing workforce shortages. • Projections of the physician market.

3. Course Content 31505391 Post Midterm • Week 9Measurement and evaluation in health care. Goods, Market Failures, and Cost-Benefit Analysis. • Week 10Economic evaluation. Economics and efficiency cost analysis and cost effectiveness. • Week 11 ……………………………………………………… • Week 12Human resources in Healthcare delivery. 15-4 11:00 am GUEST LECTURE 17-4 8:00 am GUEST LECTURE • Week 13 Quality Improvements in healthcare delivery Methods to improve health care delivery. Economic effects of Bad habits including smoking and alcohol consumption • Week 14 Health Markets and Regulation and Economic regulation of health markets. • Week 15-16 Final assessment (Exams.) //-5-2019

4. Presentation outline15+17 - 4- 2019

5. Building Blocks of the Health System (WHO)

6. Healthcare as Service Sector • Healthcare more than any other sector depends on people to carry out its mission • Human Resources-HR- accounts for a high proportion of budgets assigned to the health sector • Globally > 35 million persons are employed in health sector (ILO) • The economic and human costs of poor HR are high in the health sector • Health services mission, strategic plans and quality improvement initiatives are useless unless there is appropriate policies and procedures for managing people • Health care key stakeholders are people and despite changes in the way care is provided people are always central in the provision of care whether the care is preventive, promotive, diagnostic, curative, chronic or rehabilitative

7. Types of Healthcare Organizations • Physician Offices and Clinics • Hospitals • Nursing and Personal-Care Facilities • Home Care • Health and Allied Services • Medical and Dental Laboratories • Offices and Clinics of Other Health Practitioners • Dentist’s Offices and Clinics

8. Healthcare-Science or Art • The Science of Healthcare That is achieving and delivering high quality health care products and services through use of scientific and innovative technology • The Art of Healthcare: Managing the human beings who provide the services and improve the products

9. Challenge for health systems • Physical Infrastructure • Governance • Financing • Human Resources (Work Force)

10. Healthcare Service Delivery InputOutcome Health Systems Human Resource Well being Healthcare Employees Patients Equipment / Technology Customer Satisfaction Drugs

11. Determinants of Healthcare Success Healthcare Customers Internal Customer (Employees) External Customer (Patients) Patient satisfaction Employee Satisfaction Organizational Success

12. What is Human Resource (HR) Management? The strategies, tactics, plans, and programs that healthcare organizations utilize to accomplish the work of the organization through its employees.

13. Human Resource Management at Work • What Is Human Resource Management (HRM)? • The process of acquiring, training, appraising, and compensating employees, and of attending to their labor relations, health and safety, and fairness concerns. • Organization • People with formally assigned roles who work together to achieve the organization’s goals. • Manager • The person responsible for accomplishing the organization’s goals, and who does so by managing the efforts of the organization’s people.

14. Key Initiatives of HR Management • Workforce Planning • Staffing and Selection • Compensation and Benefits • Employee and Labor Relations • Government Compliance • Training and Development • Health, Safety and Security

15. Human Resource Planning • HR Planning includes all activities managers do to forecast current and future HR needs. • Must be done prior to recruitment and selection • Demand forecasts made by managers estimate the number & qualifications the firm will need. • Supply forecasts estimate the availability and qualifications of current workers and those in the labor market.

16. The HR Function in Healthcare HR Management is becoming an equal contributor to other organizational areas: • Need to provide more efficient and effective HR services • Greater need for human resource training, skills, understanding, and competency • As challenges and complexities of healthcare HR management has grown, healthcare managers are requiring more strategic support from their HR departments

17. HR Management Activities

18. Characteristics of HR activities in the health sector • The Intersectoral nature of Health Services • The time-lag between decision making and outcome • Strong Professional Dominance • Interdependence of the different professional categories • The role of the state as the principal employer • The high proportion of the women employed in health services (Thai study) • The ambiguity of the relationship b/w health needs, service requirements and resource needs in the supply of these services • Deficiencies of the market

19. Acquisition Training Fairness Human Resource Management (HRM) Appraisal Health and Safety Labor Relations Compensation Human Resource Management Processes

20. Human Resource Management Human Resource Management includes all activities used to attract & retain employees and to ensure they perform at a high level in meeting organizational goals. These activities are made up of 1. Recruitment & selection. 2. Training and development. 3. Performance appraisal and feedback. 4. Pay and benefits. 5. Labor relations.

21. HRM Components • Component should be consistent with the others, organization structure, and strategy. • Recruitment:develop a pool of qualified applicants. Selection: determine relative qualifications & potential for a job. • Training & Development:ongoing process to develop worker’s abilities and skills. • Performance appraisal & feedback:provides information about how to train, motivate, and reward workers. Managers can evaluate and then give feedback to enhance worker performance.

22. HRM Components 4.Pay and Benefits:high performing employees should be rewarded with raises, bonuses. • Increased pay provides additional incentive. • Benefits, such as health insurance, reward membership in firm. 5.Labor relations:managers need an effective relationship with labor unions that represent workers. • Unions help establish pay, and working conditions. If management moves to a decentralized structure, HRM should be adjusted as well.

23. Recruitment • External recruiting:managers look outside the firm for people who have not worked at the firm before. • Managers advertise in newspapers, hold open houses, recruit at universities, and on the Internet. • External recruitment is difficult since many new jobs have specific skill needs. • A multi-prong approach to external recruiting works best. • Internal Recruiting: positions filled within the firm. • Internal recruiting has several benefits: • Workers know the firm’s culture, may not have new ideas. • Managers likely already know the candidates. • Internal advancement can motivate employees.

24. HRM Planning: Outsourcing • Outsourcing:managers can decide to contract with outside workers rather than hiring them. • Outsourcing is more flexible for the firm. • Outsourcing often provides human capital at a lower cost. • Outsource problems:managers lose control over output. • Outsource contractors are not committed to the firm. • Unions typically are against outsourcing that has potential to eliminate member’s jobs.

25. HR Challenges in Healthcare Recruitment and Retention • A growing number of healthcare professionals are retiring • An increasing number of aging baby boomers requiring care • Fewer younger people are choosing the profession: • Shift in view of profession from high tech to low tech • Shift from a secure & prestigious profession to chaotic & unstable • Many more employment options for women to choose from • Healthcare workers have less connection with patients due to shift to shorter-stay hospital systems • Shift from mass-production society to information society makes the 24/7 schedule demands less attractive

26. HR Challenges in Healthcare Managing Change There are many changes happening in healthcare: • Organizational Consolidation • Declining margins affected by lower reimbursements • Technological advances • Consumers demanding improvement in clinical performance • Environmental forces • Market forces

27. HR Challenges in Healthcare Managing Change Key issues for HR Management include: • Doing more with less • Compliance with quality standards • Implementing diversity planning and culturally competent care • Preparing healthcare workers for new technologies • Balancing professional and personal lives • Succession planning

28. Policy Issues • Link between effectiveness of health workforce and improved performance of health system • Nature of Health workforce Size, composition, skills, training needs, current functions and performance, appropriate roles, adaptation to changing priorities • Lack of data for evidence • Evidence on the effectiveness of HR training • Framework for assisting countries for HR planning and development

29. Insufficient Human Capacity In many developing countries there is insufficient human capacity to make use of the newly available resources New Opportunities are due to: • Scientific Advances (Vaccines…) • Infusion of new money • New drugs • Without a motivated, competent, well distributed and well supported workforce • Waste/Misuse of resources

30. Dimensions of HRH performance • Coverage: the extent to which the allocation of the workforce corresponds to needed services in terms of type of services and geographical access • Productivity: the ratio of outputs relative to inputs • Technical quality: the extent to which services have a positive impact on health status • Sociocultural quality: the extent to which services are acceptable to users and meet their expectations • Organization stability: the use of the workforce so as to guarantee the viability of services and their capacity to adapt to changing needs

31. Workforce Imbalances Imbalances between HR management practices and national policy objectives. Ex: Where Health Policies aim at developing PH Care while training programs continue to prioritize the training of specialized doctors • Mismatches of numbers:Shortages/surpluses • Qualitative disparity:resulting from gaps between the training programs and the requirements of the country’s health policy • Unequal distribution of workforce: b/w Geographical areas, professions and categories, health establishments and specialties

32. Changes Cost Reduction Improvement in Performance Improvement of Equity of access to services Decentralization of services Changes in the health model Implications for WF Staff planning, Staff distribution, Working conditions Incentive System, Work organization, Professional Development Process, Training Deployment of personnel, Methods of recruiting and retaining staff Transfer of authority, Skills needed Redefinition of professional roles, Integration of services Challenge of Health Sector Reform on HR

33. Current Research Studies Patient Satisfaction Employee Satisfaction in Healthcare • Areas • Department level • Emergency Room • Overall Hospital facilities Areas • Physician satisfaction • Nursing cadre satisfaction Key Recommendations include Satisfaction in caring for patients Less complaints from customers Key Recommendations include Change in Employee behaviour / skill/ attitude

34. Hypothesis Salary Food service Empathy Employee Satisfaction Patient Satisfaction ? Empowerment Relationship with colleagues Hospital cleanliness • Implications for healthcare • Retention of employees • Improvement of patient care

35. National Human Resources for Health (HRH) Strategy in Jordan

36. National HRH Strategy – Vision and Mission Vision To have adequate, competent, and responsive health workforce to maximize the performance of the health system in Jordan towards UHC and SDGs. Mission To strengthen all functions of HRH (governance, policy, partnership, management, education, production, development, and planning) for better health services.

37. Main HRH Challenges • Absence of a national HRH strategy. • Centralized HRH decisions in the public sector. • Brain drain of HRH. • Variation of HRH wages and incentives between private and public sectors. • In equitable distribution of health workforce among geographical areas, gender imbalance, skill mix and shortage of them in remote areas. • Inefficient contribution of the HHC in the national education policy. • Absence of continuous professional development system (CPD). • Weak HRH information system.

38. Key findings of the HRH Annual Report, 2016

39. Distribution of health workforce in the public sector by category, 2016

40. Health workforce in the Private Sector, 2016

41. عدد الأطباء/10000 نسمة لعام 2017 الترتيب السابع في الاقليم 2010 26.5 2017 22 حسب الدخل للبلد

42. Distribution of National Health Workforce by category in Jordan, 2016

43. Distribution of National Health workforce by Sector, 2016

44. Ratio of physicians per 10000 population by governorate, 2016

45. Ratio of dentists per 10000 population by governorate, 2016

46. Ratio of Pharmacists per 10000 population by governorate, 2016

47. Ratio of Registered Nurses per 10000 population by governorate, 2016

48. Ratio of Midwives per 10000 population by governorate, 2016

49. Graduates and Enrollees from Dentistry Faculties by gender, 2016 Graduates: 450 Enrollees: 2802 49

50. Recommendations • Improved HRH data production and utilization for decision making • Improve health workforce distribution all over the kingdom • Ensure adequate health workforce production to respond to growing population needs