Improving Health Service Provision
Health Service Provision, either personal health care or public health interventions, is at the core of the health system mission. It is the providers who are at the front-line in serving patients and users of the system. A health system s is only as good in providing health care and public health intervention s as its providers are.
 
In CHD we analyze, work, and provide advice on three critical aspects of health service provision: strengthening the capabilities of the holding of providers (H) (the function to manage and oversee the provider networks); strengthening the support management capabilities (PCC) ; and strengthening the clinical management capabilities and systems (C).  We do so for individual large providers, for Primary Care networks (P), and for large integrated in-patient and outpatient provider networks, public and private.
 
International experience has shown that health system transformation efforts cannot be successful in the absence of adjusting and strengthening provider capacity and capabilities. Reforms of provider payment mechanisms (e.g. towards output and result based funding) must address the changes in management systems, capabilities, and decision rights of providers to be successful. Entitle reforms, such as guaranteed health benefits or universal coverage, require both, changes in providers and in incentive framework for quality, efficiency, and responsiveness.
 
In CHD we work and provide advice on key design options and implementation strategies addressing all three of these service provision areas.​

Provider Holding Management

Managing providers as a collaborative and complementing network substantially contributes to improve effectiveness, efficiency, and responsiveness in health care. Similarly, public health interventions providers do require coordination to ensure full population coverage.

The Holding of Providers function (or network leadership function) needs to be able to facilitate the work of individual providers (professionals, primary care, in-patient, diagnostic facilities) in a way that optimizes access and cost/effectiveness of services available. It needs to have the capabilities and capacity to perform well in at least three key areas:
  • Monitoring access and quality and plan accordingly the service supply capacity and investments (CAPEX) in line with the demands of the population and the strategic purchaser demand (funding).
  • Optimize the provider network operation (facilitate the standardization of processes and systems for referrals and counter-referrals; plan for geographical location of hospitals and PHC facilities).
  • Provide technical support to individual providers in all areas (e.g. CAPEX management, training, capability development) that, given economies of scale, are more efficiently located at a holding level for all providers rather than for each individual provider to attempt to develop them themselves.

CHD works and provides advice on developing and strengthening provider holding capacities and capabilities.

Individual Provider Management

Improving effectiveness and efficiency of providers requires that the overall management of all support and back-office systems of the provider is optimal (admin, IT, HR, supply chain, etc). Among all the management and support functions, we at CHD provide support and advice in three critical areas:
  • Strategic Financing, the capacity of the provider to respond effectively and sustainably to the contractual arrangements and the provider payment mechanisms defined and/or negotiated with the strategic purchaser or funder. 
  • Plan and implement the managerial aspects of transitions from fee-for-service (traditionally in private sector settings) or historical / inputs budgets (traditionally in public sector settings) to output-based, results-based, or performance-based payment mechanisms. This also requires substantial changes to clinical operations.
  • Efficient supply management and procurement and acquisitions management of inputs such as pharmaceuticals, medical devices, and medical equipment.

Clinical
​Operations

The ultimate objective of health system service provision is to deliver the clinical service required by the patient based on sound clinical evidence, on time, and with the best cost / effectiveness possible.

To achieve this objective, providers need to achieve three objectives: a) provider clinical services are based on best available evidence organized in clinical programs and protocols that reflect that knowledge and agreed protocols that are updated periodically; b) organize the sequence of procedures and interventions provided to a patient (e.g. pre-hospitalization laboratory; in-patient diagnostic procedures; schedule surgery, etc) and manage them in a cost/effective and timely manner along a value chain for clinical treatment); c) continually monitor and evaluate the quality and cost/effectiveness of care, this is, how the protocol and the value chain performs for all patients and make adjustments for better outcomes. The process of managing these three aspects of health care provision by providers is known as clinical operations. 

Excelling at clinical operations not only maximizes best care possible for patients but, when clinical and managerial teams work together, it improves overall performance of the provider in responding to the quality and efficiency incentives set by increasingly demanding provider payment mechanisms such as DRGs and care bundles. 

​CHD collaborates with global partners working in the field of clinical operations improvements to support and provide advice in this field