Abstract

Research topicTo Determine the Decentralization effect on health care facilities at tertiary care hospitals in Pakistan.Submitted to: Dr. Imran AshrifSubmitted by: Muhammad Najam Malik (pharmacists)CMS NO. 403312To Determine the Decentralization effect on health care facilities at tertiary care hospitals in Pakistan.Abstract This study is conducted to know the impact of the Decentralizing system on health care facilities at tertiary care hospitals in Pakistan. The objective of the study is to explore the decentralize authority effects on health care facilities in hospitals. It is a qualitative study and is used to interview medical officers at tertiary care hospitals, Jinnah hospital, Lahore and service hospitals Lahore. The convenient sampling technique is used to collect information from medicals officers. All doctors are agreed that decentralize authority is helpful to improve health care facilities and performance of medical officers at tertiary care hospitals.Introduction The transfer of authority, dispersal of power, planning management and decision making from a higher level to lower level (Mills, 1990). Pakistan is the highly populated country in south-Asia. Health care facilities are limited to tertiary care hospitals. Tertiary care hospitals are also known as teaching hospitals. These hospitals provide every type of facility to patients. Such hospitals have physicians, nurses, pharmacists, and administrative employees. There are many reasons that these hospitals are not providing adequate health facilities to patients. Tertiary care hospitals have central authority system in Pakistan.Historically, centralized authority system was common in hospital and large organizations. But, today the trend has been changed, many medical officers believe that decisions need to make those individuals closest to the problems. (Robbin, 2009)Centralization is a complex process in the hospital. When a medial super dent (MS of the hospital) has not good decision-making authority and has no idea of effective and efficient management. In such circumstances, medical officers do not perform well. Because, they have not decision making authority and has not the idea of strategic planning, organizing, leading and controlling. There is not a proper way of accountability of medical officers. Therefore, patients do not get the best health-care facilities from tertiary care hospitals. Decentralization is an administrative power and is becoming an increasingly prevalent component of health sector reforms in all parts of world. This transfer of power from the center is after combined with an effort to reform in structure. Decentralization is necessary for human resource planning, training, and management. Human resource is an important component of a health system and preventative health information is key to better health for a nation (Decentralization and human resource, World Health Organization (WHO). It is important to understand there is the correlation between the performance of medical officers and decision making authority at a lower level. If a medical officer has decision making authority, then he can easily manage the situation and provides the best facilities to patients in hospitals. Medical super ident (MS) of tertiary care hospitals have centralized authority in our country. He always develops resistance, if any medical officer wants to decentralize authority at the lower level.Research objective To Determine the Decentralization effect on the health care facilities at tertiary care hospitals in Pakistan. Research QuestionsQ. No. 1 How decentralized system effects on health care facilities at tertiary-care hospitals? Q. No 2 What are the outcome of these effects on our public? Q. NO 3 Does the performance of medical offices effect on healthcare facilities at tertiary care hospitals.Problem StatementThe researcher identify the gap that decentralization has effected on health care facilities at hospitals. Decentralization is a complex process and is becoming dominated at hospitals. Because, the authority is transferred at lower level. Pakistan is highly populated country and health care facilities are limited .Therefore, such strategies are used to improve health care facilities. Such as to improve interpersonal skills of medical officers and provide training programs for medicals officers, nurses, pharmacists.3819525460375Training programs of medical officersTraining programs of medical officersResearch Model4238625358140 (Moderating Variable)2552700262890 Interpersonal Skills of medical Officers Officerofficers 0 Interpersonal Skills of medical Officers Officerofficers 4781550399415Improve health care facilities at hospital00Improve health care facilities at hospital-85725458470Decentralization effect 00Decentralization effect 39528751333501647825161925 (Independent Variable) (Mediating Variable) (Dependent Variable) 2895600294640 HypothesesDecentralization process will improve health care facilities at tertiary care hospitals.Interpersonal skills of medical officers, nurses and pharmacists will improve health care facilities at hospitals.Training programs of medical officers, nurses and pharmacists will improve health care facilities at hospitals.Literature Review The literature review-indicates decision-making authority (centralized system) is changed through planned change. The planned changed is described through many models, but the best models are Lewin and Kotter models.Lewin model theory is also called force field theory. In this theory, take a view of the present situation or status queue. Medical superintendent (MS) is not interested in decentralized authority to lower level medical officer. This is a un-freeze condition of health care organization. He shows high resistance against it. In this case, a driving force is lesser than learning force (resistance force). When the political system is intervened, then the un-freeze status is changed into move condition.A political system consists of powerful people who build a new coalition with new guiding principles. These people have a new vision. Political people have effected on health administration and medical superintendent (MS) of Hospital. Now, political people, medical superintendent (MS) and medical officers of tertiary care hospitals discuss various aspects of decentralized authority. They develop new vision and strategies for improving health care facilities. 128905390193Identify the problem, decentralized authority of medical officers at lower level00Identify the problem, decentralized authority of medical officers at lower level2852420747698013335066040Develop different planning and strategies to the decentralized authority of medical officers for improving health care facilities at tertiary care hospitalsT 00Develop different planning and strategies to the decentralized authority of medical officers for improving health care facilities at tertiary care hospitalsT 2852420205105013335055880Select the best strategy after a long discussion with the medical superintendent (MS): medical officers and political people00Select the best strategy after a long discussion with the medical superintendent (MS): medical officers and political people28524208542680133350207646Implement the strategy for achieving the required result00Implement the strategy for achieving the required result128767422910Evaluate the performance of medical officers after decentralized authority at lllthellohospital00Evaluate the performance of medical officers after decentralized authority at lllthellohospital128270622300It is observed that the best health care facilities are available at tertiary care hospitals00It is observed that the best health care facilities are available at tertiary care hospitals28524202546350A data of six months is collected from hospitals after decentralized Found that medical officers show the best performance because, they can do anything for improving health care facilities for patients, this stage is called move state.It is important to continuously monitor health care Facilities for patients and performance of medical officers. Medical superintendent; medical officers and political people are continuing to arrange a meeting after 3-months and discuss the medical facilities are provided to patients. But, after one year, they do not arrange the meeting for discussing the health care Facilities. So, the moving stage is converted into a refreeze stage. Because the health facilities are not adequately and performance of medical officer are decreased.2991264362226Unfreeze2981325185806MoveRefreezeThe literal review is also discussed under the Kotter model. The research problem is also solved by using the Kotter model. 1. Establish a sense of urgency: There is a need to develop a sense of feel, how to improve health care facilities at the tertiary hospital.2. Create a new coalition: To develop a new coalition which is consist of medical officers; MS hospital and administration.3. Develop a vision and strategy: The new team develops new vision and strategies. Then select the best st5rategy after a long discussion. Communicate change vision: It is the responsibility of the team to well communicate others medical officers and member of administrations about the vision and selection of strategy which would help to improve its health care fiaciliti8es at hospitals. Empower medical officers: To give the authority to medical officers who are performing work at wards of hospitals. Evaluate the performance of medical offices: After the implementation of the new strategy, the performance of medic la officers are improving. As a result of this health care facilities are improved at hospitals.Consolidate: Team members have also consolidated the more change and decentralized the authority. So maximum health care facilities are available at hospitals. Methodology 1. Study setting: The study is conducted at tertiary care hospitals (service and Jinnah Hospitals. Lahore) 2. Study design: It is a qualitative study. Qualitative study deals with in-depth information on human behavior and analyze human behavior and give a result.Sample technique: Convenient sampling technique is used to collect information. The non-probability sampling method is used.Sample Size: Medical officers are selected from Service Hospital, Lahore. These Medical officers are selected from Jinnah Hospital, Lahore. These medical officers are pick-up by lottery method. Date Collection: Date will be collected from the study participants with help of open-ended questionnaire-based interview by the research Data collection tool comprised of a questionnaire consist of 12 open-end questions. In open-ended questions leave the respondent free to give any answer regarding the topic.Data Analysis: Analysis of data would be done by using the matric analysis. First of all questionnaire-based data would be collected from each medical officer and have to overview it. The data collected by the researcher then evaluate the performance of medical officers and health care facilities to patients after decentralized authority.Result / DiscussionThe researchers would be taken questionnaire-based interview from 20 medical officer Service and Jinnah Hospitals before centralized authority and after the decentralized authority of hospital administration.After analyzing the data. It would be found that all medical officers would be agreed when the power is decentralized. It gives opportunities to them to show their performance it is also observed that health care facilities are improved at tertiary hospitals. The researchers would take different interview from patients who admitted in hospitals most the patients would be satisfied with the facilities and performance of medical officers. Medical officers also doing hard work to show their performance. Conclusion: From the research problem, it would be clearly understood when the centralized authority of MS Hospital, medical officer are not performing well. Because they cannot develop any SOP for better health care facilities. They cannot take any decision under an emergency condition. When the power would be decentralized. Every medical officer will be showing their best performance and develop the goodwill of the health care organization. Patients would also satisfied with the health care facilities provided by MO.Reference: Lamb and Cox, 1999Lewin, 1951Schein, 1982Koshy and waterman, 2010Lippitt,1968Kotter:2010Jelinek, 1993Lukas, 2007Tobin and J. Wells, 1999Bingham, 2010Martin and G.Gills,2005Davies and N. Edward,2010Scott and R. Davies,20003