FALL 2019 | PM magazine
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BUILDING SUCCESSFUL URBAN HEALTHCARE SYSTEMS INFRASTRUCTURE In planning for healthcare urban communities with a 360-degree health systems in urban areas public and wellness impact. Comprehensive healthcare health and private healthcare systems not only guarantee access to affordable Program Deployment SME providers are addressing healthcare they so desperately need, urban, fulla growing heterogenous scope healthcare by their very nature educate Booz Allen Hamilton demographic, multiplicity of communities as to the importance of health mainlanguages, cultural practices, and ingrained health tenance and wellness habits. attitudes and practices. These challenges are then Following a 360-degree methodology and includcomplicated by uncertainty driven by the politics ing community concern and input the University of government support and subsidization of the of Maryland Medical Center conducted a healthsystem. Planning for urban healthcare systems care assessment centered on city of Baltimore. is then much more than simply property acqui“To complete a comprehensive assessment of sition, project planning and management, and a the needs of the community, the Association for quick transition to operations and maintenance. Community Health Improvement’s (ACHI) 9-step Any plan will have to consider that patients in the Community Health Assessment Process was urban environment must be considered up front as utilized as an organizing methodology. The UMMC stakeholders in every aspect of the planning cycle. Community Health Improvement Team (CHI Team) Urban healthcare systems must plan beyond the served as the lead team to conduct the Community curative cycle and include institutional outreach Health Needs Assessment (CHNA) with input from that encourage patient-stakeholders to become other University of Maryland Medical System Baltiactive in their own wellness. more City-based hospitals, community leaders, the » Urban health systems must respond to academic community, the public, health experts, rapid demographic, social and disease tran- and the Baltimore City Health Department.” (UMMC, sition while also contending with a plural- 2018) UMMC used a 9-step process (see Figure 1) ity of providers and a need to stimulate a to complete the community needs assessment. In multisectoral response to address the wider 2018 UMMC and for the first time all of the hospitals determinants of health. and healthcare centers in Baltimore collaborated in key data collection strategies to complete a joint » Rapid urbanization presents challenges community needs assessment. (UMMC, 2018) to traditional conceptualization of health systems.
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Second: build the healthcare clinics. The clinics can be built to provide specific levels of customized care for identified patients and their diseases. Each clinic will address the unique healthcare needs of the community.
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Third: staff the healthcare clinic infrastructure with a mix of paid and volunteer physicians, nurses and allied health services employees with a Direct Employment Vehicle (DEV) to cycle in prospective employees. Healthcare Systems designers should partner in institutions to ensure their graduates receive employment after receiving degrees or licensures.
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Fourth: replicate these clinics to the identified populations. These clinics can be managed by a Healthcare Systems Infrastructure team or company like the teams I have created at local, state, and federal government levels.
Rahman A. Parker
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Conceptualization of urban health system must consider multisector responses, engagement with a plurality of providers, the role of local governments and engagement of urban residents, particularly the poor.
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Data and evidence, and technological advances in e-health, can provide the glue to hold together this complex urban health system. (Elsey, Agyegong, Hugue, et. al., 2019)
Functional healthcare systems are built on the basic principle of service. The golden rule. We are a nation of laborers, innovators, and optimistic entrepreneurs. Our spirit of ingenuity is one of the distinct features that help us reach patient care goals. With that in mind, it is important to examine the effects of a healthcare system on an urban population. Well planned, implemented and managed urban healthcare systems have community appeal. Systems built to service the whole person, oriented towards cultural and social sensitivity provides
This type of quality care delivery to an infrastructure with inherent slippage can help reduce general service/treatment waiting times that come with an inherently unorganized Healthcare System. I believe that with strategic partnerships and great focus on quality care and proper infrastructure development, we can place a fundamentally sound healthcare system in our Urban areas and create a method of healthcare delivery to show as a first rate example for global public healthcare.
“Urban healthcare systems must plan beyond the curative cycle and include institutional outreach that encourage patient-stakeholders to become active in their own wellness.“
The Next Step – Infrastructure and Services Maintenance More often than not urban institutions falter once transitioned to operations and maintenance and suffer from infrastructure “slippage”. Slippage, for the purpose of this proposal, is defined as an unplanned gap in services causing deviation from complete health coverage. We are wise to examine the infrastructure “slippage” found in other Urban Healthcare Systems worldwide; such as the systems in Ghana, and Canada’s Health System (Health Canada); to help understand how to design a proper community-based care system that can heal an urban area. One method that will address the issue of slippage with focusing on smaller patient populations and customizing unique healthcare plans and programs to those in need with a four-phase (logic model) approach to infrastructure development. »
First: identify specific communities of patients and their diseases. With this approach, those affected by diabetes can go to diabetes clinics specialized to deliver quality care with health education focused on prevention and maintenance of a balanced food diet.
“Planning for urban healthcare systems is then much more than simply property acquisition, project planning and management, and a quick transition to operations and maintenance. “
References: Rethinking health systems in the context of urbanization: challenges from four rapidly urbanizing low-income and middle-income countries, 2019) Community Health Needs Assessment & Implementation Plan, Executive Summary FY2019-FY2021, 201
