بسم الله الرحمن الرحيم
This lecture is recorded from the morning section, and it contains two subjects (introduction and health care
services), I'm really sorry but it's really very boring lecture, I wrote most of the things the doctor said, and I
included the slides, but there were a lot of … "talk" (ْٚ ,,)دنٜ مرٞز تذُٗ ٍؼthe things that was mentioned during the
lecture, but not related to it, are in the first two pages, every Thing written in Arabic is exactly what the doctor said.
. - اّا اطَٜ اىذمر٘ر ػثذ اىذنٌٞ اىؼن٘ر – دمر٘راج صذح ػاٍح – قظٌ اىصذح اىؼاٍح اخرصاؽ صذح االً ٗاىطفو
) ٍ٘اصالخ ٍ٘ ٍ٘اصالخ اىظاػح 11:01 اىَذاضزج ٗتؼذ ٍا ٝف٘خNever, I don't care( - اىَزج اىجاٛ ىِ اطَخ الٛ طاىة ٝذخو تؼذٛ ّٖائٞا
.ٌاىذمر٘ر ٗال ٗادذ ٝف٘خ تؼذٓ خيْٞا ّرفإٌ ٍِ اىثذاٝح ٗ ّنُ٘ دثاٝة درٚ ٍا ّشػينٌ- اهلل ٝزضٚ ػيٞن
.- اّا اػجغ اىْقاع تؼنو مثٞز
- I encourage you to raise your hand and say your opinion about any thing you want.
- It's fair not to talk any word in Arabic.
.- اّا ٍذاضزذٜ طاػح ماٍيح
.ٌ- مو اىرؼارٝف اىَ٘ج٘دج ٍطي٘تح ٍؼن
)slides - اىَطي٘ب ٍْنٌ ٕ٘ (اىنراب او
. %00 Final 01% ٗاهTerm Paper ٗ %21 Second 12% ٗ اهFirst - اٍرذاُ اه
: - اىَ٘اضٞغ اىٜ تذّا ّاقؼٖا
1 - Introduction.
2 - Health services.
3 + 4 - Management and managers 1, 2.
5 - Planning.
6 + 7 - Strategic planning1, 2.
8 + 9 - Communication1, 2.
10 - Marketing.
11 - Motivation.
12 – Appraising and change.
** your term paper will be about these subjects, you have to find a problem that's present in any level of
the system of healthcare delivery in Jordan, in the ministry of health (MOH),for ex , which has a lot of
problems, too many problems, that can be solved from the point of view of administration, some time
there is no planning in the MOH, if we have planning in any institution it will be perfect, so if you find a
problem, and you will, you have to discuss it and solve it as an administrator, for example : you entered a
hospital and find a lot of client (ِٞ , )ٍزاجؼworkers, elderly or babies…etc, and you say this is wrong ,but
what is the solution, you look for the criteria for a successful health service :
- What the manager can do, the function of the manager and management in the system.
- What can the planning function do to improve the services.
- Strategic planning.
- Why they don't have communication between their staff for example: doctors together and doctors with
- they don't care a bout marketing, their image a round the hospital or the system, they don't care if it's
good or bad, so we can tell them that by marketing you can make your image better and you can recruit
more good professionals to work with you and so on…
- The motivation, the working staff is motivated to work or not.
- And finally, we have to appraise the workers (to evaluate the work).
** You have to use all this items in your term paper to look into the problem and its solution. 10 ػيٖٞا مٌ؟
** Each one of you is required to present a paper, you can't work in groups, I tried that before and you
failed, I promise to read all of them !! So if there is any similarity I will find out.
)** الّ٘ ٗادذ تؼرغو مو اىؼغو ٗاىثاقٜ قاػذِٝ ٕٗذا رح ٝنُ٘ ػثأ ػيٜ الّٜ تذٛ اقزأ مو ٗرقح ىذاه (!!!!؟؟
** Minimally 2-3 pages, collected after the second exam.
....**ٝا رٝد ٝنُ٘ فٜ ٍزجؼٞح ىيَؼنيح/ ٝؼْٜ ذذاٗه ذقاتو ّاص ٗذظأىٌٖ ٕو اىَؼنيح تررنزر ٗال أل
** You might get some of these problems from the internet, you might go to studies done by researchers on
the healthcare, I encourage you to go and look at some of the problems and there solutions.
.ٓ** ػيٚ فنزج ى٘ مينٌ جثر٘ىٜ ػيٚ ّفض اىَ٘ض٘ع ٍا ػْذٛ ٍاّغ تض اىطزح ٝنُ٘ ٍخريف/ ٝؼْٜ مو ٗادذ تطزح اىَ٘ض٘ع ٍِ ٗ جٖح ّظز
** Everyone has to give me his way in doing it, otherwise I will not accept it.
Growing size and complexity of any health system make us wander how we can do the
best, how can we make a good quality and assurance of the health care delivery.
The health care system (HCS) itself consist of :
1- Professionals (Doctors, nurses, administrators) who deliver the care.
All of these are at variable degree of satisfaction or dissatisfaction with the system,
this is due to many factors that we are going to talk about, to understand how to
mange the care and delivery of services, some of you have experience from their
countries like those from Malizia, you can bring to us your experience about your
The consumers are complaining of :
1- High cost.
2- Insensitivity of healthcare professionals to their need.
** Some doctors would not be sensitive to the patient and they might not done their job, regarding the
examination, diagnosis, treatment and so on, some times the real problem is not physical, it might be
The external and internal factors surrounding the HCS place an increase pressure
on the system and it's administration to improve the performance.
HCS in Jordan:
* In 1950 Ministry of Health (MOH) was establishes, it is a young HCS compared with other
countries, before that the HCS was not organized, there was some hospitals and private
systems but the official work started in 1950.
* In 1953 the first nursing collage was opened.
* The physician association ( )ّقاتح االطثاءwas established in 1954.
* The first civil health insurance system (ٍِٞ )اٗه ّظاً ذأwas implemented in 1965.
And these achievements continue until the public health law number 21 was approved in
1971, which you can find in the kingdom legislation, where you can read about.
* Hussain medical city in 1973.
All this tells us that the system started small and get bigger until today.
* In 1940 there was one hospital, in 2007 we have 98 hospitals in Jordan including
private sector (All sectors).
* Number of beds, health centers, maternal & child health (MCH) center, and number of
health personnel (in the MOH), all have increased, but the number of health personnel in
the MOH is variable, when we look to the # in 2000 (11,293) and in 2007 (11,755), you
can notice that the difference is small, and this is a big burden on the MOH to recruit more
professionals, and we can ask why they do not go to MOH??!!
only few hundred increased (why?) ِْٞ**ٝؼْٜ خاله 7 ط
*Health budget in 2007 is 6% of the total budget, 6% is a good number to spend, more
than that would be wrong, only 6% is not bad.
ٜ**تاىؼنض ٕ٘ رقٌ صذٜ جذا / تاىزغٌ ٍِ اُ ٍؤػزاذْا اىصذٞح ٍَراسج ٗ خذٍاذْا اىصذٞح ػيٚ ٍظر٘ٙ ػاى
despite of that ,we only spend 6% of the total public budgetجذا
*161,400,000 JD = 6% of the public budget.
The absence of disease, illness, impairment, and/ or injury with complete physical,
mental, emotional, and social well-being. It can be regarded as a continuum of well being
(including a good quality of life) at one end, and sickness at the other end, so it is not only
diagnosis and treatment you have to think of the patient as a human being and he should
have these entire components together, to be healthy.
We seek to this level (absence of illness, disease and impairment), but this is impossible,
even if you treat the patient and there is still a little bit of illness you have to recommend
for further treatment like rehabilitation, and this is the continuous sickness health
Health Care :
This is the concern of achieving and maintaining a good health status through providing
the necessary health.
Health care services, 2 types:
1- Environmental: (Community level), it's not a specialty of the MOH, it's the services
provided by the community.
2- Personal: (individual level).
Health Care System:
An organized effort to deliver health care services based on a set of predetermined goals
and objectives. Health care systems vary in each country around the world, which interact
with the political and economical environment.
So if you want a good system in any community, predetermine goals and objective must
be present, if you worked without them it will not be a system, it will be a hub hazard,
(,)ػغاىِٞ ػيٚ اىثزمحwithout goals and evaluation of the work, so at a certain point we don't
know if we achieved the goal, because there is no goal.
So if we want to say that we have a successful health system, it has to have goals and
objectives, which are specific for each country, there is no description ( )ٗصفحfor all
systems to work in the same way, they are determined by the need of the country.
Is the planning, design, and determination of health care system policy or policies, the
execution and evaluation of these policies, a good HCS has to have a good policy (which is
a big thing to do), that will shape the objectives, goals, theories and so on…
"Health Care Services"
Health care system consists of a lot of organizations and facilities, if they work as a
team, with objectives and predetermined goals; they will succeed, so they should be
viewed as a part of a whole system or body, in which all members operate
**Before 15-20 years ago they tried to unit all these organizations under one umbrella, which is called
( ,)اىَؤطظح اىطثٞح اىؼالجٞحthis institution worked for one year only, then stopped, it didn't stop because it did
not work, it worked, but special interest of some doctors, people, or hospitals wasn't satisfied with
working under one umbrella.
this institution would be the reference for all of us, and will have objectives described, for
example, by the head of this institution, the objectives to reduce infant mortality rate , or
some strategic planning for the next 2 or 5 years, so when we look into the indicators of
performance ) ,( ٍؤػزاخ اىؼغو اىٜ ترؼرغئ ٗسارج اىصذح اٗ اٛ ٍؤطظحand you say ,what we did in
the last 5 years (for ex), is it good or bad? Did we achieve some of the goals or not, and
that why we have these goals.
**For example, maternal mortality (the death of a woman during delivery, or within 42 days of
termination of pregnancy) if we get the number of deaths and divide it on 100,000 life birth you will get
the maternal mortality ratio (MMR).
In 2002, in Jordan MMR was 38 per 100,000 life birth, in USA it was 6 per 100,000 life Birth, in 2007 in
Jordan we expected to decrease this ratio, but one research give a number equal to 43 per 100,000 life
Birth, so which number is true, is this number represent the actual problem or not? That why we need to
till all the workers in the HCS that they should achieve the goal and stick to it.
Healthcare delivery system anywhere manages the flow of health care according to a
framework dealing with all possible factors (like, the surrounding environment, the
community, patient needs, regulations, legislations …etc) we might find some laws
concerning the medical ethics Like ( ,)قاُّ٘ اىَظأىح اىطثٞحbecause in some hospitals, doctors
make mistakes and the patient could die, so we must consider the environment.
3 main phases in any system:
1- Input. 2- Processing. 3- Output.
1- The input:
* Human resource:
- Administrative staff
2- The processing:
you give the system inputs and you expect a result, health care providing and treatment,
but if you didn't give the system enough input, like professionals, or their is professionals
but they are not well trained, or you didn't give them a good payment system, money, or
there is no equipment, or the building is falling apart….etc, then you say I need you to
give me a good work, good output, and the patient should be satisfied and so on… NO, you
can't ask the system to give you a good output without a good input, this is part of what we
call quality assurance cycle, that looks at all parts of the system(input, processing , output)
and make indication of success, for ex. If I want to evaluate the input phase, you might find
it 20% successful, this is far from the criteria that should be there, which might be 80%, so
you look for the reasons, it might be the professionals, administration staff,
**The processing phase is always affected by surrounding factors which are the
environment, needs and demands of the community, the patient is satisfied or not….etc ,
and in this phase we must always look for feedback, it might be through :
1- Patients for ex. Some boxes in any health center where the patients give their evaluation
about the work.
3- Community panel,).)ىجْٔ ٍِ اىَجرَغ
4- Questionnaire survey, the best method where you are trying to evaluate your work, so
you ask the patient or any member about the work through this survey.
Individual restore to the best possible health.
Types of health services:
1- Personal health care services (PHCS):
There is a direct involvement with individuals in which the aim is promote,
maintained, and restores health.
** Characteristics of PHCS:
1- Promotion of good health: diagnosis, treatment, and programs to improve mental,
physical well being, ex. Encourage exercises, good nutrition, concealing recognizing and
avoiding stress. I (DR) don't recall that we have any sort of concealing concerning the stress,
ٌ**تْذراج اىٚ اطرؼاراخ طثٞح ٍِ االُ فصاػذا ٗ خص٘صا ٍغ غالء االطؼار/ تاىفؼو تؼض االطثاء اىيٜ تؼرغي٘ا فٜ اىؼٞاداخ اىْفظٞح ػ
ٝؼَي٘ا ٍقارّح تِٞ قثو ػٖز 0 ٗ تؼذ ػٖز 0 / اهلل اػيٌ ػ٘ رح ٝصٞز تٜ ػٖز 0 !!؟
2- Prevention of diseases, you have to eliminate some diseases like communicable
3- Detection and treatment of diseases: some diseases can be prevented through early
detection and screening(breast cancer, other cancer, heart diseases) other diseases can be
effectively cured with treatment.
4- rehabilitation: When person is left with disability despite being exposed to treatment,
the aim is to restore the individual to the best possible health, functions, and social and
2- Environmental services:
1-Promotion of safety and prevention of accidents: Prevent hazards, (e.g. occupational
safety, public health inspection of restaurants and public places for hygiene and fire
2-Promotion of a healthy environment: Promote pure food, air, water, and land. (E.g.
standards for chemical, nuclear, solid and liquid wastes, standards for air pollution).
A hospital is a geographically fixed facility in which personnel with acceptable level of
organized professional training deliver emergency or regular medical care. This include
permanent facilities for inpatient beds, medical services, nursing services, diagnosis, and
treatment of patients. The distinctions between a clinic, health center, and hospital are
unclear, and the presence or absence of a doctor is not a determining factor in this
A range of facilities from small, basic units up to tertiary care hospitals provides an
increasing level of capability for emergency and other care.
Types of hospitals:
1-Primary-level hospital :few specialties—mainly internal medicine, obstetrics and
gynecology ,pediatrics, and general surgery, or just general practice; limited
laboratory services available for general but not specialized pathological analysis.
2-Secondary-level hospital :highly differentiated by function with 5 to 10 clinical
specialties; size ranges from 200 to 800 beds; often referred to as a provincial
3-Tertiary-level hospital:(academic or teaching hospital)highly specialized staff and
technical equipment —for example, cardiology ,intensive care unit, and specialized
units; clinical services highly differentiated by function; could have teaching
activities; size ranges from 300 to 1,500 beds
** you have to know the differences between these types, like the number of beds, 200-
800 bed in the secondary- level hospital, 300-1500 bed in the tertiary level hospital…etc
Emergency medical care (EMC):
Is that care delivered in the first few hours after the onset of an acute medical or
obstetric problem or the occurrence of an injury, including care delivered inside a fixed
Paramedical personnel refer to all persons with medical training who are involved in the
care and transportation of patients in need of emergency medical care. The length and
quality of training vary, from highly specialized personnel with capabilities for advanced
life support to those with simple first-aid training and limited field experience.
** Some time you might graduate from the medical school and yet, you are not well trained on EMC,
you have to train yourself in these years until graduation because if you don't you will feel weak.
Emergency medical role and key issues:
The Roles :
1- Actual event. 2- On-site management. 3- Transportation.
4- Health facility care.
The key issues:
1- In acute event, you need strong and fast action, recognition, surveillance, and
2- On -site management: triage, stabilization, trained personnel.
3- Transportation: safe and efficient transportation.
4- Health facility care: prompt, appropriate, and quality care trained personnel, equipment,
and organization of services.
The Emergency medical pyrmid:
1- Self limited episodes: unnecessary treatment.
2- Treatable episodes: treatment delays, still tolerated well.
3- Emergency episodes: treatment delays jeopardize life or human function, .ذٖذد دٞاج اىَزٝض
Triage is the screening of patients in the field or in the receiving area of a fixed facility to
determine their relative priority for treatment.
Triage, which is usually necessary in the occurrence of mass casualties, may be
necessary whenever a large number of patients requiring emergency care present at the
same time. It typically entails categorizing patients into three groups: those very unlikely to
survive, even with treatment; those whose conditions are minor and who will recover
without emergency care; and those with potentially lethal conditions who are likely to
survive if they receive timely emergency care. Patients in the last category form the
highest priority for emergency care.
Prehospital care encompasses the care provided from the community (scene of injury,
home, school, or other location) until the patient arrives at a formal health care facility
capable of giving definitive care.
This care should comprise basic and proven strategies and the most appropriate personnel,
equipment, and supplies needed to assess, prioritize, and institute interventions to minimize
the probability of death or disability.
** To evaluate prehospital care, we have "times" that are important parameters of the
quality of the prehospital care, the shorter these times the better the prehospital care.
-Notification time is the time elapsed from occurrence of injury or recognition of severe
illness until the EMS system is notified.
- Response time is the time elapsed from notification until arrival of an ambulance to the
site of the ill or injured person.
-Scene time is the time taken by prehospital providers from arrival at until departure from
-Transport time is the time elapsed from leaving the scene until arrival at the hospital or
other treatment facility.
Improve the efficiency of referral hospital
1- Reducing inappropriate outpatient and inpatient use of referral.
) تٞقو ٗ ٕنذاout patient تٞشٝذ اٗ اهin patient)ادٞاّا اه
2- Improving systems to allow early discharge from the hospital.
3- Ensuring that bed occupancy rates can be maintained as close as possible to optimal
rates—namely, 85 percent for referral hospitals.
4- Developing systems for booked outpatient appointments, admissions, and
procedures to permit better planning of activity and staffing, ٍٚا تٞصٞز ٗادذ ٝف٘خ ػيٚ مٞفٔ ػي
.اىَظرؼفٚ اٗ اىؼٞادج
5- Undertaking as much activity as possible on an ambulatory rather than an inpatient
basis, you don't always make patient go in.
6- Evaluating the staff skill mix and the potential for skill substitution, as well as
efficient payment strategies, on a continuous basis, you can make the staff skill mixed (they have
more than one skill).
7- Evaluating and improving processes and systems, including cost-effective clinical
guidelines for patient treatment, on a continuous basis.
8- Adapting intelligent procurement processes and engaging in effective negotiations
with suppliers in relation to prices and service levels ensuring effective ordering, stock
control, and distribution systems to minimize theft and wastage of key supplies,
ٔٞ (اىيٜ تَٞذك تاالدٗٝح) ٝرذنٌ فٞل...اّد تررذنٌ فsupplierٝؼْٜ ٍغ داَٝا ذخيٜ اه
9- Undertaking planned preventive maintenance and programmed replacement of
equipment and buildings.
Any feedback is............welcomed@@
One big hiii to all my sweet friends, and One huge thanks to my dear brother "mo3ta6m" for his
Kholoud yasser al-tarazi