Health care delivery

Health care delivery

Health care delivery is a critical assignment. It requires good structures, competencies and morally sound individuals to handle such an immense task, failure to which, dire consequences will be realized. Health care delivery requires the right infrastructure, personnel as well as supportive legislations. A number of aspects contributes to good health care delivery as discussed below.

Social equity

Social equity is the use of fairness when delivering public services. It is egalitarian in nature in that each citizen irrespective of their economic resources or personal traits is eligible and deserves to be accorded equal treatment by the political system.

Frederickson (2015) observes that social equity though an old concept only found its way into government and social justice recently after John Rawls writings about fairness. Social equity in public administration has its origin in Minnowbrook I conference (Gooden & Portillo, 2011). Before social equity was utilitarianism, the doctrine that embraces that if actions serve the needs of the majority, then they are right.

Social equity has developed through a number of processes. The distributive process which is concerned with the socially just distribution of good, integrative process involves the coordinated development and management of resources in order to yield maximum economic and social benefits equitably among populations without compromising the same resources for future generations, boundary-exchange process involves the legislature, elected executives, auxiliary staff organization, clients as well as organized interest groups. It may also look at the relationship between levels of government especially in a federal system of governance, socioemotional process refers to experiences, expressions, management of emotions and the capacity to evoke positive and rewarding relationships among people.

The VA as part of the boundary-exchange process ensures that health care is available and accessible to the deserving veterans.

The VA has allowed the veterans access non-VA health centers within their community for their treatment breaking the barriers of distance and waiting time, while enjoying social cohesion as they receive treatment from their fellow veterans (Alford & O’flynn, 2012). Such a move is enshrined within the new access standards for veterans.

Social equity is an integral part of modern day public administration and due attention regarding policy development and implementation is key, alongside efficiency and economy. Social equity perspective, can, however, be complex. This is because it speaks to the question of administrative behavior expected of frontline officials serving the public. While public officers are subject to laws and regulations, when compounded by a challenging situation, are they free to use their discretion for justice and fairness? No wonder, there were some hidden waiting list for patients to enable them receive treatment earlier than expected. Social psychology perspective would look at interpersonal and intergroup fairness and equity as the glue that holds the society together. Therefore, integration of fairness and equity at the street-level bureaucratic practice, using the officer’s discretion, results in democratic legitimacy of the public service. The paradox is that the implementation of social equity outside the rule of law raises many ethical questions (Riccucci, 2009).

Decision making

Decision making as a concept has two main parts. One is decision formulation while the other one is its implementation. Decision formulation and implementation are so interconnected that one cannot exist without the other. If decisions are not taken properly and timely, this may spoil the objective of the organization and as such utmost caution is essential in the adoption of the decision as well as its implementation.

Decision-making refers to sequence of activities that deal with stages of recognizing a problem, searching for information, definition of alternatives and finally the selection of an actor drawn from one of two or more alternatives that are in line with the ranked preferences. Decision making emphasizes on how individuals should behave when faced with risks and uncertainty. Decision making has some features that are key if the organization has to perform optimally. In decision making, there is need for compromise. Before a policy maker, there will be a number of alternatives that one has to pick.

Such an alternative should give the best results to the organization. During decision making, the policy maker must demonstrate utmost rationality. This is because the compromise and decision making are intertwined. The decision made is informed by profitability that will be realized by the organization. All aspects of policy which include elements entering into the policy formulation process and the implication of implementation must be considered. An officer engaging in this process is a rational one. Decision making process should involve teamwork if it is within an organization and where a number of stakeholders are involved, all should be brought on board to ensure effectiveness of any decision to be made. A bigger number of individuals will have an in-depth understanding of the decision to be made and how it is going to impact on them. Some institutions such as non-governmental organisations, religious groups, pressure groups, political parties among others may feature during decision making by the government and contribute in a big way (Reynaers, 2014). This is how The Missions Act and Veteran Administration came into being. Basically, decisions do not relate to a single issue but a number of them. A number of characteristics regarding decision making should be put into perspective. Such include:- who made the decision, what decision was made, time when the decision was made, location where the decision was made, the prevailing circumstances when the decision was made, why was the decision made (Menzel, 2019). The development of the VA enhanced the operations of the health facilities and made decision making path short and effective. This is because for a veteran who needs specialized treatment and may be challenged geographically, such patient is aware of where to seek treatment. Service providers in the facility where treatment will be rendered will also have an easy time since their mandate is clear. This is because decision are made in order to serve certain organizational purposes. As much as rationality is emphasized during decision making, irrationality may also set in in a democratic society. During decision making process, the conflicts between rationality and irrationality may result in a lot of confusion because the policy maker may be biased towards real situations which sometimes do not allow credence to rationality. The confusion between rationality and irrationality should not be allowed to blur the conceptualization of the rationality idea, which if allowed may be detrimental to the organization. Its mandate to serve the society may not be realized.

 

Public service motivation

Fry and Raadschelders (2013) contends that Public service motivation is an attribute of employment, whether in the government or non-governmental organization that explains why an individual has a desire to serve in the public and links the individual’s personal actions to the overall public interest.

It is closely related to altruism, prosocial as well as intrinsic motivation. The three are key in driving civic engagement which is a result of political participation, volunteering and tax attitude and associated behavior.

Public service motivation is composed of three mainstay motives as follows:- affective, rational and norm-based motives. Each of the motives again narrows down to a number of dimensions:- commitment to public interest, attraction to policy making, social justice, civic duty, compassion and self sacrifice. Of all the dimensions above, self sacrifice remains key and the strongest as public service is about serving the needs of others so that the society is a better place to live (Kim &Vandenabeele, 2010). While at times the health personnel are confronted with challenging situations such a violent behavior of some patients, they are expected to treat them with compassion and selflessly (Jeon & Robertson, 2010). The understanding of public service motivation is key in influencing individual behaviours which affect the way services are delivered to the society and the quality of such services. The behaviours results in different identities such as communitarians, humanitarians, Samaritans as well as patriots. The communitarians believe that they have a civic duty to give back to their community, humanitarians address issues that affect the common good of all so that the society is a habitable place, the Samaritans identify with the less priviledged in the society as well as others with dire and immediate needs and seek to help such people. Some of the veterans are the society’s most poor. If required to copay, they may not afford that. Therefore, it calls for the health personnel to show mercy, the patriots thinks of how to influence things at the wider spectrum for the society .

Prosocial motivation endeavours at giving the best to others (Herzberg, 2017). Altruism is more broader and may cover a community of people, a state, a nation or the general humankind. Altruism which integrates compassion and self-sacrifice can be very rewarding as it will build trust, enhance collaboration which results in positive effect (Wright, Moynihan & Pandey, 2012). The establishment of the The Missions Act and Veteran Administration was primarily to assist the veterans of war gain meaningful treatment.

However, altruism is different from public service motivation as it deals with known identities with public service motivation dealing with hidden identities, its action time on an issue is shorter because it seeks to meet an immediate need. The motivation in altruism is on a small scale as opposed to motivation in public service motivation.

Accountability

Accountability as well as transparency are two important aspects of government oversight that ensure that things are done ethically. The two characteristics are part of the top core values that define the personality of a public officer or the organization. The two characteristics are key to any government agency and are to be upheld.

Accountability refers to the administrative responsibility through which public officers can have an answer for general notions of democracy, morality and also for specific legal mandates. Elected and appointed public officers work directly for the public. Kettl (2016) notes that public officers draw their wages and benefits from taxes paid by the public. The VA member of staff are paid by taxpayers’ money. Therefore, they have a mandate to meet the expectations of the public and remain accountable to them for the work they are doing on their behalf.

Elected officials are put into account by elections which happen after a number of years. The best performing officials retain their seats while the ones not performing are replaced. The elected officers are in office to perform a certain mandate for the constituents who placed them in that office. Quite a number of them may not perform their mandate for a number of reasons. Sometimes the means of putting them into task over their underperformance is not available (Jarvis, 2014).

However, with the emergence of media reporting on performance of elected officials, things seem to be improving (Ball, Grunic & Birchall, 2014). Unfortunately, a poorly regulated media may not achieve the desired results as it may be abused by some of the officials who fund them to falsify the intended information. Less level of accountability is notable among appointed and administrative officials as compared to elected officials. This is because the elected officials are at the mercies of the electorate who may not be easily swayed in their decision making once they have observed performance of duty by the official. Appointed and administrative officers have their way of managing the challenges of leadership through the support of the appointing authority. The inability of the media to play an oversight role has prompted governments to purse the accountability agenda through the legislature…………. In the legislature, there are committees that are formed touching on most of the functions of the government. Bovens, Schillemans and Goodin (2014) notes that in the committees are individuals who are experts in those functions and are able to interrogate an officer of the government to get answers into what is happening within the functions that they are mandated to perform . Montgomery (2011) rules that such interviews when broadcasted to the public raises the level of accountability by the public officer.

Denhardt and Denhardt (2015) concludes that executive officers are supposed to supervise those under them and to take responsibility of their actions. The VA ensures that its staff is trained on best practices for the industry to improve on their performance. The working conditions are employee friendly to have a motivated employee, thus giving superior services. Employees are enabled to cover great heights through installation of lift equipment.

 

Values

Values are those enduring beliefs that directs the choices that we make in the midst of available means or ends. There are a number of public service values that are key in enhancing efficiency and effectiveness during delivery of services within the public sector. Brewer, Leung and Scott (2014) points out that ethical values such as honesty, accountability and integrity are key in maintaining organizational legitimacy in the eyes of stakeholders. Ethical values are not just limited to the public service but are an integral part of an officer’s lifestyle. An officer who is rich in ethical values outside the working environment will not struggle to maintain the same in the area of work.

Professional values are values acquired as a result of training or experience so that an individual possesses some expertise. Professional values will include:- expertise, reliability and dedication. For example, a lack of expertise may give an appearance of incompetency and thus compromise a public officer’s capability to show cause for actions and decisions carried out. In the VA most of the employees receive trainings on how to handle specialized conditions beyond the regular conditions. Such trainings include the latest evidence-based treatments for Post Traumatic Stress Disorder(PTSD). Such trainings ensures efficiency and effectiveness in the treatment process.

Democratic values arising from fair governance are seen as primary tools used to encourage communities to trust government institutions. Such values include transparency and inclusiveness. Democratic space that allows for involvement of the public in key decision making processes results in successful implementation of such decisions. The individuals’ recognition that they are part of a system that values their inputs feel more comfortable giving as much ideas as possible. There were series of meetings and workshops which involved the veterans before the enactment of The Missions Act and Veteran Administration.

Human values such as inclusiveness and transparency have a capacity of promoting the common interest and are easily welcomed within the context of our political tradition. Human values are key to public officers while pursuing their work, especially where they have to create positive relationships with their colleagues as well as with other citizens. The VA facilities ensures that the working environment of their staff is okey. Lift equipment have been installed to secure the nursing staff from debilitating and often career-ending back, shoulder and neck injuries. The above discussed values are useful for the public service. However, the administrative context in which they are practiced will have an effect on the level of importance that they will have in particular situations. Since the working environment within the public service may not be accommodative to public service values, such values should be emphasized in order to regain legitimacy within the public sector.

The members of staff, a majority composed of veterans themselves have revolutionalized the medical environment where they are able to show empathy and solidarity between the patients and themselves. Such patients enjoy peace of mind while receiving treatment from such staff and accelerate their healing process.

Ethics

Ethics are means of guiding human conduct. It attempts at helping man leave a good life through application of moral principles. Ethics refers to standards of right and wrong which are well based and prescribe what man should do, usually in terms of obligations, rights, fairness, specific virtues or benefits to the society. Ethics consists of rightness and wrongness as well as propriety. Whatever thing is right is ethical while that which is wrong in unethical.

Rissler and Shields (2016) note that for productivity and efficiency to be enhanced in the work place, institutions establish ethical codes for their personnel. The codes of conduct form the framework upon which professions are established. The codes are what the professionals will use to make the claim that they are professionals (Cooper, 2019). Such codes are enforceable within the rules and regulations of the institutions that established them. The VA currently is supposed to ensure that its care providers make use of evidence-based guidelines for prescription. equally community health care providers should have appropriate access to the medical history of the patient. In any democratic society, every public office holder is ultimately accountable to the people. The form of accountability is enshrined in rules and laws enacted by peoples’ elected representatives. It is the ethics that provides the basis and guides the creation of such laws and rules. Any office holder derives power from the people and exercise such power on their behalf. The institutions must create boundaries to ensure that each employee concentrate on their work without having to interfere with the work of others. Lawton, Rayner and Lasthuizen (2013) concludes that an ethical officer must understand the extent of the rules and laws that are relevant in performing a certain task and commit to upholding both the spirit and the letter of such a provision. A number of ethical codes of conduct exist for public officers (Arowolo, 2012). Such ethical codes include:- advancement of public interest- promotion of societal interest and putting service to the public above service to self. The VA’s interest is to have the veterans of war access quality health care. All persons should be served with respect, courtesy. Dedication to high standards is key, upholding of rules and laws- respecting and supporting government enacted rules and laws while endeavoring to improve on rules and laws that further public good. The employees at VA are receiving regular training to ensure that they are upto date with current legislation, strengthening of social equity- all persons should be treated with fairness, equality, justice and there should be respect for individual differences, others rights and freedoms. Such freedoms and rights include career advancement by the female gender (LaPierre & Zimmerman, 2012). Distance factor and waiting time has been solved by the VA by allowing patients to access to health centers of their choice. The public officer should exercise integrity, compassion, courage, optimism and benevolence, promote ethical organizations- strive to achieve highest standards of ethics, public service and stewardship while serving the public, fully informing and advising- information availed to elected and appointed institution officials, organizational superiors as well as governing board members should be accurate, honest, timely and comprehensive, strive for professional excellence- individual’s capacities to act competently and ethically should be strengthened while encouraging professional development of other officers.

Virtues go hand in hand with ethics. They are critical in realizing organizational results.

Moral heroism – this is intentional and selfless upholding of a moral value. According to Hackett and Wang (2012), the VA is exercising justice and compassion when they allow choice of health care facilities for veterans who may be disadvantaged by distance or waiting time. Engagement of veteran health officers in the facility ensure that trust is gained between the care giver and the patient (Jørgensen & Sørensen, 2012).

 

Conclusion

Health care delivery requires utilization of both the hardware and software within the institution. While the physical infrastructure is key, its value cannot be realized when the organizational personnel are lacking in some human values. The idea of health care delivery begins with decision-making by an individual. Then there is acquisition of the right personnel. Such a personnel should be versed with the requirements of public service such as social equity, decision making, public service motivation, ethics, values and virtues as well as accountability in order to deliver for the organization.