Health System Improvements Assignment Help

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 Step 1 Clinical Scenario (10 marks, 250 words)

HH is a 20-year-old male originally from Afghanistan and arrived to Australia in 2013 with his family. He works at a carwash andsince November 2016 has been living in Belmont. Prior to that he was living with his family including parents and 8 siblings who also live in Geelong. HH and his family came to Australia as refugees from Afghanistan where they were widely discriminated because of their religion and ethnic differences. The constant persecution resulted in a distressing childhood for HH and he had to drop out from school at an early age.

HH has a longstanding history of substance use mainly THC with no clear past history of mental health issues that were reported but there was a significant history of multiple traumas in the past. He had an admission to Swanston Centre Psychiatric Unit in 2014 with a diagnoses of schizophrenia.

Currently, HH presented to the Jigsaw community mental health team due to relapse of psychotic symptoms. He appeared distressed but cooperative with the interview. He reported his mood as depressed and fearful of dying because of the voices he can hear. Moreover, he reported experiencing and seeing images from his past traumatic events.

The National health priority area to which HH presents is Mental Health, specifically schizophrenia complicated by substance use. My interaction with HH occurred during my mental health rotation. I met HH with my community team for an assessment. I took a history and performed a Mental State Examination. I also attended the consult with the psychiatric registrar who decided to admit HH. I followed him up on the ward the following days before he was discharged home.

Step 2 Health System Concept Map (25 marks, 100 word equivalent)

Step 3 Health System Improvements (55 marks and 800 words overall) Health service delivery is the health system component that had the most detrimental impact on HH. There is literature that discusses the barriers to accessing health care services by refugees in Australia. (1) Barriers including language difficulties, cultural differences and cost have shown to be the biggest contributors. (2)  Among the refugee population where HH belongs, service delivery is severely impacted due to language barriers. (3) (4) This applies strongly for patients like HH with mental health issues where majority of the investigation and treatment is via verbal communication. For instance, to understand whether HH experiences hallucinations or to offer cognitive behavioral therapy(CBT) as treatment communicating with HH is vital. The language barrier will make it difficult for health care specialists to interact with HH and hinder in trying to bridge the underlying cultural differences.

Good health service delivery includes a range of key characteristics according to WHO such as providing a patient with continuity of care which was not the case for HH since he relapsed and presented for re-admission due to non compliance during a period of discontinuity in care. (5) Moreover, another key characteristic is offering health care services to the entire population including people from different cultural and linguistic backgrounds. Over 28% of the Australian population represent diverse backgrounds making the health care delivery challenging for the health system to deliver accessible and culturally competent care. (6) The approach of developing homogenous solutions for the entire population is detrimental for people from backgrounds such as HH. (6)

Furthermore, cost has shown to impact service delivery significantly and interacts with the financing component of health systems. (7) (8). HH has no private insurance and is casually employed on a minimum wage making it unfeasible to afford insurance and this would prevent accessing private services such as private psychiatrist.

Health workforce which is another health system component interconnects with effective service delivery. Such as the lack of awareness of issues specific to refugees among the health workforce. Understanding the hurdles to accessing health service for patients such as HH is crucial for healthcare workers to provide appropriate services. (6)

Moreover, another health system component interconnecting with health service delivery is information systems. Refugees who are introduced to a new healthcare environment, access to information which is adapted to their needs is crucial for effective health service delivery. (9) Finally, there is a discussion around the lack of research around refugee health claiming that the scholarly inattention is due to refugee health not fitting into the existing disciplinary categories of research. (10) However there is evidence of an increase in the scope of research as the refugee population continue to rise worldwide. (11)

Table 1: Changes to the health system component to improve future patient journey.

Proposed Changes	Steps for Implementation	Who is Responsible
Short term change: Running focus groups to understand the barriers faced in accessing health services within the community by refugees. Then training the workforce to tackle those barriers to ensure improved health service delivery.	1.    Identifying the different communities and sectors within the refugee population to ensure the focus group represents individuals from diverse backgrounds. 2.    Working with experts in refugee health to create surveys and identifying the outcomes of the focus groups. 3.    Partnering with consumer research companies that are experts in running focus groups. 4.    Working with local communities to recruit participants to join focus groups. 5.    Collating and analyzing the data obtained from the focus groups and using it to train workforce.	Step 1 – Experts in refugee health, Diversitat, Refugee aid NGOs Step 2 – Researches with background in refugee public health from universities such as Deakin Step 3 – Consumer research company like iData (idataresearch.com) Step 4 – Local community organizations, local community leaders and influences Step 5 – Data experts, researchers, human services department
Medium term change: Building systems such as a SMS reminder service to increase compliance of treatment and medication of high risk patients.	1.    Working with specialists who understand the barriers faced by refugees to access health service. 2.    Hiring a technology company to build the software needed to send bulk SMS reminders. 3.    Identifying high risk patients who are more likely to struggle with compliance. 4.    Launch pilot campaigns of sending automatic SMS reminders to adhere and comply with medication and appointments. 5.    Compare and analyze for effectiveness and tweak to improve the process for higher efficacy.	Step 1 – Refugee health experts & researchers Step 2 – Software engineers, technology experts Step 3 – People with knowledge of database and patient demographic data Step 4 – Projects implementation experts Step 5 – Quality analysts
Long term change: Community education and outreach to increase engagement and awareness of refugees to about health services.	1.    Hiring a team of experts in consumer education and knowledge of refugee health. 2.    Work with experts to develop interactive content that can be used for educating refugees. 3.    Working with local communities to organize logistics for running sessions. 4.    Partnering with local organization to recruit participants for attending sessions. 5.    Following up with all attendees to ensure retention and continuous attendance in future sessions.	Step 1 – Department of health and human services, recruitment experts Step 2 – Refugee health subject experts, educators from Deakin university, Consumer health advocates Step 3 – Local community members and businesses, event organizers, council Step 4 – Local community members, local health care services, NGO’s Step 5 – Campaign managers, quality assurance analysts, case managers, social workers

Health System Improvements Assignment Help

Step 4 Actions of a Trainee Medical Practitioner (5 marks, 100 words) 

Being a third year medical student I can influence the component of health service delivery by facilitating continuity of care of a patient which is one of the key characteristic of adequate health service delivery. SinceHealth System Improvements Assignment Help as medical students we are placed in different teams in mental health like Access, Community teams, inpatient wards, psychologists, registrars and consultants. During handover meetings, I can alert the team if I have seen a patient in another setting and give brief heads up to allow contextual and personalized care.

The public health skills I would draw upon for this role:

• Understanding the upstream and downstream effects that impact health and highlighting them when communicating with other health care workers.
• Awareness of health inequalities and the skills to be able detect high risk individuals so I can be efficient in selecting patients who would benefit most from continuity of care.
• Skills of researching current evidence in health service delivery and using them to offer assistance to my colleagues when planning care management.
• Knowledge of the public healthcare system and the available services which I can use to alert other health care teams for referral or integration to offer the best patient centered care.

References

• Murray S, Skull S. Hurdles to health: immigrant and refugee health care in Australia. Australian Health Review. 2005;29(1):25.
• Asanin J, Wilson K. “I spent nine years looking for a doctor”: exploring access to health care among immigrants in Mississauga, Ontario, Canada. Social science & medicine. 2008;66(6):1271-83.
• Aroian KJ, Wu B, Tran TV. Health care and social service use among Chinese immigrant elders. Research in Nursing & Health. 2005;28(2):95-105.
• Ponce NA, Chawla N, Babey SH, Gatchell MS, Etzioni DA, Spencer BA, et al. Is there a language divide in pap test use? Medical care. 2006;44(11):998-1004.
• Health service delivery – World Health Organization [Internet]. 1st ed. 2010 [cited 27 May 2017]. Available from: http://www.who.int/healthinfo/systems/WHO_MBHSS_2010_section1_web.pdf?ua=1
• Henderson S, Kendall E. Culturally and linguistically diverse peoples’ knowledge of accessibility and utilisation of health services: exploring the need for improvement in health service delivery. Australian Journal of Primary Health. 2011;17(2):195.
• Lasser KE, Himmelstein DU, Woolhandler S. Access to care, health status, and health disparities in the United States and Canada: results of a cross-national population-based survey. Health Policy: Crisis and Reform in the US Health Care Delivery System. 2008:379.
• Steele LS, Lemieux-Charles L, Clark JP, Glazier RH. The impact of policy changes on the health of recent immigrants and refugees in the inner city: A qualitative study of service providers’
• Finney Lamb C, Smith M. Problems refugees face when accessing health services. New South Wales Public Health Bulletin. 2002;13(7):161.
• Stein BN. The experience of being a refugee: Insights from the research literature. Refugee mental health in resettlement countries. 1986:5-23. Keyes E. Mental health status in refugees: An integrative review of current research [Internet]. Taylor & Francis. 2009 [cited 27 May 2017]. Available from: http://www.tandfonline.com/doi/abs/10.1080/016128400248013

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