Strategies Initiatives Improved Community Health

Background information

Healthcare is a crucial element to the people living in the UK. The growing population and increased healthcare needs have necessitated the development of a robust system to handle various medical concerns of the population. Hackney borough in the UK presents a unique health profile of the people living within the area. The borough demonstrates its commitment to healthcare and is one of the towns with the highest number of people cycling to work. However, this is one of the measures as a response to the dire health condition in the area.

In Hackney, studies have established that many people are dying early or are having a long period of ill health resulting in terminal illness (Hackney 2014). Interestingly, the area also reports that smoking contributes to approximately a third of the deaths in the borough. Among the highest healthcare expenditures allocated in the borough, expenses on sexual health service stand at approximately £9.9 million representing 34%. Adults and other health programs receiving £7 million, 24 % while substance misuse gets an allocation of £6.4 million, approximately 22% of the allocations (Hackney 2014). Additionally, in an effort to enhance the service delivery in healthcare, and tackle the numerous health problems facing the people in the borough, Hackney launched 4 health hubs in the community in the financial year 2014-2015. These hubs were equipped with medical technologies to ensure effective detection and diagnosis of chronic medical conditions.

However, there are four main healthcare challenges in Hackney. First, the people in the borough are grappling with a constrained budget and the rising cost of advanced medical treatment. Thus medical expenses drain their finances leaving little or no funds left for other expenses. Secondly, there is increasing complexity and cost of delivering care to the aging and comorbid population. Third, there is increasing patient expectations and demands for better quality, patient-centred healthcare. Finally, Hackney is grappling with reduced availability and increasing cost of HCPs, inpatient beds, and residential care places. These problems necessitate the integration of technology as a viable solution to the health care situation.

Analysis

Technological advancement has witnessed its widespread application in healthcare to provide various health services. Healthcare is a crucial aspect of human life with the benefits of its adoption being evident. In healthcare, various health technologies have been developed to manage the health records, assessment of patients, and diagnostics. Connected health, also referred to as technology-enabled care (TEC) refers to telecare, telehealth, telemedicine, m-Health, and digital health services developed to integrate technology in the provision of healthcare (Gavan et al, 2018; Sophie 2018). In the UK, the devolvement of healthcare from National Health Services to local administration placed the role of enhancing healthcare under distinct boroughs like Hackney.

Health and social care services are offered through combined technologies such as digital media platforms and mobile devices. The increasing adoption of technology in healthcare presents different solutions aimed at enhancing quality healthcare to patients. Digitization of health is achieved through customized health applications aimed at improving the efficiency of services offered in healthcare. An electronic medical record (EMR) is one of the solutions for digitizing health care.

The electronic medical record is a digital platform that manages the information of clients to enhance medical provision. Information such as the medical history of the patients, their diagnosis, and medical prescriptions are some of the information stored in the EMR (Durrani 2016). This makes it easy for retrieval and sharing between different departments of the hospital to aid in the quick and easy treatment of the patients.

Do-it-yourself (DIY) offers a technological platform where patients access health information and perform self-diagnosis (Gavan et al, 2018). Mobile, as well as web-based applications, have been developed to offer health information to patients in regards to medical conditions, their causes, signs, diagnosis, and treatment. Patients can access these services and find information which they use for personal diagnosis. Remote care is increasingly being adopted into mainstream healthcare (Wachter 2015). The UK, for instance, has allocated over £45 million for a period of five years to support the uptake of online consultations. While the uptake of online consultations is still slow, there is significant progress and patients are considering seeking healthcare services from these ‘virtual clinics’ (NHS England 2018). Video consultations and asynchronous forms of communication such as email conversations in healthcare provide an opportunity for the growth of new models of delivery of healthcare. The utilization of online consultations can lead to reduced unnecessary referrals for secondary care and outpatient follow-up appointments.

Synthetic biology is a technological healthcare tool which blends science and engineering and aids in the construction of artificial biology pathways, organisms, and devices or redesigns the existing natural biological systems.

Pharmacogenomics provides a technological platform where customized medicine genome sequencing is applied (Lily et al, 2011). The platform emphasizes the role of genes and genomic variants in chemical treatment. With technology, the human genome can now be sequenced within a few days. This advances enabled the UK to become the first system to introduce genomics into mainstream healthcare in 2015 (Department of health and social care 2018). This makes pharmacogenomics to be a precision medicine making its application to contribute to quality healthcare.

Technological advancements by no doubt present a number of benefits to health care. First, the successful integration of technology provides easy access to healthcare by patients. The increased prevalence of mobile phones allows people to easily access healthcare through mobile platforms.

The term artificial intelligence was first coined up in 1956 and refers to techniques that allow computers to perform tasks typically thought to require human reasoning and problem-solving skills. Artificial intelligence is increasingly being adopted in different situations. Healthcare is one such sector experiencing adoption of artificial intelligence in handling various medical complications.

Artificial intelligence is based on algorithms that are developed and used to interpret images from the CT and MRI scans to identify tumours (Lily et al, 2011; Steel et al 2018). This machine learning technique has been identifying to have more benefits compared to the risks. There are a number of issues with AI that should be examined.

Patient safety raises a concern on whether AI should be extensively used in health care as compared to using the doctors. An argument in support of AI and technology is the fact that machines don’t get tired, and their judgements aren’t influenced by emotions. Machines execute commands based on the program information and this can’t be easily subjected to manipulations during their operations. On the contrary, human judgement is viewed to be a fundamental component of clinical activity.

Algorithms are also viewed to be beneficial since the machine could standardize assessments and treatment of medical conditions based on up-to-date guidelines. This is because the machines automatically update their systems acquiring the latest guidelines in the discharge of medical duties. However, while AI has been linked with improved healthcare, unsafe use of the system could present harm to patients across the healthcare system. For instance, the technology is susceptible to hacking (Newton et al 2018), or wrongful programming which significantly hampers the machine’s performance, leading to wrong medical assessments, wrong diagnosis and wrong treatments whose impacts might be grave.

The other debate surrounding the technology adoption into healthcare is the relationship between the doctor and the patients. With reliance on technological platforms like online consultancies, machines can significantly reduce the face-to-face interaction between the doctor and the patient (Hex et al, 2015). Doctors and physicians are expected to take a holistic approach in discharging healthcare duties thereby providing care tailored to each patient’s wishes and based on shared decision making. Machines, however, rely on programs and may offer a generalized diagnosis to patients with similar medical conditions based on the diagnosis and may cause duplication of diagnosis.

Public acceptance and trust is another issue that cut across the use of technology in healthcare. Questions are raised surrounding the perception of technology-based healthcare by the public and the confidence to access technology-based healthcare. Getting the trust of patients to AI is an essential step in the development of AI in healthcare (Newton et al 2018). In fact, there is a possibility of variations in patient’s preferences with the younger generations seemingly drawn to technology-based healthcare and the older generation, on the other hand, favouring the conventional doctor-based healthcare.

Accountability for decisions in healthcare raises a major debate topic. Questions arise on who will bear the responsibility and accountability in the event machines blunder and their diagnosis causes harm to patients. Comparatively, in case of errors and unforeseen consequences in medical care, nurses will easily be tasked to take accountability of their actions. This might be difficult when the errors are explicitly from machines. AI recommendations may be accompanied by automation bias and rubber-stamping of the instructions (Stafford et al 2018).

Data quality, consent, and information governance is another issue of concern regarding technology in health and social care. Machines utilize data from the patient’s records and history to make diagnosis and treatment (Maguire et al 2018). Questions around the quality of data and protection arise in relation to technology. The UK government and health, and social care systems have a legal duty to maintain the privacy and confidentiality of its citizens (Department of health and social care 2018).

The application of healthcare and the successful integration of technology in health and social care in Hackney borough can be shaped by the management of health facilities. Different definitions of management have been developed by different scholars. Taylor defines management as the art of knowing what to do and seeing that it is done easily and cheapest way. On the other hand, management entails forecasting, planning, organizing, commanding, creating and controlling activities aimed at achieving a specific set of objectives (Bamford and Forrester 2003).

The application of management is quite imperative in the successful operations of the organizations. Health facilities are focused on the provision of healthcare and bearing in mind the type of services offered, management becomes a crucial element in efficient healthcare. The UK health facilities are run with managers in charge of running the health facilities. According to the office for national statistics, the promotion of managers in the UK workforce by 2014 was at 15.4% (NHS England 2018). Additionally, there were approximately 77, 000 health facilities in the UK with health service managers across these institutions and that 4.8% of the NHS workforce was composed of the managers. This emphasizes the importance of management in healthcare (Kumar et al. 2013).

Henry Fayol identifies that managerial activities include planning, organizing, commanding, coordinating, and controlling. Planning is the function of management that involve the projection of new projects, resource mobilization, drawing strategic plans, identifying the needs of human resource necessary for the operation of the institution (Garrison et al. 2017). Organizing as a function of management entails the development of structures for service delivery, deploying human resources and structuring the activities imperative for an organization’s performance. Managers are also in charge of providing authority, providing direction to the staff and monitoring the behaviour of the staff (Harbison et al. 1959).

Management is important for the success of health institutions. There are benefits associated with effective management. First, management leads to the productivity of manpower, materials, machinery, and money. Managers rely on contribution from the staff; provide guidance, instructions, commands, and motivation to the staff in order to enhance their productivity. Through setting visions, objectives, goals and pulling together the available resources are major activities of managers and aid in the productivity of the health facilities. Effective management provides prudent utilization of resources develops and orients the staff towards achieving specific objectives and the vision of the organization.

Effective management is prudent for economic and social development. This is achieved through systemic and purposefully developing the capacity of managers enabling them to make critical decisions that help in attaining the objectives of the institutions. Integration of healthcare into health facilities and the success of the operations of health and social care can only be achieved through effective management (Kumar et al. 2013). Thus, the transformation from conventional healthcare to technology-based healthcare, a move that is envisioned and taking shape in health facilities rely on change management.

A number of theories have been developed to explain management and its application in healthcare. Fayol developed the principles of management as the division of labour, authority, discipline, unity of command, unity of direction, the subordination of individual interest, centralization of hierarchy, order, and equity, the stability of staff, initiative, remuneration, and esprit de corps.

These principles are crucial in the effective operations of health facilities and adherence to these principles by managers in health care can aid in ensuring quality healthcare by successfully integrating technology into the health services.

Taylor, on the other hand, concentrated on components of work rather than the structures within which it is carried out (Taylor 1911). He advocates that effective management entails breaking down of tasks into components to enable workers to use minimum energy while producing maximum output. This focus aims at striking the balance between discharging f duties and preservation of human dignity as well as enhancing equity among the staff. Therefore, with the integration of technology in healthcare, the management has a role to ensure that the efforts of staff are valued and allowed to fully exploit their potential. This might include blending both technology-based healthcare and conventional healthcare where machines serve to complement human labour and not eliminate their contribution in as far as healthcare is concerned.

Bureaucratic theory of management by Max Weber explains that bureaucracy is based on governance structures and the rational-legal authority is paramount in management (Bamford and Forrester 2003). Therefore, persons occupying high management level wield the highest authority and decision-making power. Therefore, managers have the main decision-making power and it is their responsibility to define the objectives and direct the staff in achieving the objectives. Weber further explains that with management, division of labour is clearly established with regular tasks and duties of the particular members within the bureaucratic system.

Systems theory by Ludwig von Bertalanffy (1901-1972) explains that management is a system which brings together a set of elements into a meaningful set of relationship. A system is made up of different parts or structures each with a unique contribution to the system at large. This theory blends with the idea that healthcare is a complex system with many interconnected sections which must work together for the efficiency and quality health service delivery (Bamford and Forrester 2003).

However, there are some challenges associated with management in healthcare. First, healthcare is a very large scale business with health facilities housing different multiple departments making the management of these facilities to be quite demanding. Bearing in mind the prudent role of these facilities, any lapse in management might have devastating impacts (Harbison et al 1959).

Secondly, healthcare is everybody’s business and thus people closely monitor the performance of the health facilities, evaluate their services and are concerned with the quality of healthcare in these facilities. The constantly growing pace of technological innovations and the changing nature of the user and consumer expectations and preferences are other major challenges that affect the management of health facilities. Managers must adopt the technology and balance between quality healthcare and the needs, and preferences of the users.

The discussion above point to the fact that technology has a vital role to play in enhancing healthcare and that successful integration of technology in the provision of health services can have numerous benefits. Hackney borough’s efforts to digitize healthcare are quite encouraging and should be pursued. This is because technology can help in performing tasks like a diagnosis of serious medical conditions and thus help in discharging timely health services to the patients.

However, there are numerous questions around the application of technology in healthcare and it is important to strike a balance between digitization of healthcare and ensuring the comfort of patients in accessing healthcare. Therefore, a number of recommendations can be drawn to enhance effective healthcare in Hackney.

First, there should be an investment in quality healthy technology. In the pursuit of technology to be integrated into healthcare, it is important to buy quality technology equipment since this will ensure the durability of the machines and better performance in the diagnosis and treatment of medical conditions (NHS England 2018). Automated systems are increasingly being adopted in healthcare and artificial intelligence should be well thought out by the management of the respective health facility which should seek to purchase the best quality equipment.

Secondly, the Hackney borough is composed of a dynamic population with both the young and the old. This might present an issue when it comes to access to technology-based healthcare. Therefore, the management of the respective health facility considering acquiring technology in the health facilities should work towards blending technology-based medication with conventional doctor-based healthcare. This will offer a wider variety of healthcare and seek to attract both the young, who will mostly prefer technology and the old, who will prefer doctors. Additionally, the interaction of technology and the doctors will help provide better medical equipment with each party significantly contributing to better diagnosis and treatment of patients.

Third, there should be constant monitoring and evaluation of the technologies to uncover their application, and performance in as far as quality healthcare is concerned. Constant monitoring and evaluation of technologies seek to identify the presence of errors from the equipment. Monitoring of the machines also helps to identify attempts to unlawfully access medical records and other data as well as hack the systems to inflict harm on the patients. Hacking of the systems is specifically very serious and can cause catastrophic harm to the patients. For instance, Hacking the systems containing diagnosis information of the patients can expose them to change of information which can lead to wrong diagnosis resulting in serious medical and economic implications.

Fourth, there is a need to shape the management to embrace change. Resistance to change, especially from the management team can hamper the successful implementation of technology in healthcare. Therefore, managers should provide leadership and direction to making the staff embrace technology and utilize technologies in the provision of healthcare.

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