The Satisfaction Snapshot is a monthly electronic bulletin freely available to all those involved or interested in improving the patient/ client experience. Each month the Snapshot showcases issues and ideas which relate to improving patient satisfaction and customer service, improving workplace culture and improving the way we go about our work in the healthcare industry. The Satisfaction Snapshot features: « relevant articles from healthcare industry experts « case study success stories « tips and tools for quality improvement « patient satisfaction and other industry research findings « articles with ideas to help achieve success in your role If you would like your colleagues to receive the Satisfaction Snapshot please send us their names and email addresses. The Satisfaction Snapshot is published by Press Ganey Associates Pty Ltd. All material is copyright protected. Quotation is permitted with attribution. Subscribers are permitted and encouraged to distribute copies within their organisations. Subscription to the Satisfaction Snapshot is FREE! Please direct any comments, suggestions or article submissions to: Manager of Client Relations [email protected]www.pressganey.com.au P: 07 5560 7400 F: 07 5560 7490 news, views & ideas from the leader in healthcare satisfaction measurement A Roadmap For Behaviour Accountability By Terry Grundy, Managing Director, Press Ganey Associates Australia and New Zealand. Code of Conduct Standards of Behaviour Accountability
Transcript
The Satisfaction Snapshot is a
monthly electronic bulletin freely
available to all those involved or
interested in improving the patient/
client experience. Each month the
Snapshot showcases issues and
ideas which relate to improving
patient satisfaction and customer
service, improving workplace culture
and improving the way we go about
our work in the healthcare industry.
The Satisfaction Snapshot features:
« relevant articles from healthcare
industry experts
« case study success stories
« tips and tools for quality
improvement
« patient satisfaction and other
industry research findings
« articles with ideas to help
achieve success in your role
If you would like your colleagues to
receive the Satisfaction Snapshot
please send us their names and
email addresses. The Satisfaction
Snapshot is published by Press
Ganey Associates Pty Ltd. All
material is copyright protected.
Quotation is permitted with
attribution. Subscribers are permitted
and encouraged to distribute copies
within their organisations.
Subscription to the Satisfaction Snapshot is FREE!
news, views & ideas from the leader in healthcare satisfaction measurement
A Roadmap For Behaviour Accountability
By Terry Grundy, Managing Director, Press Ganey Associates Australia and New Zealand.
Code of Conduct
Standards of Behaviour
Accountability
page 2SATISFACTIONsnapshot Most healthcare organisations have ‘Codes of Conduct’. Over the past 10 years articulating a desired, or minimum, level of employee conduct in line with the organisation’s value set has become commonplace. These documents sit alongside an organisation’s mission and vision statements, get showcased in facility foyers and on staff lunchroom walls. They also get filed away with the annual or 3 year strategic plans. High performing organisations know that a code of conduct without definitions of accepted and not accepted behaviours is just another strategic document, as it has limited relevance to the employees on a day to day basis. Why drill down from a Code of Conduct to Standards of Behaviour? While a code of conduct provides a value‐based framework through a set of conventional principles and expectations that are considered binding on any person, they often fall short in providing the required examples of behaviours that demonstrate or do not demonstrate compliance. Standards of behaviour on the other hand, help employees make sense of the value statements and how behaviours can be performed to show that the values are being lived within the organisation. In developing standards of behaviour organisations must seek, (and importantly be seen to seek) input from all employees. They can do this by establishing a service standards team to spearhead the initiative and create a first draft. DON’T have Human Resources write it and impose it. It is important to create buy‐in and that requires organisation‐wide participation.
The best approach for developing behaviour standards is to start with each Value Statement as sourced from the organisation’s vision/mission framework, for Example:
• Respect for People
• Teamwork
• Honesty and Ethics
• Respect for the Law and Government
• Integrity
• Excellence
• Compassion and Caring The next step is to simply start with a blank piece of paper, (or white board) for each value and draw a line through the middle of the page. Within a collaborative environment ask your employees to give examples of specific behaviour that demonstrate the living of the value in real circumstances, (using terminology they use every day). Place any suggestions for behaviours that would be acceptable ‐ above the centre line ‐ and place any behaviours that would be seen as not acceptable ‐ below the line. As you continue the process certain key behavioural themes with emerge that can then be summarised into statements and documented. Below is an example of one organisation’s worksheet in defining behaviours for the value: RESPECT.
O i ti V l RESPECTOrganisation Value: RESPECT
page 3SATISFACTIONsnapshot
Continue this process until all values have been explored in terms of required standards of behaviour. A final document can then be drafted, one that effectively has the direct input from staff at the coalface and by the very staff that experience these behaviours on a day to day basis. Taking the Important Next Steps Why is it that we hear so often from our colleagues and through employee surveys that these codes and standards of conduct are never adhered to and staff get away with (often deplorable) behaviour?
“If you’re not going to hold people accountable for behaviour standards – then you may as well get rid of them – they can have the reverse impact on your culture”.
The first critical step is to ensure that all employees know they’ll be held accountable for any breaches of behaviours outlined in the Standards of Behaviour document. Setting the accountability and consequences is then up to your individual performance management protocols to follow. The Code of Conduct and Standards of Behaviour should form part of the employee contract and should be signed by every employee. For new recruits this is easy to implement as part of other initial contractual documents. For long standing employees who are being asked to sign this for the first time, it is important for senior executives to take the lead in signing first and preferably in front of other staff through a forum organised for this specific purpose, (launch of the new Standards).
Follow Through – Follow Through – Follow Through The final step is to incorporate adherence to behaviour standards into your accountability framework. For those organisations that use a balanced score card approach to accountability, a scoring system for behaviours could be incorporated in an employee/culture pillar or in a service pillar. For organisations that do not follow this strategic approach then the scoring system should be incorporated into existing appraisal processes. An example of a Standards of Behaviour Accountability Document is included as the subsequent pages: Finally, it is important for leaders to ensure that adherence to standards of behaviour is a continuous auditing role that they are expected to conduct, rather than leave an evaluation until an appraisal timeslot. Unacceptable behaviour must be acted on immediately, your staff expect this from you. Exceptional behaviour must also be monitored on a continual basis for employee recognition, another major role as a leader.
page 4SATISFACTIONsnapshotStan
dards of Beh
aviour Accou
ntab
ility Framew
ork ‐ C
ommun
ication
1
Doe
s Not M
eet
Immed
iate Im
provem
ent
Requ
ired
2
Doe
s Not Con
sisten
tly Meet
Margina
l Improvem
ent
Nee
ded
3
Consistently M
eets
BASIC EX
PECT
ATIONS
4
Consistently M
eets and
Freq
uently Excee
ds (7
5%)
Exceptiona
l
5
Consistently Excee
ds (9
0%)
Mod
el
Commun
ication Standard 1. Follows basic teleph
one and em
ail cou
rtesy
Def
initi
ons
of B
ehav
iour
Doe
s no
t ans
wer
the
tele
phon
e
Doe
s no
t gre
et c
usto
mer
s pr
oper
ly
Doe
s no
t offe
r to
trans
fer c
all
Doe
s no
t offe
r to
trans
fer t
o vo
ice
mai
l or t
o ta
ke m
essa
ge
Doe
s no
t ask
per
mis
sion
to p
ut c
alle
r on
hol
d
Doe
s no
t ide
ntify
sel
f or d
epar
tmen
t w
hen
answ
erin
g th
e ph
one
Doe
s no
t res
pond
to e
mai
ls
Doe
s no
t ide
ntify
sel
f in
emai
l foo
ters
Use
s ab
rupt
or d
isco
urte
ous
lang
uage
in th
e te
xt o
f em
ails
Doe
s no
t put
on
‘Out
of O
ffice
’ m
essa
ges
Def
initi
ons
of B
ehav
iour
Doe
s no
t ans
wer
pho
ne w
ithin
thre
e rin
gs
Keep
s ca
ller o
n ph
one
too
long
Doe
s no
t che
ck b
ack
durin
g ex
tens
ive
hold
Doe
s no
t giv
e pr
oper
ext
ensi
on
Doe
s no
t ver
ify th
at p
erso
n be
ing
trans
ferre
d to
is a
vaila
ble
Doe
s no
t del
iver
mes
sage
s
Doe
s no
t ack
now
ledg
e em
ails
with
in
24 h
ours
Def
initi
ons
of B
ehav
iour
Ans
wer
s ph
one
with
a s
mile
Giv
es o
ptio
ns if
inte
nded
par
ty is
not
av
aila
ble
Kno
ws
how
to o
pera
te p
hone
s in
th
eir w
ork
area
(e.g
., Tr
ansf
ers
calls
co
rrec
tly, i
nfor
min
g ca
ller a
nd c
o-w
orke
r rec
eivi
ng c
all;
Pro
vide
s co
rrec
t ext
ensi
on b
efor
e tra
nsfe
rring
cal
l/offe
rs o
ppor
tuni
ty to
be
tran
sfer
red
to v
oice
mai
l)
Ans
wer
s pr
ompt
ly, g
reet
s ca
ller,
iden
tifie
s se
lf an
d lo
catio
n, a
nd o
ffers
as
sist
ance
, if p
ossi
ble
Ask
s an
d w
aits
for p
erm
issi
on b
efor
e pu
tting
cal
lers
on
hold
and
revi
sits
th
e ca
ller t
o co
mm
unic
ate
stat
us o
f ho
ld
Take
s ac
cura
te m
essa
ges
Dis
tingu
ishe
s be
twee
n cr
itica
l, ur
gent
, and
non
-urg
ent s
ituat
ions
Del
iver
s m
essa
ges
in ti
mef
ram
e de
emed
reas
onab
le b
y th
e un
it
Ack
now
ledg
es e
mai
ls w
ithin
24
hrs
Offe
rs a
resp
onse
to e
mai
ls o
r op
tions
for o
ther
ass
ista
nce
Iden
tifie
s se
lf in
em
ail f
oote
rs
Turn
s on
‘Out
of O
ffice
’ mes
sage
s
Def
initi
ons
of B
ehav
iour
All
of b
asic
exp
ecta
tions
+
Coa
ches
oth
ers
rega
rdin
g ph
one
skills
Dev
elop
s pr
otoc
ols
or d
evis
es
proc
edur
es fo
r ans
wer
ing
calls
Def
initi
ons
of B
ehav
iour
All
of b
asic
exp
ecta
tions
+
Trou
ble
shoo
ts c
all p
roto
cols
and
pr
oced
ures
Impl
emen
ts c
all p
roce
dure
s an
d pr
otoc
ols,
and
Trai
ns o
ther
s
page 5SATISFACTIONsnapshot
1
Doe
s Not M
eet
Immed
iate Im
provem
ent
Requ
ired
2
Doe
s Not Con
sisten
tly Meet
Margina
l Improvem
ent
Nee
ded
3
Consistently M
eets
BASIC EX
PECT
ATIONS
4
Consistently M
eets and
Freq
uently Excee
ds (7
5%)
Exceptiona
l
5
Consistently Excee
ds (9
0%)
Mod
el
Commun
ication Standard 2. D
emon
strates prop
er com
mand of language
Def
initi
ons
of B
ehav
iour
Fails
to c
omm
unic
ate
accu
rate
in
form
atio
n
Writ
es il
legi
bly
Use
s in
appr
opria
te a
bbre
viat
ions
Def
initi
ons
of B
ehav
iour
Writ
ing
is s
lopp
y/di
fficu
lt to
read
Com
mun
icat
ion
cons
iste
ntly
con
tain
s er
rors
(e.g
., sp
ellin
g, w
ord
choi
ce,
gram
mar
)
Writ
ten
and
verb
al c
omm
unic
atio
n co
ntai
n in
corr
ect i
nfor
mat
ion
Use
s in
appr
opria
te/tr
endy
sym
bols
in
prof
essi
onal
doc
umen
tatio
n
Use
s co
nfus
ing
form
s of
co
mm
unic
atio
ns (j
argo
n, a
cron
yms,
m
edic
al te
rms
that
oth
ers
may
not
kn
ow)
Def
initi
ons
of B
ehav
iour
Sel
ects
app
ropr
iate
met
hod
of
com
mun
icat
ion
(pho
ne, m
ail,
fax,
in
pers
on)
Del
iver
s in
form
atio
n to
the
appr
opria
te p
erso
n in
a ti
mel
y m
anne
r
Writ
es le
gibl
y
Avo
ids
conf
usin
g fo
rms
of
com
mun
icat
ions
(jar
gon,
acr
onym
s,
med
ical
term
s th
at o
ther
s m
ay n
ot
know
)
Org
anis
es in
form
atio
n in
a lo
gica
l m
anne
r
Def
initi
ons
of B
ehav
iour
All
of b
asic
exp
ecta
tions
+
Coa
ches
oth
ers
to e
nhan
ce
com
mun
icat
ion
Def
initi
ons
of B
ehav
iour
All
of b
asic
exp
ecta
tions
+
Dev
elop
s to
ols
and/
or m
ento
rs
othe
rs to
enh
ance
com
mun
icat
ion
Commun
ication Standard 3. R
espe
cts and maintains th
e confiden
tiality of inform
ation
Def
initi
ons
of B
ehav
iour
Shar
es c
onfid
entia
l inf
orm
atio
n w
ith
unau
thor
ised
per
sonn
el
Dis
cuss
es c
onfid
entia
l inf
orm
atio
n in
pu
blic
are
a
Plac
es c
onfid
entia
l inf
orm
atio
n in
no
n-se
cure
rubb
ish
bins
Leav
es c
onfid
entia
l inf
orm
atio
n in
pu
blic
are
a
Shar
es p
assw
ords
with
oth
ers
Def
initi
ons
of B
ehav
iour
Acce
sses
info
rmat
ion
not e
ssen
tial t
o pa
tient
car
e
Dis
cuss
es c
onfid
entia
l inf
orm
atio
n w
here
it c
an b
e ov
erhe
ard
Doe
s no
t sec
ure
conf
iden
tial
info
rmat
ion
Leav
es p
assw
ords
in th
e op
en fo
r ot
hers
to s
ee o
r in
easi
ly d
isco
vere
d pl
aces
Def
initi
ons
of B
ehav
iour
Acc
esse
s on
ly in
form
atio
n th
at is
es
sent
ial t
o th
e jo
b
Mai
ntai
ns c
onfid
entia
lity
of a
ll ac
cess
ible
writ
ten
and
elec
troni
c in
form
atio
n
Ref
rain
s fro
m d
iscu
ssin
g co
nfid
entia
l in
form
atio
n in
ele
vato
rs, h
allw
ays
or
othe
r pub
lic a
reas
whe
re it
may
be
over
hear
d
Dis
pose
s an
d se
cure
s al
l do
cum
enta
tion
cont
aini
ng p
rivile
ged
info
rmat
ion
Hol
ds o
nly
conv
ersa
tions
exp
ress
ly
rela
ted
to th
e cu
stom
er w
hen
in fr
ont
of, o
r with
in e
arsh
ot o
f tha
t cus
tom
er
Mai
ntai
ns p
assw
ord
secu
rity
Lock
s co
mpu
ter w
hen
leav
ing
desk
ar
ea
Def
initi
ons
of B
ehav
iour
All
of b
asic
exp
ecta
tions
+
Rep
orts
inap
prop
riate
use
of
pass
wor
ds a
nd/o
r bre
ache
s in
co
nfid
entia
lity
Def
initi
ons
of B
ehav
iour
All
of b
asic
exp
ecta
tions
+
Rep
orts
inap
prop
riate
use
of
pass
wor
ds a
nd/o
r bre
ache
s in
co
nfid
entia
lity
Men
tors
oth
ers
on p
oten
tial
conf
iden
tialit
y br
each
es
page 6SATISFACTIONsnapshot
1
Doe
s Not M
eet
Immed
iate Im
provem
ent
Requ
ired
2
Doe
s Not Con
sisten
tly Meet
Margina
l Improvem
ent
Nee
ded
3
Consistently M
eets
BASIC EX
PECT
ATIONS
4
Consistently M
eets and
Freq
uently Excee
ds (7
5%)
Exceptiona
l
5
Consistently Excee
ds (9
0%)
Mod
el
Commun
ication Standard 4. R
eturns calls and
other com
mun
ications promptly
Def
initi
ons
of B
ehav
iour
Doe
s no
t ret
urn
calls
or c
omm
unic
ate
(igno
res)
Doe
s no
t pro
vide
cov
erag
e w
hen
out
of o
ffice
Doe
s no
t pro
vide
eno
ugh
info
rmat
ion
to a
llow
follo
w th
roug
h
Def
initi
ons
of B
ehav
iour
Res
pond
s in
an
untim
ely,
non
-co
urte
ous
man
ner
Doe
s no
t set
-up
or k
eep
curr
ent
auto
-resp
onse
s (p
hone
, em
ail)
for
plan
ned
time
off
Def
initi
ons
of B
ehav
iour
Ack
now
ledg
es re
ceip
t of
info
rmat
ion/
requ
ests
with
in 2
4 ho
urs
or th
e st
anda
rd o
f you
r dep
artm
ent,
and
resp
onds
with
in a
n ag
reed
to
amou
nt o
f tim
e
Set
s-up
aut
o-re
spon
ses
whe
n ou
t-of-
offic
e (p
hone
, em
ail)
Def
initi
ons
of B
ehav
iour
All
of b
asic
exp
ecta
tions
+
Con
sist
ently
exc
eeds
acc
epte
d de
partm
ent s
tand
ards
and
regu
latio
n dr
iven
resp
onse
tim
es
Def
initi
ons
of B
ehav
iour
All
of b
asic
exp
ecta
tions
+
Men
tors
oth
ers
to re
spon
d to
cal
ls in
a
timel
y m
anne
r
Commun
ication 5. Keeps peo
ple inform
ed
Def
initi
ons
of B
ehav
iour
Del
iber
atel
y cr
eate
s co
mm
unic
atio
n ba
rrier
s (e
.g.,
with
hold
ing
info
rmat
ion)
Def
initi
ons
of B
ehav
iour
Offe
rs v
ague
or i
ncor
rect
info
rmat
ion
Inco
nsis
tent
ly k
eeps
oth
ers
info
rmed
Def
initi
ons
of B
ehav
iour
Des
crib
es w
hat c
usto
mer
can
exp
ect
and
asks
if th
ere
are
any
ques
tions
Kee
ps o
ther
s in
form
ed a
nd e
xpla
ins
dela
ys, c
hang
es o
r alte
red
expe
ctat
ions
Def
initi
ons
of B
ehav
iour
All
of b
asic
exp
ecta
tions
+
Offe
rs a
dditi
onal
reso
urce
s (p
rinte
d m
ater
ials
, ele
ctro
nic
info
rmat
ion)
Faci
litat
es in
form
atio
n ex
chan
ge
inte
r-an
d in
tra-d
epar
tmen
tally
Offe
rs s
ugge
stio
ns to
impr
ove
com
mun
icat
ion
Def
initi
ons
of B
ehav
iour
All
of b
asic
exp
ecta
tions
+
Follo
ws
thro
ugh
to d
evel
op
sugg
estio
ns fo
r im
prov
ed
com
mun
icat
ion
Initi
ates
follo
w u
p co
mm
unic
atio
n th
at m
ay n
ot b
e re
quire
d bu
t add
s va
lue
to th
e co
mm
unic
atio
n (a
dditi
onal
com
mun
icat
ion)
page 7SATISFACTIONsnapshot
Stan
dards of Beh
aviour Accou
ntab
ility Framew
ork ‐ Initiative
1
Doe
s Not M
eet
Immed
iate Im
provem
ent
Requ
ired
2
Doe
s Not Con
sisten
tly Meet
Margina
l Improvem
ent
Nee
ded
3
Consistently M
eets
BASIC EX
PECT
ATIONS
4
Consistently M
eets and
Freq
uently Excee
ds (7
5%)
Exceptiona
l
5
Consistently Excee
ds (9
0%)
Mod
el
Initiative Standard 1. Steps outside
of role to fu
lfill custom
er needs
Def
initi
ons
of B
ehav
iour
Res
ists
/refu
ses
to a
ct o
n re
ques
ts o
r di
rect
ions
Def
initi
ons
of B
ehav
iour
Nee
ds d
irect
ion
to id
entif
y cu
stom
er’s
spe
cial
nee
ds
Def
initi
ons
of B
ehav
iour
Trea
ts o
ther
s w
ell b
y “d
oing
the
right
th
ing”
Is w
illin
g to
and
/or d
oes
wha
t nee
ds
to b
e do
ne (e
.g.,
pick
ing
up ru
bbis
h,
clea
ning
spi
lls, t
akin
g m
eetin
g m
inut
es, c
lean
ing
up c
onfe
renc
e ro
om, c
lean
ing
out d
epar
tmen
t re
frige
rato
r)
Ass
ists
oth
ers
(e.g
., ca
rryi
ng h
eavy
lo
ads,
ope
ning
doo
rs)
Def
initi
ons
of B
ehav
iour
All
of b
asic
exp
ecta
tions
+
Ass
umes
new
or a
dditi
onal
re
spon
sibi
litie
s
Thin
ks o
f way
s to
exc
eed
cust
omer
ex
pect
atio
ns
Def
initi
ons
of B
ehav
iour
All
of b
asic
exp
ecta
tions
+
Ant
icip
ates
and
act
s on
spe
cial
ne
eds
of c
usto
mer
s
Nav
igat
es th
e sy
stem
and
act
s as
a
cham
pion
on
the
cust
omer
’s b
ehal
f
Wow
s cu
stom
ers
by e
xcee
ding
ex
pect
atio
ns
Initiative Standard 2. Provide
s suggestio
ns and
new
ideas in a positive m
anne
r
Def
initi
ons
of B
ehav
iour
Unw
illin
g to
acc
ept a
role
in
impr
ovin
g th
e or
gani
satio
n
Activ
ely
fight
s ch
ange
Def
initi
ons
of B
ehav
iour
Is c
ompl
acen
t; ac
cept
s st
atus
quo
Rar
ely
offe
rs n
ew s
ugge
stio
ns to
im
prov
e pr
oces
ses
and
is re
sist
ant t
o ch
ange
Def
initi
ons
of B
ehav
iour
Pro
vide
s su
gges
tions
and
new
idea
s fo
r pro
cess
impr
ovem
ent,
cust
omer
ex
celle
nce,
and
/or c
ost e
ffect
iven
ess
Is o
pen-
min
ded
and
rece
ptiv
e to
ch
ange
Def
initi
ons
of B
ehav
iour
All
of b
asic
exp
ecta
tions
+
Enc
oura
ges
co-w
orke
rs, s
uper
viso
r an
d m
anag
er to
thin
k ou
tsid
e th
e bo
x
Is n
ot s
atis
fied
with
“goo
d en
ough
”
Hel
ps w
ith s
ugge
stio
ns to
mov
e us
fro
m g
ood
to g
reat
Act
ivel
y pa
rtici
pate
s in
per
form
ance
im
prov
emen
t pro
ject
s an
d cu
stom
er
exce
llenc
e pr
ojec
ts
Res
earc
hes
chan
ge
Def
initi
ons
of B
ehav
iour
All
of b
asic
exp
ecta
tions
+
Lead
s ch
ange
effo
rts
page 8SATISFACTIONsnapshot
Stan
dards of Beh
aviour Accou
ntab
ility Framew
ork ‐ T
eamwork
1
Doe
s Not M
eet
Immed
iate Im
provem
ent
Requ
ired
2
Doe
s Not Con
sisten
tly Meet
Margina
l Improvem
ent
Nee
ded
3
Consistently M
eets
BASIC EX
PECT
ATIONS
4
Consistently M
eets and
Freq
uently Excee
ds (7
5%)
Exceptiona
l
5
Consistently Excee
ds (9
0%)
Mod
el
Team
work Standard 1. Takes prid
e in th
e Organisation
Def
initi
ons
of B
ehav
iour
Spea
ks n
egat
ivel
y of
the
orga
nisa
tion
and
indi
vidu
als
with
in
the
orga
nisa
tion
Def
initi
ons
of B
ehav
iour
Doe
sn’t
supp
ort m
anag
emen
t
Def
initi
ons
of B
ehav
iour
Follo
ws
thro
ugh
on w
hat i
s ex
pect
ed
and
assi
gned
Spe
aks
wel
l of t
he O
rgan
isat
ion
Tak
es p
rope
r car
e of
wor
k en
viro
nmen
t and
mai
ntai
ns
equi
pmen
t
Def
initi
ons
of B
ehav
iour
All
of b
asic
exp
ecta
tions
+
Follo
ws
thro
ugh
with
man
agem
ent
initi
ativ
es, p
lans
and
stra
tegi
es
Def
initi
ons
of B
ehav
iour
All
of b
asic
exp
ecta
tions
+
Is a
role
mod
el fo
r oth
ers
to fo
llow
by
dem
onst
ratin
g qu
ality
, exc
elle
nce
and
enth
usia
sm in
per
form
ing
job
dutie
s
Team
work Standard 2. W
orks with
other dep
artm
ents to
ensure the efficient delivery of care and services in
