31 st august 2007 domains and dimensions of health systems research health systems research: purpose...
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Health Systems Research: Purpose and Scope
Stiofan de Burca
Health Systems Research Centre, UL
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Health
• Status & Needs: – Origins, problems, environmental ecology
• Services – Determinants and orientation– Limitations in complexity
• For All (WHO/ Alma Ata, 1978) – Diversity of stakeholders and inputs– Primary health care approach …individuals & communities … at
the centre of attention
• System– Community, Delivery System & Environment– Compatibility of these elements?
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IDRC
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IDRC
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What focus?
• Research– Health problems & technologies
• Services Research– Operation & modes of delivery – Needs, provision and performance / impact
• Systems Research– Philosophy .. Timely, policy relevant, R&D link, collaborative,
participative– Mode of working.. Totality explored, multidisciplinary and multi-
sectoral– Field .. Systems, recognises and addresses complexity of issues
and interventions
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Health Systems Research• Purpose
– Inform policy, management and professional practice to …– Empower decision-makers to – Improve people’s health & well-being through optimal use of resources
and opportunities to– Enable participation & contribution … social and economic life
• Context– Complexity of health sector issues, policies & programmes
• Orientation– Problem-solving, action-oriented, timely and relevant– Multi-disciplinary, participative
• Perspectives– Levels, functions and roles that normally connect– Multi-disciplinary and trans-disciplinary teamworking and understanding
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Consequences of Limiting Participation
• Decision-makers – Limited to post-study .. “shelved”
• Staff / community– Limited to data collection or response …
motivation for accuracy
• Researchers– No role in implementation … feasibility
of Recs?
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HSyR General Topics• Comparative performance
– Comparability of health care systems!• Effectiveness
– Theory, measurement, evaluation and outcomes– Clinical & population perspectives
• Efficiency– Allocative and production– Derived demand function for medical care
• Equity– Sociology & behavioural model– Substantive & procedural– Characteristics of community variations
• Policy analysis– Rational comprehensive– Problem of allocative processes … cost utility– Informed democratic decisions, veil of ignorance
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Health Systems Research Centre
• DoHC / HSE support
• Policy Advisory Group
• External Academic Advisory Group
• Management Committee
• Stakeholder Groups
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Current projects
1. Experience of ageing in the community
2. Community mental health teams: determinants of effectiveness
3. Customised QI Frameworks for Clinical Directorates (Pilot)
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Experience of Ageing in the Community
• Problem / policy context– Consequences of variability in health and socio-economic status
in local neighbourhoods (Limerick cluster: 4 parishes)• Objectives
– Understanding of causes & consequences of variation • inform policies & practice • improve expectancy & quality of life in reducing disparities between
local communities– Inform & develop a forum & continuing partnership with older
people • active citizens & consumers .. • enabling independence & self-(health) management
– Identify areas for improvement in provision .. • Design, delivery & coordination .. • Changes relating to individuals, communities, services and systems
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Experience of Ageing in the Community
• Complexity– Multiple lifetime and current variables & contexts that affect
health status in older people .. – Result … dependency / independence status– Levels & categories of current interventions & outcomes by
whom & for whom?– Connecting objective & subjective health status indicators with
ecological factors!
• Team composition– Thomond Cluster (parish & older people)– Public and voluntary sector stakeholders (HSE, LA, PAUL, WLR)– Research Team .. HSyRC, Sociology, Dept of Medicine for Older
People, MWRH (HSE West)
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Community Mental Health Teams: Determinants of Effectiveness
• Problem / Policy Context– Reported performance of multidisciplinary teams in
mental health services after more than 20 years of change & implications for service users
• Objectives– Profile the functioning of CMHTs & factors affecting
their performance– Explore the determinants of and barriers to team
effectiveness– How to improve team working?– Translation & adoption strategies to ensure outcomes
influence practice
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Community Mental Health Teams: Determinants of Effectiveness
• Complexity– Context of Total System Reform & delivery of a major multi-
method study of key stakeholders (user, provider, system)– Systemic, intrinsic and professional constraints– Clinical teams in embedded influencing context (e.g.
externalities)– Problem of causality & attribution in complex dynamic
environments
• Team composition– Mental Health Directorate HSE– HSyRC & Strategic Health Management Research Group UL– Expert Panel incl. User Rep and Professionals– CMHT Liaison and HSE MH Network
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Customised QI Frameworks for Clinical Directorates
• Problem / policy context– Reliability in the service delivery system .. – Summative statement of performance … – Achievement of optimal outcomes, role of clinicians in
management & clinical governance
• Objectives– Map current policy, procedures, practices, recording &
reporting … espoused theory and theory in use, & preferred theory
– Create an effective partnership to move to reflective adoptive, implementing and evaluative phases
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Customised QI Frameworks for Clinical Directorates
• Complexity– Context of Total System Reform & adopted
embedded strategies– Early stage development of CD and / or QI
programmes– Concurrent developments and demands– Prior exposure to organisational research
• Team Composition– W&C Directorate, HR, Q&R GUH– Liaison Group– HSyRC, Enterprise Research Centre & Strategic
HMR Group UL