annex - european commission...the infographic on adherence gives an overview of the issue of...
TRANSCRIPT
1
AG A1. Annex. Workshop Report. Planning for the future 2016-‐2018
European Innovation Partnership on Active and Healthy Ageing
Annex
• List of participants • Communication (fiche distributed + infographic A1 Singel Column + Infographic A1 Printer
Friendly) • CSA PROEIPAHA (PPT distributed) • Scaling up Strategy of the European Union • Fiches of each project idea discussed in the afternoon
European Innovation Partnership on Active and Healthy Ageing
List of participants
Surname Name E-Mail Organisation
Bergkvist Christensen Anna [email protected] Skåne County Council Bolufer De gea Ángela Angela.BOLUFER-DE-
[email protected] European Commission - DG SANTE
Capian Raphael [email protected] European Commission - DG SANTE
Carlos de la Cruz Martinez [email protected] MICOF-Valencia Dévé Isabelle [email protected] European Commission - DG
SANTE Folgado Martín Juan Jose [email protected] MICOF-Valencia Gatzoulis Loukianos [email protected] European Commission - DG
SANTE Giardini Anna [email protected] S. Maugeri Foundation Isiegas Germán Carolina [email protected] BMA (BIO-MED ARAGÓN) Mair Alpana [email protected] NHS Scotland Martín Gutiérrez Laura [email protected] Consejo General de Colegios
Oficiales de Farmacéuticos - Madrid
Martínez Usero José Angel [email protected] Funka Nu AB - Spain Massot Mireia [email protected] Catalan Health Institute_IDIAP
Jordi Gol Menditto Enrica [email protected] University of Naples Federico
II Monaco Alessandro [email protected] AIFA Novak Dominika European Commission -
facilitator Ocaña Noriega Gema [email protected] Junta de Andalucía -
Delegación en Brusselas Pardo López María Ángeles [email protected] Universidad Miguel
Hernández de Elche Pepiol Salom Enrique [email protected] MICOF-Valencia Pinto Antunes Jorge [email protected] European Commission - DG
SANTE Prados Torres Alexandra [email protected] Grupo EpiChron de
Investigación en Enfermedades Crónicas
Riegler Salvatore [email protected] University of Naples Federico II
Roman Nora [email protected] European Commission - DG SANTE
Salvador Rute [email protected] Ageing@Coimbra - Pharmacists Association
Santos Lúcia [email protected] Ageing@Coimbra - Pharmacists Association
Savin Magda [email protected] GIRP Toft Conrad European Commission -
facilitator Toppi Nicole [email protected] GIRP Quilici Sibilia [email protected] Sanofi Pasteur MSD Zara Yahni Corinne [email protected] Regió Sanitària
Barcelona/Consorci Sanitari de Barcelona
EUROPEAN COMMISSION DIRECTORATE-GENERAL HEALTH AND FOOD SAFETY
Action Group A1 Communication activities 2015 Page 1 of 2
COMMUNICATION ACTIVITIES 2015
1. COMMUNICATION ACTIVITIES CONDUCTED TO RAISE AWARENESS ON THE A1 ACTION GROUP ON
ADHERENCE
1.1. INFOGRAPHICS
Coinciding with European Summit on Active & Healthy Ageing, the European Commission launched a
series of infographics which offer an overview of the work undertaken by the Partnership to respond to
the societal challenge of ageing.
The infographic on adherence gives an overview of the issue of adherence to medical plans to allow a
better understanding of what it is, raise awareness and explain which actions are being undertaken by
the European Innovation Partnership on Active and Healthy Ageing in this field.
1.2. SUMMIT VIDEO
Also coinciding with European Summit on Active & Healthy Ageing, partners were offered the possibility
to submit videos featuring the results of their commitments. A video loop of all the received submissions
was produced. The European Commission is looking into publishing this video in the Marketplace
complying with copyright issues.
1.3. NEWSLETTER INTERVIEWS
The EIP Newsletter, issued every month, has a section dedicated to partners' achievements in which
results from individual commitments and collaborative work are highlighted.
As an example, the March newsletter featured the CatSalut initiative 'Health Education Programme
targeting the Elderly on the Correct Use of Medicines' (PESGG) which aims to promote the proper use
of medicines amongst older people.
1.4. SPEAKING OPPORTUNITIES
Throughout the year partners have been contacted in order to be offered speaking opportunities in
events or conferences. These opportunities have been offered to partners with already submitted
finished deliverables that were of relevance in specific agenda and programme items of these events.
Some examples are the eHealth week, the 3rd Conference of Partners or the 2015 European Summit on
Active & Healthy Ageing.
Action Group A1 Communication activities 2015 Page 2 of 2
2. ADDITIONAL COMMUNICATION ACTIVITIES FORESEEN FOR 2015
2.1. PUBLICATION ON THE A1 ACTION GROUP
Depending on the results and deliverables of the collaborative activities, a publication on the work
undertaken by the Action Group A1 since its inception could be produced for the 4 th Conference of
Partners.
The document would be produced by the European Commission together with Partners and would
highlight the vision of the group to improve adherence to medical plans, as well as individual and
collaborative achievements.
2.2. VIDEO ON THE A1 ACTION GROUP
Under the contract with the PROEIPAHA Consortium the production of a video drawing attention to the
achievements of each of the Action Groups is foreseen. More information on this activity will follow
during the year.
2.3. MULTIMORBIDITY CONFERENCE
Following the interesting work on multimorbidity and polypharmacy highlighted by Action Group A1
partners and the interest of EIP partners on the topic, the European Commission will organise a
Conference on Multimorbidity.on 27 October 2015 in Brussels.
The goal of the conference is to identify gaps and potential initiatives to make multimorbidity a priority in
public health policy in Europe. The conference will be a participatory event in which the floor is given to
the participants themselves, to explore and debate on the issues they consider relevant. These
discussions will be supported by professional facilitators. 150 participants are expected.
A preparatory workshop will also be organised with the members of the Multimorbidity synergies groups
as well as with representatives of EU-funded projects that have working packages on multimorbidity.
WHAT IS ADHERENCE?
Adherence to medical plans for older peopleA European Innovation Partnership on Active and Healthy Ageing priority
The overall adherence process consists of:*
Adherence is the extent to which a person's behaviour corresponds with agreed recommendations from a healthcare professional. It encompasses:
APPROPRIATENESS INITIATION IMPLEMENTATION PERSISTENCE
prescribing the righttreatment to the patient
filling the prescriptionin the hospital or pharmacy
taking the medicinesfollowing the prescription
continuing the treatmentfor its whole duration
medication physical activity diet visits to health professionals
*e.g
. whe
n ta
king
med
icin
es
WHAT HAPPENS IF PATIENTS DO NOT ADHERE TO THEIR MEDICAL PLANS?
Consequences for patients
potential harm or little clinical benefit
risks due to additional prescribing
development of resistance to therapy (e.g. antibiotics)
!Consequences for the healthcare system
the cost of initial care service
medicines dispensed but not used
increased use of health servicesin cases of worsening of symptoms
!
Increased health costs due to:
WHY ARE WE WORKING ON ADHERENCE…
… IN AN AGEING POPULATION?
of patients typically take their medications as prescribed
premature deaths per year among Europeans are related to non-adherence
"Increasing the effectiveness of adherence interventions may have a far greater impact on the health of the population than any improvement in specific medical treatments"
Multimorbidity, the co-occurrence of multiple diseases, affects more than half of the elderly population
Polypharmacy, the simultaneous use of multiple medicines by a single patient, for one or more conditions, is common in older people: 40% of people aged 65and over consume between five and nine medicines per week
Share of populationover 65 is increasingin OECD countries:
28,4%
18,2%
28.4%
18.2%
2013 2060
Euro
stat
50% 200,000
WH
O re
port
on
adhe
renc
e to
long
-ter
m th
erap
ies
Cost
ing
stat
emen
t: M
edic
ines
adh
eren
ce, N
ICE
ONLY NEARLY
Health illiteracy (lack of understanding of one’s condition and significance) and health beliefs
Non-adherence can be motivated by several factors:
WHY DO PATIENTS NOT ADHERE TO THEIR MEDICAL PLANS?
Access to healthcare (e.g. cost of medication, geographical availability)
Misunderstanding of prescription instructions
Forgetfulness
Complex regime (high number of medicinestaken at different times) or restrictive precautions (e.g. no alcohol or cheese)
Reduction, fluctuation or disappearance of symptoms
Adverse effects (real or imagined)
?
!
?
The European Innovation Partnership on Active and Healthy Ageing (EIP on AHA)The European Innovation Partnership on Active and Healthy Ageing (EIP on AHA), set up in 2012, gathers stakeholders at EU, national and regional level from the public and private sector across different policy areas. Together they share knowledge and expertise on common interests and engage in activities and projects to find innovative solutions that meet the needs of the ageing population.
Under the framework of the EIP on AHA, the Action Group on adherence to medical plans works to improve the quality of life and health outcomes of older people by supporting patient adherence to care plans while empowering them and delivering improvements in the healthcare system.
https://webgate.ec.europa.eu/eipaha/
HOW ARE WE IMPROVING ADHERENCE TO MEDICAL PLANS IN OLDER PEOPLE?
hospital pharmacy
CardiologistGP Orthopaedist
Prescription of several drugs, physical activity & nutrition advice
PROBLEMSENCOUNTERED
WORK UNDERTAKEN BY THE EIP ON AHA
The European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) supports public and private actors across the EU to improve adherence to medical plans through a multidisciplinary approach that impacts upon each step of the patient’s journey through the healthcare system.
• System works in silos• Prescriptions not cross-checked
• Electronic prescription• Collaborative digital platforms
between HCP• Integrated care approaches• Decision-support tools for
appropriateness of prescription (e.g. guidelines, dispensing protocols, risk stratification)
• Patient electronic health records• Training programmes for HCP
• Health literacy and lifestyle interventions (including ICT tools) around medicines, physical activity & nutrition
• Medication review for appropriateness of prescription
• Web-based social platforms• Information and counselling
campaigns
• Patient misunderstands the health problem or prescription instructions
• Patient forgets to take medication• Patient has a complex
medication regime• Patient misunderstands
prescription instructions• Patient has an adverse
drug reaction
• More knowledge and evidence needed on adherence related issues, especially in polymedicated patients
• Need to identify most effective interventions
• Electronic devices and alert systems• Age-friendly medicines
and packaging (e.g. Personalised Dosage Sytems)
• Adherence monitoring platforms for HCP
• Medication review and reconciliation protocols
• Pharmacovigilance tools
• Indicators/algorithms on appropriate prescription, adherence measurement, polypharmacy
• Scientific studies on adherence related issues
• Data repositories• Cost-effectiveness and
intervention analyses
Old personwith severalconditions
Focus on prescription of drugs
Patient fills in prescription of drugsat hospital or community pharmacy
Patient seeks assistancein case of problems with medication
?
Visits to different healthcare professionals (HCP)
?
!
H
ND
-02-
14-8
14-E
N-N
WHAT IS ADHERENCE?
Adherence to medical plans for older peopleA European Innovation Partnership on Active and Healthy Ageing priority
The overall adherence process consists of:*
Adherence is the extent to which a person's behaviour corresponds with agreed recommendations from a healthcare professional. It encompasses:
APPROPRIATENESS INITIATION IMPLEMENTATION PERSISTENCE
prescribing the righttreatment to the patient
filling the prescriptionin the hospital or pharmacy
taking the medicinesfollowing the prescription
continuing the treatmentfor its whole duration
medication physical activity diet visits to health professionals
*e.g
. whe
n ta
king
med
icin
es
WHY ARE WE WORKING ON ADHERENCE…
… IN AN AGEING POPULATION?
of patients typically take their medications as prescribed
premature deaths per year among Europeans are related to non-adherence
"Increasing the effectiveness of adherence interventions may have a far greater impact on the health of the population than any improvement in specific medical treatments"
Multimorbidity, the co-occurrence of multiple diseases, affects more than half of the elderly population
Polypharmacy, the simultaneous use of multiple medicines by a single patient, for one or more conditions, is common in older people: 40% of people aged 65and over consume between five and nine medicines per week
Share of populationover 65 is increasingin OECD countries:
28,4%
18,2%
28.4%
18.2%
2013 2060
Euro
stat
50% 200,000
WH
O re
port
on
adhe
renc
e to
long
-ter
m th
erap
ies
Cost
ing
stat
emen
t: M
edic
ines
adh
eren
ce, N
ICE
ONLY NEARLY
Health illiteracy (lack of understanding of one’s condition and significance) and health beliefs
Non-adherence can be motivated by several factors:
WHY DO PATIENTS NOT ADHERE TO THEIR MEDICAL PLANS?
Access to healthcare (e.g. cost of medication, geographical availability)
Misunderstanding of prescription instructions
Forgetfulness
Complex regime (high number of medicinestaken at different times) or restrictive precautions (e.g. no alcohol or cheese)
Reduction, fluctuation or disappearance of symptoms
Adverse effects (real or imagined)
?
!
?
WHAT HAPPENS IF PATIENTS DO NOT ADHERE TO THEIR MEDICAL PLANS?
Consequences for patients
potential harm or little clinical benefit
risks due to additional prescribing
development of resistance to therapy (e.g. antibiotics)
!Consequences for the healthcare system
the cost of initial care service
medicines dispensed but not used
increased use of health servicesin cases of worsening of symptoms
!
Increased health costs due to:
The European Innovation Partnership on Active and Healthy Ageing (EIP on AHA)The European Innovation Partnership on Active and Healthy Ageing (EIP on AHA), set up in 2012, gathers stakeholders at EU, national and regional level from the public and private sector across different policy areas. Together they share knowledge and expertise on common interests and engage in activities and projects to find innovative solutions that meet the needs of the ageing population.
Under the framework of the EIP on AHA, the Action Group on adherence to medical plans works to improve the quality of life and health outcomes of older people by supporting patient adherence to care plans while empowering them and delivering improvements in the healthcare system.
https://webgate.ec.europa.eu/eipaha/
• Health literacy and lifestyle interventions (including ICT tools) around medicines, physical activity & nutrition
• Medication review for appropriateness of prescription
• Web-based social platforms• Information and counselling
campaigns
HOW ARE WE IMPROVING ADHERENCE TO MEDICAL PLANS IN OLDER PEOPLE?
hospital pharmacy
CardiologistGP Orthopaedist
Prescription of several drugs, physical activity & nutrition advice
PROBLEMSENCOUNTERED
WORK UNDERTAKEN BY THE EIP ON AHA
The European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) supports public and private actors across the EU to improve adherence to medical plans through a multidisciplinary approach that impacts upon each step of the patient’s journey through the healthcare system.
• System works in silos• Prescriptions not cross-checked
• Electronic prescription• Collaborative digital platforms
between HCP• Integrated care approaches• Decision-support tools for
appropriateness of prescription (e.g. guidelines, dispensing protocols, risk stratification)
• Patient electronic health records• Training programmes for HCP
• Patient misunderstands the health problem or prescription instructions
• Patient forgets to take medication
• Patient has a complex medication regime
• Patient misunderstands prescription instructions
• Patient has an adverse drug reaction
• More knowledge and evidence needed on adherence related issues, especially in polymedicated patients
• Need to identify most effective interventions
• Electronic devices and alert systems
• Age-friendly medicines and packaging (e.g. Personalised Dosage Sytems)
• Adherence monitoring platforms for HCP
• Medication review and reconciliation protocols
• Pharmacovigilance tools
• Indicators/algorithms on appropriate prescription, adherence measurement, polypharmacy
• Scientific studies on adherence related issues
• Data repositories• Cost-effectiveness and
intervention analyses
Old personwith severalconditions
Focus on prescription of drugs
Patient fills in prescription of drugsat hospital or community pharmacy
Patient seeks assistancein case of problems with medication
?
Visits to different healthcare professionals (HCP)
?
!
H
ND
-02-
14-8
14-E
N-N
1
2
The goal is to help addressing the challenges identified by the stakeholders and the experts group report, by providing a wide range of high quality support services for the EIPAHA, from secretariat services, R&I facilitation, policy guidance, awareness and stakeholder’s engagement support, fostering open and sustainable collaboration. IMPORTANT: The project is not designed as a coordination of EIPAHA, but as a support to the existing structures of governance, such as coordinators and thematic networks, in order to provide the tools and methodologies to help them deliver the expected results.
3
The consortium is composed by a balanced set of organization to provide high quality support services to the existing and future Action Plans, identifying synergies across Action Groups, and providing expert knowledge on Research and Innovation on Active and Healthy Ageing (in wide range of domains impacting the issue), policy and legislation, standardization, innovative procurement, knowledge sharing tools and governance methods, plus dissemination and awareness activities.
4
5
6
The PROEIPAHA Consortium brings together 14 organizations considered as European “knowledge champions” in the different topics pointed out by the call and related to EIPAHA. FUNKA, PAU and OUT have extensive experience providing support services to the European Commission and the EIPAHA Action in managing and coordinating the execution of the Action Plan. SWE, CDR, ERRIN and OE have a varied expertise in the area of funding instruments, policy analysis and monitoring in the AHA arena. VTT, TCNL and INO bring to the Consortium a long track record of R&D initiatives connected with EIPAHA, as well as capabilities for research analysis, definition of research priorities and elaboration of R&D roadmaps. AENOR and EHMA are contributing more to the standardisation initiatives, and finally, NHG and RESAH contribute with unique expertise in innovative procurement and an impressive networking capability in this field. Form a more practical perspective, FUNKA is the Scandinavian leader in the development of accessible ICT web solutions. Therefore FUNKA will be responsible for the project website and the Knowledge Management platform. PAU is one of the most relevant communication agencies running European initiatives (in fact PAU was responsible for the EC EY2011 and EY2012 campaigns). In a similar way OE has become a specialist in online policy debates at EU level. Finally, OUT has relevant experience with stakeholders’ engagement in Digital Agenda initiatives.
7
To sum up, the PROEIPAHA Consortium is composed by a set of partners that have been selected taking into account their potential contribution to the project outcomes, results and impact, covering the different topics addressed in the call. The consortium is also supported by a group of 4 Collaborators: AGE Platform, UPC, Empirica and ETSI.
7
8
9
10
11
12
WP1 on “Support to EIPAHA Action Plans” provides typical “secretariat” services to contribute to the efficient management of the Action Groups. Moreover, the Consortium has planned the role of “promoter” that will be a relevant organisation building the bridge between EIPAHA existing Action Groups and the PROEIPAHA Consortium, facilitating the information interchange, providing dynamisation activities and contributing to the leverage of the varied activities carried out in the context of the 6 existing Action Groups. WP 2 on “Support to new Action Plans and Synergies” is devoted to the conceptualisation of methodological activity, providing relevant “methods” that will efficiently contribute to the development of potential new Action Plans and the formalisation of synergies among Action Groups. Once the Action Plans and Synergies are conceptualised, PROEIPAHA will provide also a “secretariat” support services and a “promoter” for them. These tasks will depend on EC decisions regarding policy and strategy. Therefore, the methodological work will be adapted to EC needs and expectations. WP 3 on “Knowledge Sharing, Collaboration and Engagement” sets up the “tools” to facilitate knowledge interchange among EIPAHA members, foster collaboration and strengthen engagement. WP 4 “Policy analysis and monitoring”, WP 5 on “Research and Innovation”, WP 6 on “Standardisation” and WP 7 on “Innovative procurement” are providing expert “knowledge” to contribute to build more favourable framework conditions to implement
13
the actions outlined in the Action Plans. WP 8 on “Dissemination” is facilitating awareness, related events, publicity, media attention and social network impact regarding the key outcomes of the EIPAHA Action Plans. Finally, WP 9 on “Project Management” is a horizontal work package oriented to the overall management of the project to effectively monitor the project in administrative, technical and financial terms.
13
14
15
16
17
18
19
20
...
European
.
Strategy
.
in Active &Healthy Ageing
.
The European Innovation Partnershipon Active and Healthy Ageing
...
s
.
c
.
a
.
l
.
i
.
n
.
g
.
-
.
u
.
p
DISCLAIMER
By the European Commission.
The information and views set out in this publication are those of the au-thors and do not necessarily reflect the official opinion of the Commission.The Commission does not guarantee the accuracy of the data included. Nei-ther the Commission, the Action Groups nor the Reference Sites may be heldresponsible for the use which may be made of the information containedtherein.
© European Union, 2015. All rights reserved. Certain parts are licensedunder conditions to the EU.
Reproduction is authorised provided the source is acknowledged.
EuropeanScaling-upStrategy
in Active andHealthy Ageing
Part of the European Innovation
Partnership on Active and Healthy Ageing
Contents
Introduction 6The European Innovation Partnership on Active and Healthy Ageing . . . . . . . . . . . . 6Scaling-up . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Definition of scaling-up . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
What to scale-up? 10Step 1 - Building a database of good practices . . . . . . . . . . . . . . . . . . . . . . . . . 10Step 2 - Assessment of viability of good practices for scaling-up . . . . . . . . . . . . . . 11Step 3 - Classification of good practices for replication . . . . . . . . . . . . . . . . . . . . 13
How to scale-up? 15Step 4 - Facilitating parterships for scaling-up . . . . . . . . . . . . . . . . . . . . . . . . . 15
Collaborators' roles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Diffusion of good practices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Step 5 - Implementation - Key success factors and lessons learnt . . . . . . . . . . . . . 17Planning the innovative service, and setting up a system for change . . . . . . . . 18Organisational process and design choices . . . . . . . . . . . . . . . . . . . . . . . 23Monitoring, evaluation and dissemination . . . . . . . . . . . . . . . . . . . . . . . . 26
Actions and timetable 30
Bibliography 33
Introduction
Health and care services in Europe are undergoing changes to adapt systemsto a growing demand caused by ageing and the expansion of chronic dis-eases. is restructuring, which combines health and social care resources,involves the developing and testing of innovative solutions and eventuallythe large-scale implementation of the most successful practices.
e multitude of good examples developed throughout the EU has ledto a realisation that a comprehensive scaling-up strategy is needed at Eu-ropean level. e European Innovation Partnership on Active and HealthyAgeing (EIP AHA or Partnership), which brings together key stakeholders inthis policy area and supports the good practices and References Sites devel-oped by its partners, can act as a catalyst to foster scaling-up across regionsand countries.
is paper presents five steps for seing up an effective European scaling-up strategy. e first three constitute a ”what to scale up” element, whilethe remaining two constitute the ”how to scale up” part. ese steps areshown in Figure 1.
..Step 1 - Building a database of good practicesStep 2 - Assessment of viability of good practices for scaling-upStep 3 - Classification of good practices for replication
.
Step 4 - Facilitating partnerships for scaling-upStep 5 - Implementation: key success factors and lessons learned
. What?.
How?Figure 1: Five steps for an effective Euro-pean scaling-up strategy.Step 5 sets a framework for developing an individual scaling-up strategy
and provides the reader with a set of practical examples from the Partner-ship on how the different stages of implementation have been successfullyaccomplished. ese consist of:
1. Planning the innovative service and seing up a system for change
2. Organisational process and design choices
3. Monitoring, evaluation and dissemination
The European Innovation Partnership on Active and HealthyAgeing
e Partnership was established in 2012, and is now in its implementationstage with more than 3.000 partners involved (300 leading organisationsare actively forming coalitions and consortia, covering stakeholders from
- 7
all EU Member States, representing approximately 1,000 regions and mu-nicipalities).
e Strategic Implementation Plan of the EIP AHA focuses on promot-ing people oriented, demand driven innovation for ageingwell, which bringstangible and proven benefits to end-users, helps health and care systems tocontain costs and unlocks business opportunities on European scale.
Partners are working in two main strands: (1) the Reference Sites, whichare 32 regions, cities, or integrated hospitals/care organisations that imple-ment a comprehensive, innovation-based approach to active and healthyageing and can give concrete evidence and illustrations of their impact onthe ground; and (2) the 6 Action Groups, which over 3,000 partners havejoined by submiing a Commitment (over 500 commitments received). eAction Groups focus on sharing information and solutions on how to over-come bolenecks, pooling knowledge and resources and acting towardsshared goals.
..A1 Prescription and adherence to medical plans
By 2014: To deliver tangible adherence approaches for various chronic disease areas in at least 30 EU regions.
..A2 Personalised health management and falls prevention
By 2015: To have in at least 10 European countries (15 regions) validated and operational programmes for earlydiagnosis and prevention of falls.
..A3 Prevention and early diagnosis of frailty and functional decline
By 2015: to have validated programmes for prevention of functional decline and frailty (with first action focusedon malnutrition) among older people supported by tools, networks and information reaching at least 1,000 careproviders across the EU.
..B3 Replicating and tutoring integrated care for chronic diseases, including remote monitoring atregional level
By 2015: Availability of programmes for chronic conditions/case management (including remote manage-ment/monitoring) serving older people in at least 50 regions, available to at least 10% of the target population(patients affected by chronic diseases in the regions involved).
By 2015-2020: Based on validated, evidence-based cases, scale-up and replication of integrated care pro-grammes serving older people, supported by innovative tools and services, in at least 20 regions in 15 MemberStates.
..C2 Development of interoperable independent living solutions
By 2015: Availability of key global standards and validated implementations of interoperable platforms, solutionsand applications for independent living, and also, availability of evidence on the return on investment of thesesolutions and applications, based on experience involving at least 10 major suppliers, 100 SMEs and 10,000users.
..D4 Innovation for age-friendly buildings, cities & environments
By 2012: launching, based on the WHO age friendly cities initiative, a network of majorcities/regions/municipalities committed to deploying innovative approaches to make their living environmentmore age friendly, including the use of ICT solutions.
Table 1: Deployment targets in the Partner-ship’s Strategic Implementation Plan
8
..Strategic visionfor Active andHealthy Ageing
. Mobilising & engag-ing critical mass
.
Pooling expertise& resources
(Action Groups)
.
Recognisingexcellence (RS &AG good practices)
. Scaling-up lo-cal successes
.Areas for action& evidencebased policy)
Figure 2: EIP AHA model of the stages ofimplementation
eActionGroupswork towards the clear deployment targets in each ofthe six Specific Actions of the Partnership’s Strategic Implementation Plan:
Scaling-up
e scaling-up strategy constitutes another step in the development of theEIP AHA. e EIP AHA scaling-up ambition can be defined as follows:
To mobilise sufficient resources and expertise, which combined with thecollection of good practices and Reference Sites experiences, will ensureimplementation of innovative solutions for active and healthy ageing on a
European scale.
Definition of scaling-up
eWHO Guide for scaling-up1 defines the term as 1 World Health Organization. Practicalguidance for scaling up health serviceinnovations. WHO, Geneva, 2009.http://whqlibdoc.who.int/publications/2009/9789241598521_eng.pdf
``... deliberate efforts to increase the impact of health serviceinnovations successfully tested in pilot or experimental projects so as
to benefit more people and to foster policy and programmedevelopment on a lasting basis.''
is definition stresses the importance of recognising the innovative so-lutions that are first successfully piloted and then become a mainstreampolicy.
..Database of goodinnovative practices
.
What to scale up
1. Proven Good Practices(GPs)
2. Viability of GPs
3. Classification of GPs forreplication locally
.
How to scale up
4. Facilitating partnerships
5. Implementation - keysuccess factors andlessons learned
Figure 3: e European Scaling-up strategy:e five-step model of scaling-up.
- 9
But scaling-up is not only about quality of the impact, scale and sus-tainability.2 e literature identifies four types of scaling-up in terms of 2 A Hartmann and J Linn. Scaling up:
A framework and lessons for developmenteffectiveness from literature and practice.Wolfensohn Center for DevelopmentWorkingPaper, (5), 2008
structures, programs, strategies or resource bases: quantitative, functional,political or organisational3 (for details see the Annex).
3 P Uvin. Fighting hunger at the grassroots:paths to scaling up. World Development, 23(6):927–939, 1995
Despite their differences all these dimension of scaling-up are interre-lated and oen go together as scaling-up rarely occurs in one single dimen-sion. antitative or functional scaling-up requires organisational adjust-ments and further expansion is triggered by political developments.
scaling-up is oen considered as a continuous process of change andadaptation that can take different forms. It requires selection of good prac-tices, the assessment of their viability for scaling-up, the adjustment of goodpractices for replication locally followed by the lengthy implementation pro-cess.4 Relevant work on scaling-up has been carried by various organisa- 4 A Hartmann and J Linn. Scaling up:
A framework and lessons for developmenteffectiveness from literature and practice.Wolfensohn Center for DevelopmentWorkingPaper, (5), 2008
tions such as the ExpandNet and WHO5 and the Centre for Telemedicine
5 World Health Organization and Ex-pandNet. Nine steps for developing ascaling-up strategy. WHO, Geneva,2010. http://www.expandnet.net/PDFs/ExpandNet-WHO%20Nine%20Step%20Guide%20published.pdf
and Telehealthcare in the Region of Central Denmark.6
6 Centre for Telemedicine and Telehealth-care. Check! Telehealthcare at Scale.Central Denmark Region, 2013. http://www.rm.dk/files/Sundhed/Center%20for%20Telemedicin/English/Check_final_UK.pdf
eapproach proposed in this paper focusses on two key elements—whatto scale up and how to scale up. e what includes identifying practices,projects and innovations to be scaled up, and the how focuses on the meth-ods of going to scale. e laer part also discusses the organisational rolesinvolved in scaling-up (who and where) in the European context.
What to scale-up?
Step 1 - Building a database of good practices
Good practices are inspiring real-life examples of successfully applied inno-vations in active and healthy ageing. e Partnership, through the work ofthe Action Groups and Reference Sites, developed a collection of examplesof what needs to be done for ageing people to stay active, independent andhealthy for as long as possible. ese also examined how to innovate inhealth and social care systems, and in age-friendly environments, in orderto cater for real needs in a more effective and efficient way.
Action Groups ecollections reveal a snapshot of innovative practices acrossthe EU in 2013 in the areas covered by the Actions Groups.7 7 Action Group specific collections of good
practices can be found on http://europa.eu/!xJ44MMReference Sites e Excellent Innovation for Ageing “How to” Guide pro-
vides valuable information on how the Reference Sites have created theirsuccesses, what they learned along the way, and what elements of theirapproach could be transferred to or copied by others.8 8 European Commission. Excel-
lent Innovation for Ageing—“Howto” Guide. 2nd edition, 2014. http://ec.europa.eu/research/innovation-union/pdf/active-healthy-ageing/how_to.pdf
e templates used by the Action Groups and Reference Sites for thiscollection used broadly the same key elements, described below.9
9 e templates were built according toCORRECT features—seven key characteris-tics of innovation that have been foundto facilitate its wider application. esefeatures must be Credible, Observable,Relevant, Relative advantage, Easy andCompatible.
For further reference please refer toE M Glaser, H H Abelson, and K N Garrison.Puing knowledge to use: Facilitating the dif-fusion of knowledge and the implementationof planned change. Jossey-Bass, San Fran-cisco, 1983.
• Description of the practice—methodology, process (how it was done),timing, target population, objectives, funding.
• Innovation—key innovative elements and ways of overcoming barriersto innovation.
• Impact / results—evidence on the coverage, health benefits, system’s im-proved efficiency.
• Formal or informal evaluation / added value.
• Success criteria used to determine whether the initiative is working well.
• Transferability aspects for other organisations / regions.
• Lessons learnt and recommendations for others.
rough this work on the good practices from the Action Groups andthe Reference Sites’ “How to” guide, various lessons learnt and key successfactors for effective scaling-up are emerging. is knowledge and collectionof good practiceswill eventually expand into an on-line database, whichwillserve as a toolkit for successful scaling-up.
- 11
While extensive reference has been made so far to good practices com-ing from EIP AHA stakeholders, it is recognised that several other goodpractices exist in Europe, from stakeholders who are not yet engaged in thePartnership. ese practices constitute equally valuable knowledge and en-rich further the pool of expertise in applying innovations in the domainof active and healthy ageing. Such practices are also to be included in thedeveloped database and become available for the steps of the strategy pre-sented in this paper.
..
The European Commission, in cooperation with the EIP AHA partners, will:
.
• develop an integrated on-line database of good practices, building on existing catalogues and repositories,
• support stakeholders in showcasing successful and inspiring bottom-up innovation in active and healthyageing,
Step 2 - Assessment of viability of good practices forscaling-up
ere is an important but difficult step to be taken when moving from theidentification of promising initiatives, pilots and smaller projects to scaling-up: assessing their viability for scaling-up. Due to the complex and dis-ruptive nature of the interventions in the health and care area it is oendifficult to measure their effects in terms of efficacy and efficiency directly.It oen takes a long while before the results of large scale changes can beassessed. e evidence to date points to the potential of innovative solu-tions for improving care, reducing waiting times, avoiding duplication ofservices, reducing elective admissions and outpatient aendances etc. Atthe same time, the results should be interpreted with caution as for certainstudies the numbers are small, and the methodology debatable.
at is why this strategy proposes to assess the viability for scaling-upby using comparability frameworks rather than “classic” evidence, such asthat coming from randomised controlled trials. It is possible to comparesystems on a larger scale and thus identify each system’s characteristicsand indicators of efficiency. is approach helps not only to relate practicesto each other, but also to identify the characteristics of each practice andsystem.
is approach was also followed by the Member States in the CouncilConclusions on a reflection process aiming to identify effective ways ofinvesting in health, so as to pursue modern, responsive and sustainablehealth systems,10 which invited theMember States to use health system per-
10 Employment, Social Policy, Health andConsumer Affairs Council configuration(EPSCO Council). Council conclusions onthe “Reflection process on modern, respon-sive and sustainable health systems”. http://www.consilium.europa.eu/uedocs/cms_data/docs/pressdata/en/lsa/140004.pdf,December 10th 2013
formance assessment (HSPA) for policymaking, accountability and trans-parency.11 e Council’s review was analysed by a multi-sectorial and in-
11 Working Party on Public Health at SeniorLevel. Reflection process on modern,responsible and sustainable health sys-tems—Report by sub-group 5: Measuringand monitoring the effectiveness of healthinvestments: Annex 1—Health SystemsPerformance Assessment: A review.http://register.consilium.europa.eu/doc/srv?l=EN&t=PDF&gc=true&sc=false&f=ST%2012981%202013%20ADD%204,October 2013
dependent Expert Panel, set up by the European Commission, which pro-vides advice on effective ways of investing in health. In its opinion,12 the 12 Expert Panel on Effective Ways of
Investing in Health. Definition andEndorsement of Criteria to IdentifyPriority Areas when Assessming thePerformance of Health. http://ec.europa.eu/health/expert_panel/opinions/docs/002_criteriaperformancehealthsystems_en.pdf,February 2013
Expert Panel proposed an assessment framework comprising an evaluationof: impact on common values, impact on outcomes, and a feasibility study,all analysed within a specific contextual frame (see Figure 4).
12
..
Healthproblem
Sustainabilityproblem
. Area/Policy.
Impact on common values
UniversalityEquitySolidarityHigh quality services
.
Impact on Outcomes
Health equityHealth risk factorsResponsivenessEconomic impact
.
Feasibility
Knowledge / Political Agenda / Reaction time / StewardshipAcceptability / Costs / Monitoring
.
Cost effectiveness
..
Context/Non-healthcare factors
.
What impact canbe expected, consid-ering the context?
.
Is it feasible?
Figure 4: Elements for selection and priori-tisation of policies/interventions. Adaptedfrom [Expert Panel on Effective Ways of In-vesting in Health, 2013].
ere are also other examples of assessment frameworks that relate tospecific types of innovation. For example, assessment tools have been de-veloped by WHO-Europe together with the Healthy Cities Network in thearea of age-friendly environments. Another example is MAST, the modelfor assessment of telemedicine.13 It provides a structured framework for as- 13 KKidholm, AGEkeland, L K Jensen, J Ras-
mussen, C D Pedersen, A Bowes, S A Flot-torp, and M Bech. A model for assessmentof telemedicine applications: MAST. Inter-national Journal of Technology Assessmentin Health Care, 28(1):44–51, 2012
sessing the effectiveness and contribution to quality of care of telemedicineapplications and covers three parts: preceding considerations before an as-sessment, a multidisciplinary assessment of the outcomes and an assess-ment of the transferability of results. e key multidisciplinary assessmentincludes seven domains of outcomes:
1. Health problem and characteristics of the application
2. Safety
3. Clinical effectiveness
4. Patient perspectives
5. Economic aspects
6. Organisational aspects
7. Socio-cultural, ethical and legal aspects
MAST is a widely used framework for assessment of the outcomes oftelemedicine in Europe. A description of relevant outcome measures andmethods for data collection within each domain has been produced.14 14 See the deliverables of the RENEW-
ING HEALTH project on their web-site, http://www.renewinghealth.eu/en/assessment-method.
An impact analysis of common values and outcomes is a vital step inidentifying good practices which are viable for replication. e Partnershiphas stressed the importance of evaluation and evidence to assess interven-tions. Given the national or regional competence of health systems man-agement, the performance of these assessments is le nonetheless to thosestakeholders involved in transfer and scaling-up.
- 13
..
The European Commission, in cooperation with the EIP AHA partners, will:
.
• Collect assessment tools and frameworks for innovations in active and healthy ageing.
• Provide a set of parameters and frameworks to enable stakeholders to carry out the viability assessmentof good practices
The European Commission will also launch, if necessary, additional studies or projects in the field of assess-ment tools and frameworks for innovations in active and healthy ageing, addressing assessment in differentEuropean contexts
Step 3 - Classification of good practices for replication
To enhance the potential for scaling-up across borders and regions, theidentified good practices need to contain elements that can be sufficientlygeneric to allow their transferability and adaptation to varying local cir-cumstances and conditions. ere is no one size fits all. erefore, goodpractices should be classified according to feasibility and contextual factors,as well as the characteristics of the system in which are they implemented.Feasibility, as proposed by the Expert Panel,15 covers: 15 See Figure 4 and reference [Expert Panel
on Effective Ways of Investing in Health,2013]Knowledge — gaps between knowledge and practice (research, specific),
existence of tested solutions (good examples, specific), large variationsbetween countries (good examples, general).
Reaction time —calendar (time needed for implementation), effects/visibility(time needed to assess impact).
Stewardship — administrative and political capacity. Leadership, insidethe health sector and in other sectors (Health in All Policies).
Political agenda — electoral programme, social concerns, crisis, interna-tional institutions recommendations/conditions, etc.
Costs and affordability — it is important to consider the cost of the pro-gramme for selecting priority areas for investment. ere could be de-cisions that need relevant investments (e.g. equipment, personnel, etc.)while others involve low direct economic cost (e.g. anti-tobacco strate-gies and legislation). e costs of a programme have to be consideredin the context of the economic situation of the country (GDP/inhabitant;expansion/recession/stagnation; private and public debt; etc.).
Acceptability — the support or the opposition that a certain policy is go-ing to aract.
Monitoring capability — the availability of the necessary information tomonitor the starting point, the processes and the outcomes. It highlightsalso the importance of transparency.
Similarly, the contextual factors to be taken into account include demo-graphic, social and economic conditions, cultural factors, and other non-healthcare determinants of health that impact on population health and
14
wellbeing. e Expert Panel argues that determining the relative influenceof health systems on health outcomes from the impact of the broader de-terminants of population health, especially living and working conditions,education etc., will be an important challenge. In addition, the time lagsbetween policy changes and their impact on health outcomes, includingpossible unintended consequences, will also need to be taken into account.
e Reference Site guide16 also included examples of additional systemic 16 See reference [European Commission,2014]elements to be considered for good practice adjustment to the local set-
ting, notably type of health system (OECD clusters)17, level of systems’ 17 I Joumard, Christophe A, and C Nicq.Health care systems: Efficiency and institu-tions. OECD Economic Department WorkingPaper, (769), 2010. http://dx.doi.org/10.1787/5kmfp51f5f9t-en
development (levels of expenditure and amenable mortality), level of sys-tems’ concentration (local, regional or national, primary, secondary or ter-tiary), eHealth readiness and expected overall impact of ageing on publicfinances.18 18 European Commission (DG ECFIN) and
the Economic Policy Commiee (AWG).e 2012 Ageing Report: Economic and bud-getary projections for the EU27 MemberStates (2010-2060). 2012. http://europa.eu/!qF38ry
Furthermore, and considering the wider active and healthy ageing do-main, beyond purely health and care issues, it is important to take into ac-count the competences at local and regional level in fields such as transport,housing, urban design, etc.
..
The European Commission, in cooperation with the EIP AHA partners, will:
.
• Provide tools for classifying good practices and identifying their transferable elements on the basis ofsystems' characteristics, feasibility and contextual factors.
How to scale-up?
Once the database of good practices is established, and the proven exampleshave been validated by the interested stakeholders and classified by theircontextual factors, the “raw material” is ready for scaling-up.
But for scaling-up to happen a true collaboration between the interestedpartners needs to be established, both for the scaling-upwithin organisationas well as across organisations. e Partnership acts as a catalyst in thisregard. rough its work in Action Groups and with Reference Sites it aimsat increasing the capacity of organisations looking for innovative solutionsand the willingness of the originating organisation to share their solution.
Step 4 - Facilitating partnerships for scaling-up
Collaborators' roles
Usually there are at least two different organisational roles in scaling-up:the originating organisation that develops and pilots the model and theadopting organisation that takes up the model.19 19 R Simmons and J Schiffman. Scaling-
up reproductive health service innovations:A conceptual framework. Paper preparedfor the Bellagio Conference: From PilotProjects to Policies and Programs, 2003
Tested good practices can provide invaluable help to the adopting organ-isation looking for an innovative solution to address its needs and gaps. Itcan prove resource efficient to learn from others’ successes and mistakes,avoiding duplications and saving time needed for the discovery, learningand implementation.
e originating organisation on the other hand benefits from collectivelearning, profits from the constant improvement of solutions, is able to com-pare/benchmark their accomplishments and sometimes gain from economiesof scale.
Diffusion of good practices
ere are several proven ways of diffusing good practices, facilitating ex-change and scaling-up. Many of them rely on personal contact and effectiveinformal communication. ey aim at enabling hands on interaction withother stakeholders, helping to analyse and understand heterogeneities forefficient deployment and leading to creative problem solutions.
INTERREG IVC20 has developed a reference model for exchange of good 20 INTERREG IVC provides funding for in-terregional cooperation across Europe andis implemented under the European Com-munity’s territorial co-operation objectiveand financed through the European Re-gional Development Fund (ERDF).
practices on inter-regional level. According to their model these exchangesof experiences are in fact multidimensional and dynamic learning processes,geared towards achieving various forms of policy changes within the part-ner areas and beyond. Such a process should ideally start with learningat the project level, which then stimulates learning within the individual
16
..
The regional/localpolicy subsystems
.
The partnerorganisations
.The project.
Other external organistions& policy subsystems
.Individual learning,cross cultural grouplearning, striving forEU-wide relevance
.
Organisational learning...
.
... to achieve organisational changesand policy improvement
.
Policy learning...
.
... to achieve structural changesin regional and local policies
.
EU-level learning...
.
... to initiate policy changes in other areasoutside the project partnership
Figure 5: Interregional exchange of exper-tise—a multidimensional process of learn-ing & policy change. Adapted from a origi-nal INTERREG IVC Programme Table.
project partner organisations, and also learning between them and otherorganisations of the concerned regional/local policy subsystems in orderto achieve policy change in the involved project partner areas as well aslearning in an EU-wide perspective (see Figure 5).21 21 INTERREG IVC. Study on exchange of
experience processes. Final Report, January2013
Typical tools for the exchange of experiences are networking activitiessuch as thematic workshops, seminars, conferences, surveys, informalmeet-ings and study visits. Possible project outcomes include, for example, casestudy collections, policy recommendations, strategic guidelines or actionplans.
e Partnership has supported so far many forms of experience sharing;and several others are also being considered to be pursued too, e.g.:
• Action Groups and Reference Sites processes.
• Development of common guidelines and toolkits.
• Support to the learning networks, like in case of inter-regional collabo-ration is done via networks of regions such as EUREGHA, ERRIN, AER,ENSA and CORAL.
- 17
• Organisation of events or workshops and dedicated twinning sessions.
• Identification of leaders, pioneers or coordinators.
• (digital) Knowledge exchange platforms, like the EIP AHA Marketplaceand Yammer.
• Common projects, activities, initiatives and publications.
• Dissemination and deployment of findings from EU funded projects.
• Coaching and tutoring which can consist of:
– study visits and special training sessions allowing practical experi-ence,
– staff exchanges or short term secondments,
– tutorials and webinars, as well as
– scientific and non-scientific articles and other information material.
..
The European Commission, in cooperation with the EIP AHA partners, will:
.
• Facilitate collaboration through dedicated match-making/twinning sessions.
• Facilitate coaching and policy partnerships between regions from different European countries, aimed atsharing knowledge, objectives and programmes for the deployment of innoovations in the domain.
Step 5 - Implementation - Key success factors and lessonslearnt
Once the co-operation is established with roles clarified, the actual scaling-up process can start. e framework proposed in this paper builds on thework done byWHO/ExpandNet, which identifies that strategic choices haveto be made in the following five areas.22. 22 World Health Organization. Practical
guidance for scaling up health serviceinnovations. WHO, Geneva, 2009.http://whqlibdoc.who.int/publications/2009/9789241598521_eng.pdf
• type of scaling-up,
• dissemination and advocacy,
• ways to organize the process,
• assessing costs and mobilising resources,
• monitoring and evaluation.
Based on WHO/ExpandNet work, and the Partnership’s work on thegood practices catalogue and Reference Sites’ ‘How to guide’, the follow-ing framework for implementation of scaling-up is proposed:
..1 Planning the innovative service & setting up a system for change
..2 Organisational process and design choices
..3 Monitoring, evaluation and dissemination
18
Each of the following section focuses on a single step of this frameworkstrategy. It aims at being general, allowing interpretation adjusted to thespecific needs. To illustrate the steps, lessons learnt and key success factorsfor effective scaling-up have been described; examples from the ReferenceSites are given in [brackets]. e list will eventually expand into a jointlydeveloped toolkit for successful scaling-up.
Planning the innovative service, and setting up a system forchange
..
Key elements
.
• Good understanding of thecontext
• Evaluation of needs
• Political endorsement
• Engagement of relevantstakeholders
• Strategy and roadmap
• Cost assessment
• Financial viability and busi-ness model
P Despite the oen intuitive advantages of scaling-up, research findings showit is necessary for the interested organisations to do first a preliminary as-sessment of the context where scaling-up will occur. is helps to ensurethat the strategy takes into account opportunities and threats in the new en-vironment and adjusts to social conditions present in the new context wherescaling-up is anticipated. It also helps to estimate the cost, both financialand non financial, of implementing changes in the system, which also in-clude the initial inefficiencies. Hence, successful transfer of innovations isfacilitated when certain aributes are present:23
23 R Simmons, J Brown, and M Díaz. Facil-itating large-scale transitions to quality ofcare: An idea whose time has come. Studiesin Family Planning, 33(1):61–75, 2002
a. e members of a user system perceive a need for the innovation, andconsider it beneficial and congruent with the system’s central ideas andconcepts.
b. e user system has the appropriate implementation capacity, values,and openness.
c. e timing and circumstances are right.
d. e user system possesses effective leadership and internal advocacy.
e. e source and user systems (from the originating and adopting organi-sations respectively) are similar in characteristics and are in close physi-cal proximity. e compatibility of a good practice with the new values,norms, organisation and systems of potential users or adopting organisa-tions defines howmuch adaptation and capacity building will be needed,and what resources will be required.
In the context of public authorities, there are two elements which affectthe adopting organisation’s commitment to scaling-up that require morein-depth analysis: securing political and stakeholders support.
N,
e starting point is to lay solid foundations, by identifying the realneeds the innovations will serve and building a strategy on that basis. iscan be achieved through an extensive consultation with a wide-ranginggroup of stakeholders concerned [Collage Ireland]. Following that, a strate-gic plan for deployment is required, with a well-defined roadmap, costs
- 19
assessment analysis and budget [Northern Netherlands]. is can alsoentail puing in place an action plan between the national, regional andmunicipal authorities involved.
Appropriate financial planning is needed, right from the outset. is canbe based on historical data, such as cost analysis of relevant good practices,and take into account the envisaged level of service coverage across thepopulation and risk adjustmentmodels, considering both direct and indirectcosts.
S
Strong, commied leadership from both the central and local authoritiesis a vital element for the scaling-up of a good practice from elsewhere. Itcan be expressed in various forms. At the top level, national and regionalparliaments can do this by passing bills on active and healthy ageing toencourage and empower the government to boost relevant actions. Na-tional and regional governments can launch initiatives to introduce inno-vative care services and commit to making their large scale deployment anational/regional priority [Scotland, Region of Southern Denmark].
Such deployment is facilitated by national and regional political deci-sions and by agreements between regional authorities and the associatedmunicipalities (city councils). For example, the creation of a ministerialportfolio with specific responsibility for e.g. older people or active andhealthy ageing was seen as an important driver [Wales]. Another exampleis the envisaged Covenant on Demographic Change, along the lines of theCovenant of Mayors on Sustainable Energy, bringing political commitmentat EU level with a peer process. In practical terms, in several successfulcases, governments have provided programme management support, whilethe support of local politicians has been secured through good evidence,engagement events and training sessions held by the local partnerships.
E -
According to the magnitude of the practice to be scaled up different typeof stakeholders must be engaged. e plan should identify key stakehold-ers relevant for each step of the implementation process. In most complexexamples, an effective working partnership is needed at all levels (national,regional and local). is requires the formation of a multi-sectorial stake-holder alliance, under the leadership of a commied national or regionalmanager who sustains the top-level will to innovate [Collage Ireland, Re-gion of Southern Denmark].
Such an alliance, or ecosystem, needs to encompass collaborators fromnational and regional authorities, municipalities, social services, health cen-tres, care organisations, insurers, housing and transport sectors, third sec-tor, industry, universities and research institutes (perhaps coming from alocal innovation cluster), and, importantly, representatives of patients andolder people. In practical terms, it involves an intimate collaboration ofthese stakeholders in multidisciplinary teams, using state-of-the-art infras-tructures and highly trained staff [Ageing@Coimbra].
20
e active co-operation of the health and social care providers and endusers in these ecosystems is essential. If the innovative service is demand-driven, e.g. from healthcare providers or patient interest organisations,then buy-in from the remaining stakeholders is eased. Clinical engagementshould therefore commence as early on as possible in the process of servicedesign and continue throughout the service implementation.
In the context of these alliances, new relationships are essential. Forinstance, between public administrations, private companies and researchcentres to foster innovation and competitiveness. Or similarly, agreementsamong public administrations, voluntary associations, community partici-pation agents and home care and telecare service providers [Basque Coun-try]. Maximum engagement can be obtained through the involvement ofthese stakeholders, including political representatives and older people’srepresentative bodies, across a range of participatory meetings and events.Such events bring these stakeholders together to commit jointly to the devel-opment of a shared strategy and a common, shared action plan. e sharedownership and shared vision on goals and outcomes can help sustain com-mon efforts [Collage Ireland].
It is important to use the expertise of each partner in the ecosystem toanalyse the local needs. Functional groups where doctors, nurses, patientsand any stakeholder involved in any care process can express their specificrequirements to be covered by the service are a means to achieve this. Sub-sequently, the developers of the service need to ensure that the needs andwishes of end users (patients or older people, including their carers) and careprofessionals are reflected in the service design. Having a service foundedon intensive participation of a wide range of stakeholders in its conceptionand realisation phases, allows a high degree of readiness to be reached forthe use of the service [Region of Southern Denmark]. Boom up initia-tives are a key source of innovation and should be encouraged and nurtured[Basque Country].
Experiences from successful implementations highlight the importanceof the participation of civil society. For example, the set-up of a represen-tative forum of older people (or older people’s champions) to guaranteethat the voices of older people, as well as their families and carers, areheard [Wales], or a Council of Elderly People [Andalusia] encompassingregional authorities, associations of older people and the third sector, to fa-cilitate social participation of older people into political life of the region.Being guided by the voices and participation of older people underpins thelegitimacy and helps prioritise needs. ere are several ways to engage pa-tients in the planning and implementation phase of an innovative service.For example, the opinions of patients (and carers) can be sought during theprocess of procuring a service, in terms of detailing specifications and as-sessing equipment which is offered by various bidders [Northern Ireland].
To ensure that everyone involved is positive to the changes required, itis essential to anchor the changes to all the actors in the care chain andto demonstrate the benefits to all of them before the innovative service isintroduced. And prior to this, a “narrative” beyond “cost containment” isrequired as a start, to provide an aractive vision and common understand-ing on where the main problems are, what the key issues to tackle are and
- 21
how to do this [Basque Country].In cases where a programme or service is imported from elsewhere, there
is a need to make changes to adapt it to the local seing. It is important thatthe local staff take true ownership of this process of adaptation [CollageIreland, Northern Netherlands].
All parties should be involved, not only in the design phase as mentionedabove, but also in the development, financing, implementation, evaluationand dissemination of the service. For instance, it is beneficial to establishstandards and treatment pathways agreed by all partners. Formalised agree-ments between parties can consolidate their common undertaking. A JointGoverning Board, or oversight group, comprising all the key stakeholders,is a practical mechanism to maintain the engagement, support the neces-sary policy framework and ensure that the innovative service delivers theexpected outcomes [South Holland, Collage Ireland].
Once implementation has begun, care professionals, citizens and patientsshould be empowered to use the service, e.g. to access their health datathrough their personal health records [Andalusia, Region of SouthernDenmark].
Sometimes, financial incentives, as well as provision of technical and or-ganisational support, may help motivate stakeholders such as care profes-sionals to participate in the collaborative networks and eventually use theservice. Some examples encountered in practice are [Emilia Romagna]:
• funding of IT equipment and data connections
• fee given to general practitioners (GPs)
• payment of the care professionals involved in the pilot projects
Pilots can bring to participating stakeholders the experience of real-lifedeployment of services. is can give birth to a set of champions in thepilot locations, which in turn can facilitate a snowball effect for the largerdeployment of services in these locations [Catalonia].
S
Lile can be achieved without a plan for securing financial support. Ex-periences from the ground recommend providing ring-fenced financing forscale up [Scotland], and having all the partners involved in the cooperationcontributing to the financial plan.
Dedicated public funding is seen as a catalyst. In many cases, it has beenprimarily the public authorities, including government departments, financ-ing from their annual budgets (e.g. by dedicating a small percentage annu-ally [Basque Country]) the development and introduction of innovativeservices and change, as well as their maintenance. Public authorities areseen also to fund directly the programme management, events and learningand coordination networks. Performance-based funding can be configuredat national and regional level to underpin the continuation and expansionof services [Skåne]. In addition, public authorities can promote standard-isation of procurement, in support of interoperability (see relevant sectionbelow). Seing up a fund-raising organisation can be a success factor.
22
A combination and grouping of funding from various sources has beenapplied, and has been essential, in many cases (national, regional, local,private, from hospitals, non-profit organisations etc.) [Regions of Ile-de-France, Pays de la Loire and Northern Netherlands].
Various European funding programmes can be considered for the abovepurposes. Activities under the INTERREG, Horizon 2020 and the PublicHealth Programme can support interregional co-operation for pilot actionsand transfer of knowledge and good practices. e European Structuraland Investment Funds (ESIF) can provide regions with significant supportfor the deployment of operational services at large scale.
C
e lack of a businessmodel or of arrangements for the reimbursement ofthe service is oen quoted as a significant barrier to large scale deployment.Nevertheless, several practices on the ground can provide useful examplesof how this major issue can be addressed.
It is noted that the development of a business model based on rental ofthe technology system rather than individual acquisition, can facilitate thescaling-up [Region Ile-de-France].
e establishment of a shared risk model with a shared savings agree-ment (Public-Private-Partnership in investment) between the key participat-ing stakeholders is seen as a promising option, e.g. between the healthcareprovider and the IT provider, or between the municipality and the healthinsurer [Catalonia].
Performance-based funding and rewards is another approach that hasbeen applied in a few cases; those doing well can be given extra funding[Skåne, Scotland].
Such agreed “risk and reward share” approaches, combined with appro-priately defined tariffs in a Payment by Results system, can remove the re-luctance of stakeholders who would otherwise feel deterred from deployinginnovative services if that deployment meant an income reduction for theirorganisations [Yorkshire and the Humber].
Self-financing can be an option for some elements of the service: e.g.training courses can be paid by the users themselves [Liguria].
It is seen that in some cases, remote care services have been financedin the same manner as traditional care by national health care insuranceand private insurance companies. Health insurers have also issued specialmodules for e.g. “integrated care” to finance the care provided through thismodel [Nijmegen, South Holland and Northern Netherlands]. Insur-ance companies and municipalities have also developed joint business casesto stimulate integrated and structural financing of integrated care modelsfor older people living in the community [Northern Netherlands]. Bun-dled payment schemes can also be considered in NHS type systems, linkinga predefined part of the budget to shared objectives of different healthcareorganisations such as primary care, hospitals and nursing homes [BasqueCountry].
Finally, the implementation of the preventive measures is in some prac-tices paid by the national healthcare systems, to ensure that screening, early
- 23
diagnostic and prevention of infections are sustainably done [NorthernNetherlands].
Organisational process and design choices
..
Key elements
.
• Investing in human capital
• Integrating ICT solutions
• Organisational changes
T -
Education for care professionals and citizens (patients) in the use of newtools and services is an essential element for success. To this end, a na-tional/regional/local training strategy must be developed and implemented,starting from the identification of the training needs [Northern Ireland].
e new services may require a redesign of a care professional’s role oreven new roles, e.g. the role of case manager as the lead for the differentpatient management programmes. is calls for training of staff in relevantskills and promotion of professional qualifications. e laer is ultimatelyto be addressed via formal educational routes; for example, remote moni-toring of patients with chronic diseases becoming part of the curriculumof schools for staff of care organisations [Noord-Brabant], and trainingprogrammes being organised on the changing roles and tasks of all pro-fessionals from all disciplines involved in the provision of integrated care[Northern Netherlands].
New job roles, shaping the profile of present and future care workers,introducing tele-assistance, community medicine tools, integrated and per-sonalised care, new models of prevention-centred care, etc. should be de-signed with post-graduate faculties and in strict co-operation with civil so-ciety and regional stakeholders such as associations, city councils and in-formal carers [Piemonte]. e role of universities and research centresis relevant in this respect, whilst the engagement of carers and patients isimportant to the success of this process.
e development of a range of guidelines and Standard Operating Proce-dures (SOPs) for care professionals, end users and any staff who could be inthe service of older users (even from outside the care sector, e.g. in publictransport) helps embed the technical solution into daily practice. is needsto be accompanied by an up-skilling and training programme to ensure thatall stakeholders are able to competently undertake their new roles and re-sponsibilities in the context of the service. Various other channels can beconsidered to help with the training and re-skilling of patients and of thecare workforce. ese may employ methods of e-learning and of internet,television and radio channels to make remote teaching resources availablefor educational courses to citizens and professionals, formal and informalcarers [Galicia].
M -
ICT solutions are best developed through active user involvement in thedevelopment phase. It is fruitful to have both the ICT provider and the careprovider contributing human resources in developing the service platform
24
[Catalonia].Good infrastructure, e.g. internet and broadband are essential. e tech-
nical implementation is strengthened by developing ICT as tools to supportthe work process that relates to the agreements and instructions.
Simple and robust technological solutions are preferable for ensuring in-teroperability, and extensive adoption. An open ICT platform supportingorganisational interoperability and collaborative work is an important en-abler of implementation [Catalonia]. Adopting (open) standard formatsand processes/procedures promotes the interoperability and scalability ofthe achieved solutions, while a scalable design of the ICT systems is a pre-requisite for large scale implementation, either at regional or national level.
I -
e successful implementation of a technical solution requires signifi-cant aention. Dedicated resources are required to develop and incorpo-rate the technical solutions as part of the daily practice, as well as organiseand manage the new service. e design phase is crucial and adequate timeshould be devoted to it. A motivated programme management team needsto be in place, both at top and local level [Liverpool, Scotland]. is teamshould be tasked with following the entire process, ready to support theimplementation of the new organisational structures, but also to assist inthe roll-out of the new technical tools. In areas where there is joint collabo-ration between several players, it is beneficial to establish working groupswith representatives of the different sectors to further the decision makingprocess and to develop the new organisation of services [Region of South-ern Denmark].
When the innovative service is being set-up, e.g. for the very first timeor through the transfer of a good practice, an initial version of the solutionis to be made available as a first prototype, to be improved and refined fromlearning by early adopters [Valencia, Scotland]. During the implemen-tation phase, workshops should be organised with care professionals andend users (patients and citizens) to get their input, first in the design of thesolution (usability) and, subsequently, for its continuous refinement on aniterative basis through comments, evaluations and proposals. Engagementof care professionals and end users in such a way ensures that any ongoingissues and desired improvements are being aended to [Andalusia]. eimplementation is, at the same time, an ongoing process of testing and eval-uating the co-operation between all partners [Saxony, Region of South-ern Denmark].
Flexibility should be built within the service to support innovative useby care professionals as well as to personalise care in order to suit the needsof the different profiles of patients with long term conditions who may beat different stages of their disease (i.e. at different clinical state and so-cial status). e End-to-End Managed Service model (where a provider as-sumes the responsibility for building-operating-managing the service pack-age) is a useful proposition for developing services which require innova-tion and flexibility [Northern Ireland]. Customer Relations Management
- 25
tools (CRM) allow for information flows and care coordination between andwithin patients and health professionals [Basque Country].
To ease the integration of new soware modules in the solution, a mod-ular design should be adopted, keeping interoperability needs in mind. Astrong interaction between the provider of the technical solution and themanagement of the care centre (e.g. hospital) and its ICT services is at thecore of this process, to ensure maximum impact [Campania].
P,
User training and a strong helpdesk for user support eases the introduc-tion of a new service.
roughout the operational period of any service, it is essential to havea team available for continuous development of services and for upgradingthe services when new technological possibilities arise.
Support officers or support centres can be put in place, with key dutiesof ensuring that the system and associated processes are integrated intodaily practice by providing frontline support, local training, working along-side staff as and when needed, and helping with stakeholder engagementactivities [Northern Ireland, Andalusia].
A - ()
Organisational processes, both clinical and administrative, have to beclearly defined and shared among stakeholders. A common interventionplan and agreement for the new services, shared among all the care profes-sionals involved (either from the health care or social care side) is at thefoundation.
e organisational implementation works best when clear agreementsand instructions on the tasks of all individual stakeholders and on the use ofany ICT solutions are formulated. Cross-sector organisational implementa-tion is most successful when the procedures and instructions are a result ofcooperation across all sectors and new practices are taught in a cross-sectorset-up, where staffs from the various sectors are trained together [Regionof Southern Denmark].
Organisational and cultural aspects of the change need to be prioritised.Recognising tensions and taking them into account in the service designphase is crucial. A modular approach is wise to adopt, with small scale test-ing and refinement of a change in a locality, before moving to implemen-tation; the spread to larger scale is then more successful [Collage Ireland,Scotland]. is modularity can be also applied differently, with gradual roll-out of complementing functionalities. For example, start with one simpleservice but implement it universally and once it has matured and is usedproactively and widely by the target group, move on to implementing an-other service, profiting from the existing infrastructure as much as possible.
Several success factors and recommended approaches for achieving changemanagement can be derived from experiences to date [Northern Ireland,LanguedocRoussillon, Catalonia, Region of SouthernDenmark]. Change
26
management can be addressed by:
• adopting a recognised project management approach;
• agreeing strategic and operational objectives along with responsibilities;
• investing time to build relationships between the clinical triage team andthe patient care team;
• developing and implementing an agreed operational plan;
• accepting that things take time and that the plan for the change must bedynamic;
• establishing new structures, e.g. new clinics or care units that applythe new service and organisational structure right from the beginningof their operations;
• developing and executing a communications strategy and a regional train-ing strategy;
• incentivising change by consolidating an appropriate business model.
Scientific societies of stakeholders involved in the care chain, such ashealth care professionals and pharmacists, can contribute to change man-agement through their support and advocacy.
Strong political leadership is fundamental to service transformation. System-wide transformative change happens when many policy levers are alignedand activated in the same direction. Organisational strategies should beequally aligned [Basque Country, Catalonia, Andalusia]. e drivingrole of public administrations is extremely important for change manage-ment; it can maximise the change of all sectors and stakeholders throughcontinuous and consistent support to joint actions and co-participation. Forinstance, transition can be facilitated by making the transformation of thehealthcare model a priority health policy, with a clear vision and definedobjectives. Culture change can be delivered through distributed leadership,with such leadership reaching the local level too [Basque Country]. It isimportant to have dedicated local implementation officers to support thecentral implementation teams, perhaps in the form of a cross-agency office,anchored in the local authority, to provide support to the local stakehold-ers. Such a set up entails ”local leaders” or ”local coordinators” being inplace to support all tasks, measures and activities to bring about the imple-mentation of new strategies, structures, systems, processes or behaviours[Liguria, Scotland].
Monitoring, evaluation and dissemination
..
Key elements
.
• Assessment indicators
• Mutual learning
• Dissemination activities
• Scaling-up of the new GP
E Robust performance monitoring and evaluation of the service should beembedded from the start, to ensure the collection of high quality evidence ofthe benefits, which oen is compulsory anyway in order to ensure regionalgovernment support.
- 27
Economic evaluation is needed to examine cost effectiveness, in orderto guarantee the sustainability of the services and unlock the support forcorporate strategies and adaptation to change.
e evaluation should however, not only focus on the economic aspectsbut also aspects covering the patient and care giver perspectives, clinicaleffectiveness, health outcomes, impact on daily activities etc.
Use of surveys, routinely collected data and dedicated studies to monitorand evaluate outcomes can be employed for these purposes (e.g. the EHR-IMPACT study ).
K
In order to make sure that any problems encountered in one area are notreplicated across other areas, collaboration between areas is to be encour-aged via Learning Networks, for learning and sharing best practices. Suchnetworks also provide a means to learn about what works and what doesnot work, and the best methods to adopt. Special training meetings for net-works of stakeholders, e.g. on the care of patients suffering from a specificcondition [Saxony] or the School of Patients, a network of patients, carersand associations [Andalusia], turned out to be very successful in severalpractices. Similarly, knowledge transfer and sharing of learning and expe-riences in the development of care pathways have been facilitated by learn-ing events and courses [Piemonte], as well as via regular contact with the”local leaders” or ”local coordinators” and with patients, their families andinformal carers (see above). In cross border and other international seings,there are benefits to be gained from offering language training [NorthernNetherlands]. Next to such learning networks, it can be useful to establishmechanisms to encourage clinicians to champion their success stories anddisseminate good practice.
C
e implementation process must be accompanied by a strategy for com-munication and dissemination. Such a strategy may consist of high-levelpolitical statements, speeches, official launches, dissemination at Parliamen-tary fora, conferences, workshops and training courses, with wide coveragein the national and local media. It may also include a marketing plan witha powerful branding to raise awareness of the offer, its wider goals andadded value. A network of community champions (or “local leaders” - men-tioned above) is another proven mechanism to raise awareness and demand[Wales, Liverpool].
Roadshows for the wider public and meetings with key groups across aregion can take place to explain the new process and illustrate its benefits.For instance, combining health promotion and screenings with local sportevents is an effective way to enhance the awareness of active lifestyle forgood health [Campania].
Making a range of multimedia learning resources, good practice exam-ples and stories (personal experiences) from end users available for widedissemination can facilitate adoption. e value of the laer should not be
28
underestimated; patients listen and rely on the experiences of their fellowcitizens.
-
Besides the lessons learnt and success factors mentioned above, there arefurther elements to consider when embarking on large-scale deployment atregional, national or cross-border level. Many of these elements apply toall these three levels. For reasons of brevity, they are mentioned only underthe section dealing with scaling-up at regional level.
Within the region
A plan for service growth and implementation at scale needs to be de-fined at the outset. e scaling-up plan needs to build on the strengths ofthe local ecosystem, with the all necessary support from national, regionalor local authorities. Usually, an initial feasibility study or pilot is carried out,which may provide evidence of benefits and result in recommendations toapply the service at scale. is recommendation needs to be underpinned bya commied political decision, at national, regional or local level [NorthernIreland, Andalusia]. In addition to this, assigning dedicated personnelfor this purpose is a key factor in taking forward implementation at scale[Campania, Region of Southern Denmark].
A further point is the development and use of appropriate tools for con-tinuous assessment of the deployment experience. is is critical to thescaling-up process, because it provides the results and lessons learned dur-ing the implementation process, which can be used to drive adoption furtherin the most effective way. A flexible pace of adoption is a sensible strategyto overcome contextual factors beyond immediate control [Catalonia].
A well-defined ICT policy can ease implementation (e.g. all hospitals inthe region deploying the same Hospital Information System, with these sys-tems bound to a unique identifier for patients). Existence of pre-deployedElectronic Health Care Record and Integrated Information Systems is a ma-jor facilitator for the wide implementation of new services and ways ofworking [Andalusia, Galicia].
Large home care organisations can be the first buyers of innovative ap-plications, for example eHealth ones. is can result in critical mass forfurther development and expansion.
Other measures can be considered with regards to specific types of stake-holders. One way to support the wide use of innovative services in GP prac-tices is through the inclusion of such services in GP contracts [Scotland].
Within the country
Large scale deployment within the country can be based on combinationof project-based approaches and policy-driven decisions. Nationwide takeup is facilitated if the composition of the local/regional multi-stakeholderecosystems can be replicated organisationally in adjacent regions or locali-ties [Collage Ireland].
Using national networks, e.g. the Mutualité Française network in France,for exchange of knowledge and good practices can shorten the learning
- 29
curve for the local authorities which are about to embark on implementa-tion. Short-term secondment of personnel provides practical and meaning-ful support to the transfer of a good practice to another locality.
Across EU regions
Replicability across EU regions can rely on inter-regional collaboration;this can be a key element to analyse and understand heterogeneities for effi-cient deployment. Such collaboration can be sought via networks of regionssuch as EUREGHA, ERRIN, ENSA, CORAL, Regions for Health Networkfrom OMS-Europe and AER.
Cross border collaboration can lead to creative problem solutions, boost-ing also the productivity of SMEs. It is therefore important to have a contin-uous interaction with other international stakeholders in the field to learnfrom others’ experiences. Initiatives such as the EIP AHA, the AAL JointProgramme and the INTERREG programme offer opportunities to this end.
..
The European Commission will:
.
Encourage national and regional authorities to
• scale-up viable good practices
• enhance the viability of practices that need further improvement.
Further to this, the Commission will examine the feasibility of the PPI instrument (Public Procurement forInnovative solutions) in Horizon 2020 to support scaling-up.
Member States and Regions can consider the use of instruments such as Structural Funds, national innova-tion funds and innovative procurement schemes in order to finance the deployment of innovative serviceson large scale.
Actions and timetable
e five steps of the presented European scaling-up strategy need to besupported by specific actions, as listed in the table below. Some actionsneed to conclude and deliver in the short-term, in the period 2014–2016,while others have a more continuous nature, carrying on in the long run.
Action Responsible Actors Timing
1
Develop an integrated on-linedatabase of good practices,building on existing catalogues andrepositories
European Commission,Reference Sites, ActionGroups and the EIP AHASupport Action funded byHorizon 2020
First Version: June 2015Updated Versions: December 2015and December 2016
2
a. Collect assessment tools andframeworks for innovations inactive and healthy ageing.
b. Provide a set of parameters toenable viability assessment ofgood practices.
European Commission,Reference Sites, ActionGroups
a. By February 2015
b. By April 2015 and updated on aregular basis (every 6--12months)
3
Launch, if necessary, additionalstudies or projects in the field ofassessment tools and frameworksfor innovations in active and healthyageing, addressing assessment indifferent European contexts
European Commission During 2016
4
Provide tools for classifying goodpractices and identifying theirtransferable elements on the basisof systems' characteristics,feasibility and contextual factors
European Commission,Reference Sites, ActionGroups
By June 2015
5
Support stakeholders in showcasingsuccessful and inspiring bottom-upinnovation in active and healthyageing
European Commission Continuously
6Facilitate collaboration throughdedicated match-making/twinningsessions
European Commission,Reference Sites, ActionGroups
Continuously
- 31
Action Responsible Actors Timing
7
Encourage and facilitate nationaland regional authorities in:
• scaling-up viable good practices.
• enhancing the viability ofpractices that need furtherimprovement.
European Commission Continuously
8
Member States and Regionsengaging in collaborationpartnerships for sharing knowledgeand programmes, transfer ofelements of good practices and fordeployment of innovations in thedomain
Reference Sites in the lead,working with National andRegional authorities
Continuously, with the followingmilestones:
• By March 2015: Reference Sites,National and other Regionalauthorities to identify each 1--3other regions to twin with and atleast one other region to coach.
• By July 2015: agreements andplans for twinning on specifictopics are in place and coachinghas commenced
• Within 2015: Regions wouldhave the possibility to apply forany funding available viaINTERREG
• By June 2016: coaching is upand running and adoptingregions have startedimplementation of elements oftransferred practices.
9Member States and Regions financethe deployment on a large scale
Reference Sites in the lead,working with National andRegional authorities
By end of 2015:
• Regions would have thepossibility to apply for StructuralFunds via calls issued by theManaging Authorities
• Committing national innovationfunds
• Making use of innovativeprocurement schemes
10
Examine the feasibility of the PPIinstrument (Public Procurement forInnovative solutions) in Horizon2020 to support scaling-up
European Commission In calls of 2015 and 2016
Annex
Following the classification proposed by Uvin,24 there are several types of 24 P Uvin. Fighting hunger at the grassroots:paths to scaling up. World Development, 23(6):927–939, 1995
scaling-up:
antitative scaling-up is the geographical spread to more people and com-munities within the same sector or functional area. is form is oenreferred to as horizontal scaling-up or scaling out.
Functional scaling-up is expansion by increasing the scope of activity, whenan organisation expands the number and the type of its activities. isscaling-up is largely vertical and involves institutionalisation of moreservices.
Political scaling-up refers to expansion through efforts to influence the po-litical process and work with other stakeholder groups. rough politi-cal scaling-up, individual organisations can move beyond their scope ofactivities toward empowerment and change in the larger organisationalstructures, thus achieve greater influence and affect political and institu-tional change that sustains scaled up interventions.
Organisational (or institutional) scaling-up means the expansion of the or-ganisation implementing the intervention, mainly by increasing their or-ganisational strength so as to improve the effectiveness, efficiency andsustainability of their activities. is can involve both horizontal and ver-tical organisational expansion, the former involving similar institutionswhile the laer means going up the ladder from community to local toregional to national (and in some cases even supra national) institutions.
Bibliography
Centre for Telemedicine and Telehealthcare. Check! Telehealthcare at Scale.Central Denmark Region, 2013. http://www.rm.dk/files/Sundhed/Center%20for%20Telemedicin/English/Check_final_UK.pdf.
Employment, Social Policy, Health and Consumer Affairs Councilconfiguration (EPSCO Council). Council conclusions on the “Re-flection process on modern, responsive and sustainable health sys-tems”. http://www.consilium.europa.eu/uedocs/cms_data/docs/pressdata/en/lsa/140004.pdf, December 10th 2013.
European Commission. Excellent Innovation for Ageing—“How to” Guide.2nd edition, 2014. http://ec.europa.eu/research/innovation-union/pdf/active-healthy-ageing/how_to.pdf.
European Commission (DG ECFIN) and the Economic Policy Commiee(AWG). e 2012 Ageing Report: Economic and budgetary projections for theEU27 Member States (2010-2060). 2012. http://europa.eu/!qF38ry.
Expert Panel on Effective Ways of Investing in Health. Definition andEndorsement of Criteria to Identify Priority Areas when Assessming thePerformance of Health. http://ec.europa.eu/health/expert_panel/opinions/docs/002_criteriaperformancehealthsystems_en.pdf, February 2013.
E M Glaser, H H Abelson, and K N Garrison. Puing knowledge to use:Facilitating the diffusion of knowledge and the implementation of plannedchange. Jossey-Bass, San Francisco, 1983.
A Hartmann and J Linn. Scaling up: A framework and lessons for devel-opment effectiveness from literature and practice. Wolfensohn Center forDevelopment Working Paper, (5), 2008.
INTERREG IVC. Study on exchange of experience processes. Final Report,January 2013.
I Joumard, Christophe A, and C Nicq. Health care systems: Efficiencyand institutions. OECD Economic Department Working Paper, (769), 2010.http://dx.doi.org/10.1787/5kmfp51f5f9t-en.
K Kidholm, A G Ekeland, L K Jensen, J Rasmussen, C D Pedersen, A Bowes,S A Floorp, and M Bech. A model for assessment of telemedicine appli-cations: MAST. International Journal of Technology Assessment in HealthCare, 28(1):44–51, 2012.
34
R Simmons and J Schiffman. Scaling-up reproductive health service inno-vations: A conceptual framework. Paper prepared for the Bellagio Con-ference: From Pilot Projects to Policies and Programs, 2003.
R Simmons, J Brown, and M Díaz. Facilitating large-scale transitions toquality of care: An idea whose time has come. Studies in Family Planning,33(1):61–75, 2002.
P Uvin. Fighting hunger at the grassroots: paths to scaling up. WorldDevelopment, 23(6):927–939, 1995.
Working Party on Public Health at Senior Level. Reflection processon modern, responsible and sustainable health systems—Report by sub-group 5: Measuring and monitoring the effectiveness of health in-vestments: Annex 1—Health Systems Performance Assessment: A re-view. http://register.consilium.europa.eu/doc/srv?l=EN&t=PDF&gc=true&sc=false&f=ST%2012981%202013%20ADD%204, October 2013.
World Health Organization. Practical guidance for scaling up health serviceinnovations. WHO, Geneva, 2009. http://whqlibdoc.who.int/publications/2009/9789241598521_eng.pdf.
World Health Organization and ExpandNet. Nine steps for developing ascaling-up strategy. WHO, Geneva, 2010. http://www.expandnet.net/PDFs/ExpandNet-WHO%20Nine%20Step%20Guide%20published.pdf.
.
AG A1. Annex. Workshop Report. Planning for the future 2016-‐2018
European Innovation Partnership on Active and Healthy Ageing
Project ideas
HOW TO REINFORCE THE ROLE OF PHARMACIST IN INTEGRATED CARE Who proposed it
Alpana Mair (NHS Scotland)
Who participated
Anna Bergkvist (Skåne), Magda Savin (GIRP), Rute Salvador (Ageing@Coimbra), Enrica Menditto (University of Naples), Lúcia Santos (Ageing@Coimbra), Enrique Pepiol (MICOF).
Key points discussed
• Being visible • What we want as pharmacists to provide to patients
in 2020 • Integrated member of healthcare team: prescribers
who review medication & are part of the patient pathway for multiple morbidities
• Public health, patient/carer empowerment
Next steps • Liaise with other EU organisations
• Gather evidence, value of medication review • Liaise with PGEU • Liaise with Action Group B3 • Standardised and competency-‐based education –
under postgraduate training • Policy
Who should be involved • European Commission
• PGEU and other pharmacist associations, GIRP • AG B3
Who wishes to keep working on it Anna Bergkvist (Skåne), Magda Savin (GIRP), Rute Salvador
(Ageing@Coimbra), Enrica Menditto (University of Naples), Lúcia Santos (Ageing@Coimbra), Enrique Pepiol (MICOF), Juan José Folgado (MICOF), Alexandra Prados (BioMed Aragón)
AG A1. Annex. Workshop Report. Planning for the future 2016-‐2018
PROPER IMPLEMENTATION OF THE “ADHERENCE” CONCEPT Who proposed it
Sibilia Quilici (Sanofi Pasteur MSD)
Who participated
Alessadro Monaco (AIFA), Anna Bergkvist (Skåne), Nicole Toppi (GIRP), Alexandra Prados (BioMed Aragón), Carolina Isiegas (BioMed Aragón), Ángela Bolufer (EC), Isabelle Dévé (EC), Nora Roman (EC)
Key points discussed
• Focus on holistic prevention • Structured communication between healthcare
providers and patients • Listen to patients’ own desires • Lifestyle changes tailoring interventions and
prevention • Change the way adherence is implemented
Next steps Pan-‐European observational study of effects of lifestyle Who should be involved The whole healthcare “chain” from policy makers to patients
Who wishes to keep working on it Nicole Toppi (GIRP), Alexandra Prados (BioMed Aragón), Juan
José Folgado (MICOF)
AG A1. Annex. Workshop Report. Planning for the future 2016-‐2018
EUROPEAN HEALTH INTEGRATED INFORMATION SYSTEM
Who proposed it
Salvatore Riegler (University of Naples)
Who participated
María Ángeles Pardo (Universidad Miguel Hernández), Enrica Menditto (University of Naples), Alexandra Prados (BioMed Aragón), Carlos de la Cruz (MICOF), José Martínez (PROEIPAHA), Raphaël Capian (EC)
Key points discussed
• Need for a common database/repository • Observational research at EU level, minimum dataset • Identification of data gaps • Need of protection and anonymisation of data • Common methodologies, scaling information to
individual level • Ownership of data, legal and deontological concerns
Next steps Define a common data set Who should be involved Governments, Hospitals, Academia, Private insurance
companies, Caregivers, Patients associations, Pharmacies. Who wishes to keep working on it Salvatore Riegler (University of Naples), María Ángeles Pardo
(Universidad Miguel Hernández), Enrica Menditto (University of Naples), Alexandra Prados (BioMed Aragón), Carlos de la Cruz (MICOF)
AG A1. Annex. Workshop Report. Planning for the future 2016-‐2018
IMPORTANCE OF CAREGIVER EMPOWERMENT Who proposed it
Carlos de la Cruz (MICOF)
Who participated
Carolina Isiegas (BioMed Aragón), Juan José Folgado (MICOF), Alexandra Prados (BioMed Aragón), Enrique Pepiol (MICOF), José Martínez (PROEIPAHA)
Key points discussed
• Need for additional information and training • Identify who can or should be a caregiver • Importance of the impact of the caregiver in the
patient health
Next steps • Integration of healthcare professionals into caregivers support, training and empowerment
• Unique policies and protocols to standardise actions • Optimise available resources maximising impact –
small group
Who should be involved Healthcare professionals Who wishes to keep working on it Carlos de la Cruz (MICOF), Juan José Folgado (MICOF),
Enrique Pepiol (MICOF)
AG A1. Annex. Workshop Report. Planning for the future 2016-‐2018
BETTER COLLABORATION AMONG HEALTH PROFESSIONALS
Who proposed it
Isabelle Dévé (EC)
Who participated
Sibilia Quilici (Sanofi Pasteur MSD), Mireia Massot (IDIAP Jordi Gol) María Ángeles Pardo (Universidad Miguel Hernández), Magda Savin (GIRP), Nora Roman (EC), Raphaël Capian (EC)
Key points discussed
Communication difficulties, such as cultural and political
Next steps • Change management to improve or find links to better collaboration (pilots, support of human resources, financial incentives, political leadership, etc.)
• Studies, Training, Curriculum • Share of information via ICT tools. Access to
information for HP and patients • Support of industry partners to raise interaction at
local and national level
Who should be involved Who wishes to keep working on it Lúcia Santos (Ageing@Coimbra), Enrique Pepiol (MICOF),
Magda Savin (GIRP), Carolina Isiegas (BioMed Aragón), Alpana Mair (NHS Scotland), María Ángeles Pardo (Universidad Miguel Hernández)
AG A1. Annex. Workshop Report. Planning for the future 2016-‐2018
HOW TO CREATE A SPACE FOR PATIENT EMPOWERMENT Who proposed it
Ángela Bolufer (EC)
Who participated
Nicole Toppi (GIRP), Gema Ocaña (Junta de Andalucía), Alexandra Prados (BioMed Aragón), Nora Roman (EC)
Key points discussed
• Increase the role of other HCP such as nurses, pharmacists, etc., in providing information, training
• Patient-‐tailored information
Next steps • Cross-‐check patient role in integrated care models • Focus on an “Activated Patient” • Guidelines to be created from patients for patients • Protocols to involve patients in decision-‐making of
their treatment
Who should be involved AG B3 on Integrated Care Who wishes to keep working on it Nicole Toppi (GIRP), Gema Ocaña (Andalucía)