Local and regional workforce return on investment from sponsoring rural generalist-based training for medical students

The objective of this case study was to examine and evaluate the retention of medical graduates for a hospital and health service partnering with a university to deliver a rural medical program. Eight cohorts of the Griffith Rural Medical Longlook program were followed for workforce outcomes, including both rural and local workforce outcomes for the Darling Downs Hospital and Health Service (DDHHS) and the region. The DDHHS partnered with Griffith Health for capital investment in the region, creating three main campuses in rural generalist hospitals and augmented resources in other rural health facilities. Most (60%) medical graduates placed for a year or more on the Longlook program chose regional internships in Queensland, including 31% who chose internship in the DDHHS. Students spending 2 years on the program in the DDHHS were more likely to remain for local internship (odds ratio (OR) 5.7) and to be practicing locally after internship (OR 3.3). Local retention of medical graduates from the partnership between the Faculty of Health at Griffith University and the DDHHS to establish and conduct the Rural Medical Longlook Program includes resourcing and utilisation of spare training capacity in rural generalist hospitals and in addressing junior medical workforce recruitment. What is known about the topic?Rural medical programs improve choice of regional centres for early career placements. Rural longitudinal integrated clerkships (LICs) are effective in influencing regional choices for early medical career placements. What does this paper add?This was a case study on the local retention of medical graduates for health services sponsoring rural medical programs. LICs are sustainable in rural generalist hospitals to increase clinical training capacity. There is evidence for longer rural placements improving rural retention, specific for rural LICs. Longer LICs are more effective in influencing regional internship choices and regional retention, as well as local internship choice and local retention. What are the implications for practitioners?Investment in increasing clinical training capacity in rural generalist health facilities can produce significant retention of medical graduates for the junior medical workforce. Retaining students in the regional health service for longer periods increases the likelihood of retention upon graduation.

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Doctor Retention in Ireland - What it may mean for the Global Health Workforce Reform Agenda Comment on "Doctor Retention: A Cross-sectional Study of How Ireland Has Been Losing the Battle"

International Journal of Health Policy and Management ◽

10.34172/ijhpm.2020.126 ◽

2020 ◽

Author(s):

Bernard Hope Taderera

Keyword(s):

Global Health ◽

Health Workforce ◽

Cross Sectional Study ◽

Early Career ◽

Healthcare Personnel ◽

Health Coverage ◽

Cross Sectional ◽

Middle Income ◽

Reform Agenda ◽

Medical Graduates

The study of healthcare personnel migration in Ireland reports that most medical graduates plan to leave the country’s health system. It may be possible to address this challenge by understanding and addressing the reasons why young doctors plan to leave. Future studies should contribute to the retention of early career doctors in highincome countries such as Ireland. This will help reduce the migration of doctors from low- and middle-income countries in order to address the global health workforce crisis and its impact on the attainment of universal health coverage in all health systems.

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Effects and mechanisms of an allied health research position in a Queensland regional and rural health service: a descriptive case study

Australian Health Review ◽

10.1071/ah17086 ◽

2018 ◽

Vol 42 (6) ◽

pp. 667 ◽

Cited By ~ 2

Author(s):

Rachel J. Wenke ◽

Anna Tynan ◽

Annette Scott ◽

Sharon Mickan

Keyword(s):

Health Service ◽

Allied Health ◽

Research Capacity ◽

Research Culture ◽

Building Research ◽

Potential Value ◽

Research Collaborations ◽

Rural Health Service ◽

Use Of Technology

The aim of the present case study is to illustrate the outcomes of a dedicated allied health (AH) research position within a large Queensland regional and rural health service. The secondary aim of the case study is to describe the enabling and hindering mechanisms to the success of the role. Semistructured interviews were conducted with the Executive Director of Allied Health and the current AH research fellow incumbent within the health service. A focus group was also undertaken with six stakeholders (e.g. clinicians, team leaders) who had engaged with the research position. Outcomes of the AH research fellow included clinical and service improvements, enhanced research culture and staff up-skilling, development of research infrastructure and the formation of strategic research collaborations. Despite being a sole position in a geographically expansive health service with constrained resources, key enabling mechanisms to the success of the role were identified, including strong advocacy and regular communication with the Executive. In conclusion, the case study highlights the potential value of an AH research position in building research capacity within a large non-metropolitan health service. Factors to facilitate ongoing success could include additional research and administrative funding, as well as increased use of technology and team-based research. What is known about the topic? Dedicated research positions embedded within health care settings are a well cited strategy to increase research capacity building of allied health professionals (AHPs). However the majority of these positions are within metropolitan health settings and unique challenges exist for these roles in regional and rural areas. Few studies have described the impact of dedicated AH research positions within regional health centres or the factors which facilitate or hinder their role. What does this paper add? Dedicated research positions within a non-metropolitan Australian health service may have a positive impact on AH clinical services, research culture, staff upskilling, research infrastructure and research collaborations. Key enabling mechanisms to support the role may include advocacy from higher level management, strong networks and communication channels. Additional research and administrative funding, the use of technology and team based research may enhance sustainability of such roles. What are the implications for practitioners? AH research positions have potential value in building research capacity within a large non-metropolitan health service. Health managers and researchers should be aware of the unique challenges to these roles and consider mechanisms that may best enhance and sustain outcomes of the positions including: the development of infrastructure (i.e. technology, website of resources), networks, and communication strategies (i.e. regular meetings with leadership and promotion internally).

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Protocol for establishing an Adaptive Diseases control Expert Programme in Tanzania (ADEPT) for integrating care of communicable and non-communicable diseases using tuberculosis and diabetes as a case study

BMJ Open ◽

10.1136/bmjopen-2020-041521 ◽

2021 ◽

Vol 11 (4) ◽

pp. e041521

Author(s):

Stellah G Mpagama ◽

Kaushik Ramaiya ◽

Troels Lillebæk ◽

Blandina T Mmbaga ◽

Marion Sumari-de Boer ◽

...

Keyword(s):

Operational Research ◽

Communicable Diseases ◽

Health Facilities ◽

Learning System ◽

Management Approach ◽

African Countries ◽

Non Communicable Diseases ◽

Research Outcomes ◽

The Government

IntroductionMost sub-Saharan African countries endure a high burden of communicable infections but also face a rise of non-communicable diseases (NCDs). Interventions targeting particular epidemics are often executed within vertical programmes. We establish an Adaptive Diseases control Expert Programme in Tanzania (ADEPT) model with three domains; stepwise training approach, integration of communicable and NCDs and a learning system. The model aims to shift traditional vertical programmes to an adaptive diseases management approach through integrating communicable and NCDs using the tuberculosis (TB) and diabetes mellitus (DM) dual epidemic as a case study. We aim to describe the ADEPT protocol with underpinned implementation and operational research on TB/DM.Methods and analysisThe model implement a collaborative TB and DM services protocol as endorsed by WHO in Tanzania. Evaluation of the process and outcomes will follow the logic framework. A mixed research design with both qualitative and quantitative approaches will be used in applied research action. Anticipated implementation research outcomes include at the health facilities level for organising TB/DM services, pathways of patients with TB/DM seeking care in different health facilities, factors in service delivery that need deimplementation and the ADEPT model implementation feasibility, acceptability and fidelity. Expected operational research outcomes include additional identified patients with dual TB/DM, the prevalence of comorbidities like hypertension in patients with TB/DM and final treatment outcomes of TB/DM including treatment-related complications. Findings will inform the future policies and practices for integrating communicable and NCDs services.Ethics and disseminationEthical approval was granted by The National Research Health Ethical Committee (Ref-No. NIMR/HQ/R.8a/Vol.IX/2988) and the implementation endorsed by the government authorities. Findings will be proactively disseminated through multiple mechanisms including peer-reviewed journals, and engagement with various stakeholders’ example in conferences and social media.

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The Problem of Success and Failure in Public-private Innovation Partnerships

Journal of Social Policy ◽

10.1017/s0047279421000192 ◽

2021 ◽

pp. 1-21

Author(s):

JONATHAN HAMMOND ◽

SIMON BAILEY ◽

OZ GORE ◽

KATH CHECKLAND ◽

SARAH DARLEY ◽

...

Keyword(s):

Public Sector ◽

Health Service ◽

Policy Maker ◽

Policy And Practice ◽

Policy Success ◽

Political Effects ◽

Innovation Project ◽

Multi Level ◽

Test Beds

Abstract Public-Private Innovation Partnerships (PPIPs) are increasingly used as a tool for addressing ‘wicked’ public sector challenges. ‘Innovation’ is, however, frequently treated as a ‘magic’ concept: used unreflexively, taken to be axiomatically ‘good’, and left undefined within policy programmes. Using McConnell’s framework of policy success and failure and a case study of a multi-level PPIP in the English health service (NHS Test Beds), this paper critically explores the implications of the mobilisation of innovation in PPIP policy and practice. We highlight how the interplay between levels (macro/micro and policy maker/recipient) can shape both emerging policies and their prospects for success or failure. The paper contributes to an understanding of PPIP success and failure by extending McConnell’s framework to explore inter-level effects between policy and innovation project, and demonstrating how the success of PPIP policy cannot be understood without recognising the particular political effects of ‘innovation’ on formulation and implementation.

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Reproductive, maternal, newborn and child health service delivery during conflict in Yemen: a case study

Conflict and Health ◽

10.1186/s13031-020-00269-x ◽

2020 ◽

Vol 14 (1) ◽

Cited By ~ 2

Author(s):

Hannah Tappis ◽

Sarah Elaraby ◽

Shatha Elnakib ◽

Nagiba A. Abdulghani AlShawafi ◽

Huda BaSaleem ◽

...

Keyword(s):

Child Health ◽

Health Service ◽

Service Delivery ◽

Health Service Delivery ◽

Child Health Service ◽

Newborn And Child Health ◽

And Child Health

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How to increase the value of self-reported health service data by using data linkage: a case study

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.1279 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

W Peng ◽

J Maguire ◽

A Hayen ◽

J Adams ◽

D Sibbritt

Keyword(s):

Data Collection ◽

Health Service ◽

Health Services ◽

Stroke Prevention ◽

Data Linkage ◽

Recurrent Stroke ◽

Service Planning ◽

Stroke Survivors ◽

Reported Data

Abstract Background This is a case study for recurrent stroke prevention. Lifestyle factors account for about 80% of the risk of recurrent stroke. Most health services studies examining stroke prevention rely on stroke survivors' self-reported lifestyle behaviour data. How can researchers increase the value of collected self-reported data to provide additional information for more comprehensive assessments? Methods 45 and Up Study is the largest ongoing study in the Southern Hemisphere focusing on the health of people aged 45 years and older living in NSW, Australia. This case study linked self-reported longitudinal lifestyle data in the 45 and Up Study, with corresponding mortality data (i.e. NSW Registry of Births, Deaths and Marriages & NSW Cause of Death Unit Record File) and hospital data (i.e. NSW Admitted Patient Data Collection) via the Centre for Health Record Linkage (CHeReL). The main outcome measures are health services, clinical outcomes, and mortality rates for stroke care. The analyses will include descriptive analysis, multivariate regression analysis, and survival analysis. Results A total of 8410 stroke survivors who participated in the 45 and Up Study were included in this data linkage study. From January 2006 to December 2015, 99249 hospital claims (mean: 13 times admission to hospital per person) and 2656 death registration records have been linked to these participants. The mean age of the stroke survivors was 72 (SD = 11) years, with 56% being males. These results are preliminary and more analyses will be conducted by using quality of life status, clinical diagnosis, comorbidities, and procedures. Conclusions Data linkage enables researchers to generate comprehensive findings on health services studies and gain a more holistic understanding of the determinants and outcomes of stroke prevention with lower data collection costs and less burden on participants. Key messages Data linkage brings about a new opportunity for self-reported data on health services utilisation. It is a cost-effective way to enhance existing self-reported data via the data linkage approach to increase its usefulness for informing health service planning.

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Context, culture and control: a case study on accounting change in an Italian regional health service

Journal of Management & Governance ◽

10.1007/s10997-019-09458-0 ◽

2019 ◽

Vol 24 (1) ◽

pp. 229-272 ◽

Cited By ~ 2

Author(s):

Rosanna Spanò ◽

Adele Caldarelli ◽

Luca Ferri ◽

Marco Maffei

Keyword(s):

Health Service ◽

Regional Health ◽

And Control

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A network of networks

Journal of Health Organization and Management ◽

10.1108/jhom-07-2016-0146 ◽

2017 ◽

Vol 31 (2) ◽

pp. 223-236 ◽

Cited By ~ 3

Author(s):

Rick Iedema ◽

Raj Verma ◽

Sonia Wutzke ◽

Nigel Lyons ◽

Brian McCaughan

Keyword(s):

Health Service ◽

Health System ◽

Network Governance ◽

System Reform ◽

System Transformation ◽

Content Type ◽

Multiple Networks ◽

Network Of Networks

Purpose To further our insight into the role of networks in health system reform, the purpose of this paper is to investigate how one agency, the NSW Agency for Clinical Innovation (ACI), and the multiple networks and enabling resources that it encompasses, govern, manage and extend the potential of networks for healthcare practice improvement. Design/methodology/approach This is a case study investigation which took place over ten months through the first author’s participation in network activities and discussions with the agency’s staff about their main objectives, challenges and achievements, and with selected services around the state of New South Wales to understand the agency’s implementation and large system transformation activities. Findings The paper demonstrates that ACI accommodates multiple networks whose oversight structures, self-organisation and systems change approaches combined in dynamic ways, effectively yield a diversity of network governances. Further, ACI bears out a paradox of “centralised decentralisation”, co-locating agents of innovation with networks of implementation and evaluation expertise. This arrangement strengthens and legitimates the role of the strategic hybrid – the healthcare professional in pursuit of change and improvement, and enhances their influence and impact on the wider system. Research limitations/implications While focussing the case study on one agency only, this study is unique as it highlights inter-network connections. Contributing to the literature on network governance, this paper identifies ACI as a “network of networks” through which resources, expectations and stakeholder dynamics are dynamically and flexibly mediated and enhanced. Practical implications The co-location of and dynamic interaction among clinical networks may create synergies among networks, nurture “strategic hybrids”, and enhance the impact of network activities on health system reform. Social implications Network governance requires more from network members than participation in a single network, as it involves health service professionals and consumers in a multi-network dynamic. This dynamic requires deliberations and collaborations to be flexible, and it increasingly positions members as “strategic hybrids” – people who have moved on from singular taken-as-given stances and identities, towards hybrid positionings and flexible perspectives. Originality/value This paper is novel in that it identifies a critical feature of health service reform and large system transformation: network governance is empowered through the dynamic co-location of and collaboration among healthcare networks, particularly when complemented with “enabler” teams of people specialising in programme implementation and evaluation.

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