The state-of-play in physician health systems leadership research

2019 ◽  
Vol 32 (4) ◽  
pp. 620-643
Author(s):  
Betty Onyura ◽  
Sara Crann ◽  
Risa Freeman ◽  
Mary-Kay Whittaker ◽  
David Tannenbaum
Keyword(s):  
Health System ◽  
Health Systems ◽  
Leadership Practices ◽  
Future Research ◽  
System Reform ◽  
Physician Leadership ◽  
Content Type ◽  
Physician Participation ◽  
System Leadership ◽  
Systems Leadership

Purpose This paper aims to review a decade of evidence on physician participation in health system leadership with the view to better understand the current state of scholarship on physician leadership activity in health systems. This includes examining the available evidence on both physicians’ experiences of health systems leadership (HSL) and the impact of physician leadership on health system reform. Design/methodology/approach A state-of-the-art review of studies (between 2007 and 2017); 51 papers were identified, analyzed thematically and synthesized narratively. Findings Six main themes were identified in the literature as follows: (De)motivation for leadership, leadership readiness and career development, work demands and rewards, identity matters: acceptance of self (and other) as leader, leadership processes and relationships across health systems and leadership in relation to health system outcomes. There were seemingly contradictory findings across some studies, pointing to the influence of regional and cultural contextual variation on leadership practices as well entrenched paradoxical tensions in health system organizations. Research limitations/implications Future research should examine the influence of varying structural and psychological empowerment on physician leadership practices. Empirical attention to paradoxical tensions (e.g. between empowerment and control) in HSL is needed, with specific attention to questions on how such tensions influence leaders’ decision-making about system reform. Originality/value This review provides a broad synthesis of diverse papers about physician participation in health system leadership. Thus, it offers a comprehensive empirical synthesis of contemporary concerns and identifies important avenues for future research.

scholarly journals Emerging challenges in the health systems of Kerala, India: qualitative analysis of literature reviews

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Manesh Muraleedharan ◽  
Alaka Omprakash Chandak
Keyword(s):  
Health Care ◽  
Health Economic ◽  
Health System ◽  
Health Systems ◽  
Significant Proportion ◽  
Vital Statistics ◽  
The State ◽  
Future Research ◽  
Health Seeking ◽  
Content Type

PurposeThe substantial increase in non-communicable diseases (NCDs) is considered a major threat to developing countries. According to various international organizations and researchers, Kerala is reputed to have the best health system in India. However, many economists and health-care experts have discussed the risks embedded in the asymmetrical developmental pattern of the state, considering its high health-care and human development index and low economic growth. This study, a scoping review, aims to explore four major health economic issues related to the Kerala health system.Design/methodology/approachA systematic review of the literature was performed using PRISMA to facilitate selection, sampling and analysis. Qualitative data were collected for thematic content analysis.FindingsChronic diseases in a significant proportion of the population, low compliance with emergency medical systems, high health-care costs and poor health insurance coverage were observed in the Kerala community.Research limitations/implicationsThe present study was undertaken to determine the scope for future research on Kerala's health system. Based on the study findings, a structured health economic survey is being conducted and is scheduled to be completed by 2021. In addition, the scope for future research on Kerala's health system includes: (1) research on pathways to address root causes of NCDs in the state, (2) determine socio-economic and health system factors that shape health-seeking behavior of the Kerala community, (3) evaluation of regional differences in health system performance within the state, (4) causes of high out-of-pocket expenditure within the state.Originality/valueGiven the internationally recognized standard of Kerala's vital statistics and health system, this review paper highlights some of the challenges encountered to elicit future research that contributes to the continuous development of health systems in Kerala.

A network of networks

2017 ◽  
Vol 31 (2) ◽  
pp. 223-236 ◽  
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.

Recovery college features and context: advancing a recovery and well-being policy agenda

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Amadene Woolsey ◽  
Gillian Mulvale
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Health System ◽  
Mental Health System ◽  
Well Being ◽  
System Reform ◽  
Educational Approach ◽  
Content Type ◽  
Policy Objectives ◽  
Mental Health Association

Purpose Internationally, there has been a move towards more recovery-oriented mental health policies for people living with mental illness, and some countries have included well-being as a population-level objective. In practice, these policy objectives can be difficult to achieve because of deeply rooted policy legacies, including a biomedical approach to care and the stigma associated with mental illness. The purpose of this paper is to investigate how interventions that operate outside the formal mental health system, such as recovery colleges (RCs), may advance these policy objectives more easily than efforts at broader system reform. Design/methodology/approach This study conducted a scoping review to explore the features and context of RCs that make the model an attractive and feasible opportunity to advance a recovery and well-being agenda. Our research is motivated by the initial and growing adoption of RCs by the Canadian Mental Health Association. This paper applies the consolidated framework for implementation research to analyse features of the model and the context of its implementation in Canada. Findings The RC’s educational approach, adaptability, coproduced nature and positioning outside the formal mental health system are key features that facilitate implementation without disrupting deeply entrenched policy legacies. Other facilitators in the Canadian context include the implementing organisation’s independence from government, its federated structure and the model’s alignment with national policy objectives. Originality/value This paper highlights how interventions outside the formal mental healthcare system can promote stated recovery and well-being policy goals.

Configurations of leadership practices in hospital units

2015 ◽  
Vol 29 (7) ◽  
pp. 1115-1130 ◽  
Author(s):  
Ninna Meier
Keyword(s):  
Leadership Practices ◽  
Clinical Work ◽  
Comparative Case Study ◽  
Future Research ◽  
Clinical Settings ◽  
Content Type ◽  
Work Settings ◽  
Hospital Units ◽  
The Everyday ◽  
Everyday Work

Purpose – The purpose of this paper is to explore how leadership is practiced across four different hospital units. Design/methodology/approach – The study is a comparative case study of four hospital units, based on detailed observations of the everyday work practices, interactions and interviews with ten interdisciplinary clinical managers. Findings – Comparing leadership as configurations of practices across four different clinical settings, the author shows how flexible and often shared leadership practices were embedded in and central to the core clinical work in all units studied here, especially in more unpredictable work settings. Practices of symbolic work and emotional support to staff were particularly important when patients were severely ill. Research limitations/implications – Based on a study conducted with qualitative methods, these results cannot be expected to apply in all clinical settings. Future research is invited to extend the findings presented here by exploring leadership practices from a micro-level perspective in additional health care contexts: particularly the embedded and emergent nature of such practices. Practical implications – This paper shows leadership practices to be primarily embedded in the clinical work and often shared across organizational or professional boundaries. Originality/value – This paper demonstrated how leadership practices are embedded in the everyday work in hospital units. Moreover, the analysis shows how configurations of leadership practices varied in four different clinical settings, thus contributing with contextual accounts of leadership as practice, and suggested “configurations of practice” as a way to carve out similarities and differences in leadership practices across settings.

Studer Group® ' s evidence-based leadership initiatives

2015 ◽  
Vol 29 (6) ◽  
pp. 684-700 ◽  
Author(s):  
Kristin A. Schuller ◽  
Bita A. Kash ◽  
Larry D. Gamm
Keyword(s):  
Health Systems ◽  
Success Factors ◽  
Driving Forces ◽  
Qualitative Content Analysis ◽  
Critical Factor ◽  
Comparative Case Study ◽  
Successful Implementation ◽  
Evidence Based ◽  
Content Type ◽  
Systems Leadership

Purpose – The purpose of this paper is to analyze the implementation of an organizational change initiative – Studer Group®’s Evidence-Based Leadership (EBL) – in two large, US health systems by comparing and contrasting the factors associated with successful implementation and sustainability of the EBL initiative. Design/methodology/approach – This comparative case study assesses the responses to two pairs of open-ended questions during in-depth qualitative interviews of leaders and managers at both health systems. Qualitative content analysis was employed to identify major themes. Findings – Three themes associated with success and sustainability of EBL emerged at both health systems: leadership; culture; and organizational processes. The theme most frequently identified for both success and sustainability of EBL was culture. In contrast, there was a significant decline in salience of the leadership theme as attention shifts from success in implementation of EBL to sustaining EBL long term. Within the culture theme, accountability, and buy-in were most often cited by interviewees as success factors, while sense of accountability, buy-in, and communication were the most reported factors for sustainability. Originality/value – Cultural factors, such as accountability, staff support, and communication are driving forces of success and sustainability of EBL across both health systems. Leadership, a critical factor in several stages of implementation, appears to be less salient as among factors identified as important to longer term sustainability of EBL.

scholarly journals Improving immunization practices in United States hospitals and health systems

2017 ◽  
Vol 22 (3) ◽  
pp. 199-211
Author(s):  
Wesley D. Kufel ◽  
Dennis M. Williams ◽  
David Jay Weber
Keyword(s):  
Health System ◽  
Health Systems ◽  
Healthcare Services ◽  
Healthcare Personnel ◽  
Fee For Service ◽  
Content Type ◽  
Vaccination Rates ◽  
Immunization Rates ◽  
The Usa ◽  
Mandatory Vaccination

Purpose Payment for healthcare services in the USA has shifted from fee for service to compensation based on value and quality. The indicators used for payments are a variety of clinical measures, including administration of vaccines to patients. The purpose of this paper is to describe the implementation of programs in health systems to improve vaccination rates and patient outcomes. Design/methodology/approach A search of the literature was conducted to find examples of vaccine programs in US health systems, and also to identify policies to improve immunization rates. Findings Successful programs for improving vaccination rates require advocacy and support of leadership, a systematic and multidisciplinary approach, and an evaluation of local resources and capacity. Numerous examples exist of medical, nursing, and pharmacy led programs that improve vaccination rates. The department in charge has relied on the support of other groups to ensure the success. Social implications Mandatory vaccination of healthcare personnel (HCP) in the health system has been a growing trend in the USA. Although there has been some resistance to mandatory vaccinations for HCP, the standards and requirements have resulted in improved rates in health systems, which ultimately improve efficiency and protects patients. Originality/value This review describes considerations for implementing a successful vaccination program in a health system and provides examples of specific strategies. An overview of mandatory vaccinations for HCP is also described.

Rights of access to healthcare for undocumented migrants: understanding the Italian and British national health systems

2018 ◽  
Vol 11 (4) ◽  
pp. 232-243 ◽  
Author(s):  
Danielle da Costa Leite Borges ◽  
Caterina Francesca Guidi
Keyword(s):  
Health System ◽  
Health Systems ◽  
National Health ◽  
Universal Access ◽  
Research Question ◽  
Access To Healthcare ◽  
Health Policies ◽  
Undocumented Migrants ◽  
Content Type ◽  
British Health

Purpose The purpose of this paper is to analyse the levels of access to healthcare available to undocumented migrants in the Italian and British health systems through a comparative analysis of health policies for this population in these two national health systems. Design/methodology/approach It builds on textual and legal analysis to explore the different meanings that the principle of universal access to healthcare might have according to literature and legal documents in the field, especially those from the human rights domain. Then, the concept of universal access, in theory, is contrasted with actual health policies in each of the selected countries to establish its meaning in practice and according to the social context. The analysis relies on policy papers, data on health expenditure, legal statutes and administrative regulations and is informed by one research question: What background conditions better explain more universal and comprehensive health systems for undocumented migrants? Findings By answering this research question the paper concludes that the Italian health system is more comprehensive than the British health system insofar it guarantees access free of charge to different levels of care, including primary, emergency, preventive and maternity care, while the rule in the British health system is the recovering of charges for the provision of services, with few exceptions. One possible legal explanation for the differences in access between Italy and UK is the fact that the right to health is not recognised as a fundamental constitutional right in the latter as it is in the former. Originality/value The paper contributes to ongoing debates on Universal Health Coverage and migration, and dialogues with recent discussions on social justice and welfare state typologies.

System change in the spirit of reconciliation in action: The All Nations Health Partnership

2019 ◽  
Vol 33 (2) ◽  
pp. 61-64
Author(s):  
Ray J. Racette
Keyword(s):  
Health Disparities ◽  
Health Outcomes ◽  
Health System ◽  
Health Systems ◽  
System Change ◽  
Health District ◽  
System Reform ◽  
Health Partnership ◽  
Working Together ◽  
Improve Health

The urgency for reforming our health systems to improve health outcomes and service pathways is pressing and must be championed by leaders. Coalitions of the willing must be created to lead this movement. The All Nations Health Partners in Kenora, Ontario, have formed to lead health system reform in the Kenora Health District and are doing so in the spirit of Reconciliation in Action. All nations and organizations working together to reduce health disparities and improve health outcomes for all people.

scholarly journals Health system reforms in mature welfare states: tales from the north

2018 ◽  
Vol 31 (4) ◽  
Author(s):  
Jean-Louis Denis ◽  
Susan Usher ◽  
Johanne Preval ◽  
Élizabeth Côté-Boileau
Keyword(s):  
Health System ◽  
Health Systems ◽  
Large Scale ◽  
Medical Profession ◽  
Welfare States ◽  
System Reform ◽  
The North ◽  
Challenges And Opportunities ◽  
Canadian Health ◽  
Canada Data

Objective: This article has the objective show an essay on emerging themes in health system reforms, based on experience in Canada. Data synthesis: Reforms are the privileged mode of social change used by modern democratic societies. Persistent dysfunction and failure to adapt to emerging health needs and priorities within health systems in Canada provide a strong policy rationale to search for alternative strategies that might produce much-needed reforms. Three persistent challenges and opportunities for reform in Canadian health systems are discussed: the design of effective governance arrangements, the large-scale development and implementation of improvement and transformative capacities, and the leadership and engagement of the medical profession in working toward broad system goals. In exploring these challenges, we identify tensions that seem relevant to better understanding health system reform in mature welfare states. Conclusion: Addressing these tensions will require both a reinforcement of state and government capacities and stronger capacities at all levels of the health system to design and support change.

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