scholarly journals A critical systems evaluation of the introduction of a ‘discharge to assess’ service in Kent

2022 ◽  
pp. 026101832110650
Author(s):  
Erica Wirrmann Gadsby ◽  
Gerald Wistow ◽  
Jenny Billings
Keyword(s):  
Integrated Care ◽  
Implementation Process ◽  
Research Programme ◽  
Models Of Care ◽  
Critical Systems Thinking ◽  
Power Relationships ◽  
Critical Systems ◽  
Improvement Project ◽  
Stakeholder Perspectives ◽  
Hospital Patients

Discharge to Assess (D2A) models of care have been developed to expedite the process of discharging hospital patients as soon as they are medically fit to leave, thereby improving the efficiency and effectiveness of the healthcare system. This article focuses on the implementation of a D2A model in Kent, England, which formed a case study for a European research programme of improvements in integrated care for older people. It uses the Critical Systems Heuristics framework to examine the implementation process and focuses in particular on why this improvement project proved to be so difficult to implement and why the anticipated outcomes were so elusive. The analysis highlights the value in using critical systems thinking to better evaluate integrated care initiatives, in particular by identifying more explicitly different stakeholder perspectives and power relationships within the system and its decision environment.

Introduction

2018 ◽  
Author(s):  
Jenny Andersson
Keyword(s):  
Cold War ◽  
Critical Systems Thinking ◽  
Critical Systems ◽  
Political Ideologies ◽  
The Future ◽  
History Of ◽  
Post War ◽  
The 1960S ◽  
The Cold War ◽  
Future Visions

The book proposes that the Cold War period saw a key debate about the future as singular or plural. Forms of Cold War science depicted the future as a closed sphere defined by delimited probabilities, but were challenged by alternative notions of the future as a potentially open realm with limits set only by human creativity. The Cold War was a struggle for temporality between the two different future visions of the two blocs, each armed with its set of predictive technologies, but these were rivaled, from the 1960s on, by future visions emerging from decolonization and the emergence of a set of alternative world futures. Futures research has reflected and enacted this debate. In so doing, it offers a window to the post-war history of the social sciences and of contemporary political ideologies of liberalism and neoliberalism, Marxism and revisionist Marxism, critical-systems thinking, ecologism, and postcolonialism.

The business of integrated care: implementing new models of care in a fee-for-service setting

2018 ◽  
Vol 26 (1) ◽  
pp. 16-28 ◽  
Author(s):  
Serena Yu ◽  
Kees van Gool ◽  
Karen Edwards ◽  
Sue Kirby ◽  
Karen Gardner ◽  
...  
Keyword(s):  
Data Collection ◽  
Integrated Care ◽  
Models Of Care ◽  
Rural Setting ◽  
Fee For Service ◽  
Content Type ◽  
Practice Level ◽  
South Wales ◽  
Administration Time ◽  
Rural Sites

Purpose The Western New South Wales Integrated Care Strategy (ICS) was rolled out from November 2014 across three rural sites. The purpose of this paper is to assess its impact on general practices, and examine the feasibility of implementing an ICS, within a predominantly fee-for-service delivery model. Design/methodology/approach Mixed methods were used to analyse the implementation of the ICS, including practice-level patient data on changes in service provision. This includes unit-record data on 130 enroled patients across three rural sites, as well as qualitative data collection from providers. Findings There were significant increases in both revenue-generating and non-revenue-generating activities (primarily care coordination activities) associated with implementing the ICS. Each occasion of service involved greater contact time with practice staff other than GPs, as well as greater administration time. There is evidence that ICS activities such as case conferencing and team care planning substitute for traditional GP consultations. Overall, the study found that a significant investment of resources – namely staff time devoted to a range of activities – was required to support the implementation of the ICS. Such an investment was supported both externally and through revenue-generating practice-level activities. Research limitations/implications The data collection and evaluation project is ongoing, with analysis based on the first wave of data from three sites. Practical implications At the practice level, a substantial commitment of resources is required to invest in, and sustain, a new model of integrated care (IC). This commitment can currently be supported both through higher revenue generation at the practice level, and externally by health system stakeholders, but changes in financial settings could impact on financial viability. Originality/value This paper provides evidence on the role of blended payment mechanisms in facilitating the implementation of IC in a rural setting where there are medical workforce constraints.

Critical Systems Perspective of Strategic Decision Making

2020 ◽  
pp. 55-80
Author(s):  
Jelena Nikolić ◽  
Dejana Zlatanović
Keyword(s):  
Decision Making ◽  
Systems Thinking ◽  
Critical Systems Thinking ◽  
Strategic Decision ◽  
Strategic Decision Making ◽  
Critical Systems ◽  
Strategic Decisions ◽  
Systems Methodology ◽  
Soft Systems ◽  
Factors Affecting

Growing complexity and diversity of strategic decisions indicate the need for applying the appropriate holistic tools in strategic decision making. Thus, the chapter deals with the process of strategic decision making from the viewpoint of critical systems thinking, with emphasis on the role of values and context in strategic decision making. The main purpose is to show how systems thinking generally and critical systems thinking particularly can help decision makers involve different perceptions and values in the process of strategic decision making, as well as take into account context in which the strategic decisions are made. Considering the key internal and external factors affecting strategic decision making, the authors have selected three systems methodologies stemming from different paradigms: soft systems methodology as interpretive, team syntegrity as emancipatory, and organizational cybernetics as functionalist systems methodology. The way in which they can be combined, aimed at improving effectiveness of strategic decision making, has been presented.

A Critical Systems View of Power-Ethics Interactions in Information Systems Evaluation

2008 ◽  
pp. 3387-3403
Author(s):  
José-Rodrigo Córdoba
Keyword(s):  
Information Systems ◽  
Power Relations ◽  
Stakeholder Participation ◽  
Critical Systems Thinking ◽  
Ethical Reflection ◽  
Critical Systems ◽  
Evaluation Practice ◽  
Ethical Implications ◽  
Is Evaluation ◽  
Systems View

Current developments in information systems (IS) evaluation emphasise stakeholder participation in order to ensure adequate and beneficial IS investments. It is now common to consider evaluation as a subjective process of interpretation(s), in which people’s appreciations are taken into account to guide evaluations. However, the context of power relations in which evaluation takes place, as well as their ethical implications, has not been given full attention. In this article, ideas of critical systems thinking and Michel Foucault’s work on power and ethics are used to define a critical systems view of power to support IS evaluation. The article proposes a system of inquiry into power with two main areas: 1) Deployment of evaluation via power relations and 2) Dealing with ethics. The first element addresses how evaluation becomes possible. The second one goes in-depth into how evaluation can proceed as being informed by ethical reflection. The article suggests that inquiry into these relationships should contribute to extend current views on power in IS evaluation practice, and to reflect on the ethics of those involved in the process.

scholarly journals Contextualizing and pilot testing the Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) to primary healthcare workers in Kilifi, Kenya

2020 ◽  
Vol 7 ◽  
Author(s):  
Mary A. Bitta ◽  
Symon M. Kariuki ◽  
Anisa Omar ◽  
Leonard Nasoro ◽  
Monica Njeri ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Healthcare ◽  
Implementation Process ◽  
Research Programme ◽  
Rank Test ◽  
Situational Analysis ◽  
Successful Implementation ◽  
Pilot Testing ◽  
Health Gap ◽  
Action Programme

Abstract Background Little data exists about the methodology of contextualizing version two of the Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) in resource-poor settings. This paper describes the contextualisation and pilot testing of the guide in Kilifi, Kenya. Methods Contextualisation was conducted as a collaboration between the KEMRI-Wellcome Trust Research Programme (KWTRP) and Kilifi County Government's Department of Health (KCGH) between 2016 and 2018. It adapted a mixed-method design and involved a situational analysis, stakeholder engagement, local adaptation and pilot testing of the adapted guide. Qualitative data were analysed using content analysis to identify key facilitators and barriers to the implementation process. Pre- and post-training scores of the adapted guide were compared using the Wilcoxon signed-rank test. Results Human resource for mental health in Kilifi is strained with limited infrastructure and outdated legislation. Barriers to implementation included few specialists for referral, unreliable drug supply, difficulty in translating the guide to Kiswahili language, lack of clarity of the roles of KWTRP and KCGH in the implementation process and the unwillingness of the biomedical practitioners to collaborate with traditional health practitioners to enhance referrals to hospital. In the adaptation process, stakeholders recommended the exclusion of child and adolescent mental and behavioural problems, as well as dementia modules from the final version of the guide. Pilot testing of the adapted guide showed a significant improvement in the post-training scores: 66.3% (95% CI 62.4–70.8) v. 76.6% (95% CI 71.6–79.2) (p < 0.001). Conclusion The adapted mhGAP-IG version two can be used across coastal Kenya to train primary healthcare providers. However, successful implementation in Kilifi will require a review of new evidence on the burden of disease, improvements in the mental health system and sustained dialogue among stakeholders.

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