A system-wide transformation towards integrated care in the Basque Country: A realist evaluation

2018 ◽  
Vol 21 (3) ◽  
pp. 98-108 ◽  
Author(s):  
Maider Urtaran-Laresgoiti ◽  
Arturo Álvarez-Rosete ◽  
Roberto Nuño-Solinís
Keyword(s):  
Health System ◽  
Social Care ◽  
Basque Country ◽  
Economic Recession ◽  
Realist Evaluation ◽  
System Transformation ◽  
Structured Interviews ◽  
Long Run ◽  
Health And Social Care ◽  
Care Systems

Introduction In 2010, in a context of severe economic recession, the Basque Government launched the Strategy to tackle the challenge of chronicity in the Basque Country to transform the Basque health system to cope with the challenges of chronicity, ageing, health system fragmentation and sustainability in the long run. Methods A realist evaluation has been conducted, and through a combination of research methods, information has been analysed to identify context, mechanisms and outcomes. The research provides a snapshot of the experience of a system-wide, complex health system transformation, which aims to identify ‘what has worked, for whom and under what circumstances’. Twenty-two semi-structured interviews held between June 2015 and December 2016, allowed us to obtain both retrospective and real-time accounts on the transformation phenomenon. Results Research pointed out that system-wide transformation requires time, effort, leadership, vision and narrative, as well as commitment, inclusiveness, collaborative decision-making processes with local implementers, ‘muddling through’ and constant learning. Key levers to shake and shift the health and social care systems towards closer alignment, coordination and integration to meet the needs of people include promoting collaborative relationships between health professionals to ensure care continuity, developing new staff roles, investing in integrated electronic health records, stratifying the population by risk and facilitating bottom-up innovation. Discussion Research has shown that system-wide changes in health and social care have been viable in the Basque Health System, although the interplay between context, mechanisms and outcomes is more complex than expected, leading to many unexpected factors, patterns and relationships.

scholarly journals Improvisation during a crisis: hidden innovation in healthcare systems

BMJ Leader ◽  
2020 ◽  
Vol 4 (4) ◽  
pp. 185-188 ◽  
Author(s):  
Rene Wiedner ◽  
Charlotte Croft ◽  
Gerry McGivern
Keyword(s):  
Healthcare Professionals ◽  
Social Care ◽  
Economic Recession ◽  
Healthcare Systems ◽  
Service Area ◽  
Critical Situation ◽  
Health And Social Care ◽  
The World ◽  
Care Systems ◽  
Key Drivers

BackgroundCrises, such as the COVID-19 pandemic, risk overwhelming health and social care systems. As part of their responses to a critical situation, healthcare professionals necessarily improvise. Some of these local improvisations have the potential to contribute to important innovations for health and social care systems with relevance beyond the particular service area and crisis in which they were developed.FindingsThis paper explores some key drivers of improvised innovation that may arise in response to a crisis. We highlight how services that are not considered immediate priorities may also emerge as especially fertile areas in this respect.ConclusionHealth managers and policymakers should monitor crisis-induced improvisations to counteract the potential deterioration of non-prioritised services and to identify and share useful innovations. This will be crucial as health and social care systems around the world recover from the COVID-19 pandemic and head into another potential crisis: a global economic recession.

scholarly journals Carer Empowerment Is Key to Reduce Dementia Care Inequalities in the Middle East

2021 ◽  
Vol 18 (8) ◽  
pp. 4378
Author(s):  
Syed Fahad Javaid ◽  
Aishah Al-Zahmi ◽  
Munir Abbas
Keyword(s):  
Middle East ◽  
Social Care ◽  
Evidence Based ◽  
Political Factors ◽  
Knowledge Based ◽  
Care And Support ◽  
Health And Social Care ◽  
Care Systems ◽  
Spiritual Perspectives ◽  
Do So

Dementia represents a significant problem in the Middle East. Sociocultural and political factors that shape conceptions of health and care tend to stifle research and the dissemination of knowledge throughout the Middle East. These socio-political challenges concerning engagement with individuals living with dementia and their carers include language barriers, stigmatization, logistical constraints, lack of informal support outside of hospitals, and over-dependence on clinicians for dementia information. There is an urgent need in the Middle East to increase care and support for adults with dementia and their carers, enhance research efforts and improve the dissemination of information related to dementia in the region. One possible way to do so is to begin to promote a knowledge-based culture throughout the Middle East. This can be achieved by aligning traditional deterministic and spiritual perspectives of mental health with more Western, scientific, and evidence-based models. We suggest employing practical, multidimensional approaches to deal with the stated challenges, both at individual and societal levels. Doing so will improve knowledge of dementia and allow health and social care systems in the Middle East to begin to address a growing problem.

Health and Social Care Systems

2020 ◽  
pp. 49-66
Author(s):  
Anna Coleman ◽  
Jolanta Shields ◽  
Tim Gilling
Keyword(s):  
Social Care ◽  
Health And Social Care ◽  
Care Systems

scholarly journals The importance of a room with a view for older people with limited mobility

2018 ◽  
Vol 19 (4) ◽  
pp. 273-285 ◽  
Author(s):  
Charles Musselwhite
Keyword(s):  
Older People ◽  
Design Methodology ◽  
Social Care ◽  
Structured Interviews ◽  
Content Type ◽  
Limited Mobility ◽  
Human Element ◽  
Health And Social Care ◽  
Vantage Points ◽  
Practical Implications

Purpose The purpose of this paper is to examine how older people who are almost entirely housebound use a view from their window to make sense of the world and stay connected to the outside space that they cannot physically inhabit. Design/methodology/approach Semi-structured interviews with 42 individuals were carried out who were living at home, were relatively immobile and had an interesting view outside they liked from one or more of their windows. Findings The findings suggest that immobile older people enjoy watching a motion-full, changing, world going on outside of their own mobility and interact and create meaning and sense, relating themselves to the outside world. Practical implications Findings suggest that those working in health and social care must realise the importance of older people observing the outdoors and create situations where that is enabled and maintained through improving vantage points and potentially using technology. Originality/value This study builds and updates work by Rowles (1981) showing that preference for views from the window involves the immediate surveillance zone but also further afield. The view can be rural or urban but should include a human element from which older people can interact through storytelling. The view often contains different flows, between mundane and mystery and intrigue, and between expected and random.

scholarly journals Háziorvosok és idősellátás egy kérdőíves kutatás tükrében

2018 ◽  
Vol 159 (8) ◽  
pp. 312-319
Author(s):  
Anett Mária Tróbert ◽  
Zsuzsanna Széman
Keyword(s):  
Health Care ◽  
General Practitioners ◽  
Social Care ◽  
The Elderly ◽  
Care Process ◽  
Efficient Operation ◽  
Health And Social Care ◽  
Care Systems ◽  
Care System

Abstract: According to statistical data, the number of healthy life years is not increasing in proportion with the longer average life expectancy. In the ageing societies, the long-term care systems are increasingly overburdened; cost-efficient operation and the related coordination of services is one of the key questions for their sustainability. The present separation of the health care and social care systems causes numerous difficulties. One aim of the online research by questionnaire was to survey the attitude of general practitioners – who play a very important part in care for the elderly – towards their elder patients, the patients’ family members, and social workers providing eldercare. The other aim was to gather information on shortcomings experienced by doctors in the care system and on what possibilities general practitioners see for the improvement of eldercare. Semi-structured questionnaires were applied and analysed by descriptive and content methodology. The questionnaires were sent out to 5060 addresses around the country: a total of 145 were returned filled in. The respondents made many recommendations for the improvement of eldercare in the categories of development of social services, family support, development of health services, and societal cooperation. The areas in need of development named by the general practitioners are closely interrelated: the reform of social care would support the health care system and vice versa. More effective operation of the health and social care systems would ease the burdens of families, and at the same time encourage more active participation of families in the care process. And the systematic education of society and communities is a long-term investment that would strengthen a positive attitude towards old age and a value-oriented view of the ageing process that is one of the basic conditions for successful social integration of the elderly. Orv Hetil. 2018; 159(8): 312–319.

Beyond healthcare leadership? The imperative for health and social care systems

2020 ◽  
Vol 33 (4) ◽  
pp. 351-363
Author(s):  
John Duncan Edmonstone
Keyword(s):  
Health Care ◽  
Leadership Development ◽  
Social Care ◽  
Current Model ◽  
Healthcare Leadership ◽  
Content Type ◽  
Health And Social Care ◽  
The Future ◽  
Care Systems ◽  
The Uk

Purpose This paper aims to make the case that there is a need to move beyond a focus on an approach to leadership development which is confined to health care only. It argues that, given the economic, financial, social and organisational context within which health and social care organisations in the UK operate, there is a need to develop leadership within health and social care systems, rather than within the existing “siloed” sectors. Design/methodology/approach The paper considers the context within which health and social care organisations in the UK operate; examines the nature of those organisations; makes the case for focusing on the health and social car system through systems leadership; and identifies the need for leadership, rather than leader development. Findings There is a danger of health and social care organisations “walking backwards into the future” with eyes fixed on the past. The future lies with treating health and social care as a system, rather than focusing on organisations. The current model is individual leader focused, but the emerging model is one of collective multi-agency teams. Originality/value The paper seeks to go beyond a health-care-only focus, by asserting that there is a need to regard health and social care as a single system, delivered by a multiplicity of different organisations. This has implications for the kind of leadership involved and for how this might be developed.

scholarly journals What elements of a systems’ approach to bereavement are most effective in times of mass bereavement? A narrative systematic review with lessons for COVID-19

2020 ◽  
Vol 34 (9) ◽  
pp. 1165-1181 ◽  
Author(s):  
Emily Harrop ◽  
Mala Mann ◽  
Lenira Semedo ◽  
Davina Chao ◽  
Lucy E Selman ◽  
...  
Keyword(s):  
Systematic Review ◽  
Disaster Response ◽  
Social Care ◽  
Systems Approach ◽  
Evidence Base ◽  
System Level ◽  
Service Improvement ◽  
Current Crisis ◽  
Health And Social Care ◽  
Care Systems

Background: The global COVID-19 pandemic has left health and social care systems facing the challenge of supporting large numbers of bereaved people in difficult and unprecedented social conditions. Previous reviews have not comprehensively synthesised the evidence on the response of health and social care systems to mass bereavement events. Aim: To synthesise the evidence regarding system-level responses to mass bereavement events, including natural and human-made disasters as well as pandemics, to inform service provision and policy during the COVID-19 pandemic and beyond. Design: A rapid systematic review was conducted, with narrative synthesis. The review protocol was registered prospectively ( www.crd.york.ac.uk/prospero , CRD 42020180723). Data sources: MEDLINE, Global Health, PsycINFO and Scopus databases were searched for studies published between 2000 and 2020. Reference lists were screened for further relevant publications, and citation tracking was performed. Results: Six studies were included reporting on system responses to mass bereavement following human-made and natural disasters, involving a range of individual and group-based support initiatives. Positive impacts were reported, but study quality was generally low and reliant on data from retrospective evaluation designs. Key features of service delivery were identified: a proactive outreach approach, centrally organised but locally delivered interventions, event-specific professional competencies and an emphasis on psycho-educational content. Conclusion: Despite the limitations in the quantity and quality of the evidence base, consistent messages are identified for bereavement support provision during the pandemic. High quality primary studies are needed to ensure service improvement in the current crisis and to guide future disaster response efforts.

scholarly journals Creating allegiance: leading transformational change within the NHS

BMJ Leader ◽  
2018 ◽  
Vol 2 (3) ◽  
pp. 110-114 ◽  
Author(s):  
Alison Tweed ◽  
Andrew Singfield ◽  
Julia R A Taylor ◽  
Lucy Gilbert ◽  
Paul Mount
Keyword(s):  
Social Care ◽  
Transformational Change ◽  
System Level ◽  
Senior Leaders ◽  
Template Analysis ◽  
Health And Social Care ◽  
Care Systems ◽  
Uk National Health Service ◽  
The Uk ◽  
Healthcare Transformation

BackgroundWithin the UK National Health Service (NHS) the move to Sustainable Transformation Plans/Partnerships and Integrated Care Systems reflect the increasing need and expectation for transformational change at a system level across both health and social care boundaries. Transformational change is complex, emergent and dynamic requiring new, non-traditional forms of leadership which are highly relational and persuasive.Aim of the studyThe current study aimed to explore a small number of NHS senior leaders’ experiences of undertaking transformational change within their localities over a period of a year following participation in a national transformational change programme designed to enhance personal capabilities.MethodFour pairs of leaders working on different change programmes took part in the study and were interviewed at three time points about their approach to their change work. The data were analysed qualitatively using template analysis.ResultsA core theme of Creating Allegiance to an Emergent Future World was developed. The senior leaders created allegiance to the transformational change through a process of Connecting on three levels: relational, with purpose and vision and through practice. Allegiance creation was attempted even if the transformational change work at the year-end was deemed successful or not.ConclusionsThe study highlights the types of leadership behaviours employed by the participants reflecting the complexity and social construction of their transformational work. The findings provide further evidence to the existing system leadership literature as well as emphasising the importance of creating stakeholder, multilevel buy-in to healthcare transformation.

scholarly journals Medicines reablement in intermediate health and social care services

2017 ◽  
Vol 18 (04) ◽  
pp. 305-315
Author(s):  
Kate Gerrish ◽  
Sara Laker ◽  
Sarah Wright ◽  
Wendy Stainrod
Keyword(s):  
Social Care ◽  
Training Programme ◽  
Care Staff ◽  
Intermediate Care ◽  
Structured Interviews ◽  
Self Administration ◽  
Frontline Staff ◽  
Care Services ◽  
Health And Social Care ◽  
Pharmacy Technicians

Aim To evaluate a medicines reablement initiative involving health and social care, to include consideration of the training package, proportion of patients reabled successfully, and patient and staff perspectives of the service. Background Intermediate care services provide short-term intervention to support patients with chronic conditions transition from hospital to community-based services and involves maximising patients’ independence through reablement. The term ‘medicines reablement’ describes the process of rehabilitating patients to be independent with their medication. Methods Pharmacy technicians led the medicines reablement initiative. They delivered a competency-based training programme for frontline health and social care staff. They assessed and set goals with patients to facilitate independence in self-administration of their medication. The pharmacy technicians provided on-going support to staff helping patients to reable. They reassessed patients after six weeks to determine if medicines reablement had been successful or whether further input was needed. Data were collected by means of a questionnaire and semi-structured interviews with pharmacy technicians, frontline staff, managers, and patients. Findings Twenty per cent of patients discharged from hospital to intermediate care were assessed to be suitable for medicines reablement. Of these patients, 44% were successfully reabled and a further 25% benefited from the input of a pharmacy technician. Patients and staff were positive about medicines reablement, emphasising the importance of patients attaining independence for self-administration of medication. Although following training, health and social care staff felt confident in facilitating medicines reablement they valued on-going access to pharmacy technicians for timely support, help with problem solving, and advice throughout the reablement process. Conclusion Medicines reablement can lead to patients becoming independent with taking medication and contribute to staff satisfaction. Pharmacy technicians can play an important part in delivering medicines reablement training to frontline staff and overseeing the reablement process. Further research examining medicines reablement is needed to develop a stronger evidence base.

Sign in / Sign up

Export Citation Format

Share Document