scholarly journals Making healthcare accessible for single adults with complex needs experiencing long-term homelessness: A realist evaluation protocol

2021 ◽  
Vol 3 ◽  
pp. 73
Author(s):  
Rikke Siersbaek ◽  
John Ford ◽  
Clíona Ní Cheallaigh ◽  
Sara Burke ◽  
Steve Thomas
Keyword(s):  
Health System ◽  
Performance Management ◽  
System Performance ◽  
Realist Review ◽  
Realist Evaluation ◽  
System Level ◽  
Health System Performance ◽  
Programme Theory ◽  
Healthcare Accessibility

Background: Over the last several years, homelessness has increased in Ireland and across Europe. Rates have recently declined since the coronavirus disease 2019 (COVID-19) pandemic, but it is unclear whether emergency housing measures will remain in place permanently. Populations experiencing long-term homelessness face a higher burden of multi-morbidity at an earlier age than housed populations and have poorer health outcomes. However, this population also has more difficulty accessing appropriate health services. A realist review by the authors found that important health system contexts which impact access are resourcing, training, funding cycles, health system fragmentation, health system goals, how care is organised, culture, leadership and flexibility of care delivery. Using a realist evaluation approach, this research will explore and refine key system-level factors, highlighted in our realist review, in a local health care system. Aim: The aim of this study is to understand how funding procedures and health system performance management impact service settings, staff, providers and their ability to make services accessible to populations experiencing homelessness. Methods: A realist evaluation will be undertaken to explain how funding and health system performance management impact healthcare accessibility for populations experiencing homelessness. Data will be collected using qualitative and realist interview techniques and focus group methodology. Secondary data such as policy documents and budgets will utilised. The analysis will follow Pawson and Tilley’s iterative phases starting with building an Initial programme theory, then data collection, data analysis, synthesis and finally building a refined programme theory. Conclusion: Building on a realist review conducted by the same research team, this study will further test and refine findings that explain how health system factors impact healthcare accessibility for populations experiencing homelessness. The study has the potential to inform policy makers, health planners and managers of contextual factors that can be modified to increase healthcare accessibility.

scholarly journals How accessible is healthcare for single adults experiencing long-term homelessness and complex needs? A realist evaluation protocol

2020 ◽  
Vol 3 ◽  
pp. 73 ◽  
Author(s):  
Rikke Siersbaek ◽  
John Ford ◽  
Clíona Ní Cheallaigh ◽  
Sara Burke ◽  
Steve Thomas
Keyword(s):  
Health System ◽  
Performance Management ◽  
System Performance ◽  
Realist Review ◽  
Realist Evaluation ◽  
System Level ◽  
Health System Performance ◽  
Programme Theory ◽  
Healthcare Accessibility

Background: Over the last several years, homelessness has increased in Ireland and across Europe. Rates have recently declined since the coronavirus disease 2019 (COVID-19) pandemic, but it is unclear whether emergency housing measures will remain in place permanently. Populations experiencing long-term homelessness face a higher burden of multi-morbidity at an earlier age than housed populations and have poorer health outcomes. However, this population also has more difficulty accessing appropriate health services. A realist review by the authors found that important health system contexts which impact access are resourcing, training, funding cycles, health system fragmentation, health system goals, how care is organised, culture, leadership and flexibility of care delivery. Using a realist evaluation approach, this research will explore and refine key system-level factors, highlighted in our realist review, in a local health care system. Aim: The aim of this study is to understand how funding procedures and health system performance management impact service settings, staff, providers and their ability to make services accessible to populations experiencing homelessness. Methods: A realist evaluation will be undertaken to explain how funding and health system performance management impact healthcare accessibility for populations experiencing homelessness. Data will be collected using qualitative and realist interview techniques and focus group methodology. Secondary data such as policy documents and budgets will utilised. The analysis will follow Pawson and Tilley’s iterative phases starting with building an Initial programme theory, then data collection, data analysis, synthesis and finally building a refined programme theory. Conclusion: Building on a realist review conducted by the same research team, this study will further test and refine findings that explain how health system factors impact healthcare accessibility for populations experiencing homelessness. The study has the potential to inform policy makers, health planners and managers of contextual factors that can be modified to increase healthcare accessibility.

scholarly journals Contexts and mechanisms that promote access to healthcare for populations experiencing homelessness: a realist review

2020 ◽  
Author(s):  
Rikke Siersbaek ◽  
John Ford ◽  
Sara Burke ◽  
Clíona Ní Cheallaigh ◽  
Steve Thomas
Keyword(s):  
Health System ◽  
Health Systems ◽  
Healthcare Access ◽  
Grey Literature ◽  
Realist Review ◽  
Access To Healthcare ◽  
Staff Retention ◽  
Programme Theory ◽  
Eligibility Criteria

Abstract Objective: The objective of this study was to identify and understand the health system contexts and mechanisms that allow for homeless populations to access appropriate healthcare when needed.Design: A realist review.Data sources: Ovid MEDLINE, embase.com, CINAHL, ASSIA and grey literature until April 2019. Eligibility criteria for selecting studies: The purpose of the review was to identify health system patterns which enable access to healthcare for people who experience homelessness. Peer reviewed articles were first identified through a systematic search, grey literature searching, citation tracking and expert recommendations. Studies meeting the inclusion criteria were assessed for rigour and relevance and coded to identify data relating to contexts, mechanisms and/or outcomes.Analysis: Inductive coding was used to generate Context-Mechanism-Outcome configurations which were refined and then used to build several iterations of the overarching programme theory.Results: Searching identified 330 review articles, of which 24 were included. Additional searching of grey literature yielded 50 records of which 12 were included. An additional 11 grey literature and primary sources were identified through citation tracking and expert recommendation for a total of 47 included sources. The analysis found that healthcare access for populations experiencing homelessness is improved when services are coordinated and delivered in a way that is organised around the person with a high degree of flexibility and a culture that rejects stigma generating trusting relationships between patients and staff/providers. Health systems should provide long-term, dependable funding for services to ensure sustainability and staff retention. Conclusions: With homelessness on the rise internationally, this study will inform health systems policy-making and implementation. It contributes to our understanding how healthcare systems can be more accessible for populations experiencing homelessness by providing long-term stable funding, promoting inclusive cultures and limiting stigma. Health systems should be flexible, timely and connected.

scholarly journals Long-Term Impact of Environmental Public Health Disaster on Health System Performance

2013 ◽  
Vol 106 (1) ◽  
pp. 74-81 ◽  
Author(s):  
Jennifer R. Runkle ◽  
Hongmei Zhang ◽  
Wilfried Karmaus ◽  
Amy Brock-Martin ◽  
Erik R. Svendsen
Keyword(s):  
Public Health ◽  
Health System ◽  
System Performance ◽  
Health System Performance ◽  
Environmental Public Health ◽  
Long Term Impact

scholarly journals Impact of a long-term policy on mental health system performance and stability: the case of Bizkaia (Basque Country, Spain)

2019 ◽  
Vol 19 (4) ◽  
pp. 196
Author(s):  
Nerea Almeda ◽  
Carlos R. García-Alonso ◽  
José A. Salinas-Pérez ◽  
Carlos Pereira Rodríguez ◽  
Luis Salvador-Carulla
Keyword(s):  
Mental Health ◽  
Health System ◽  
Mental Health System ◽  
System Performance ◽  
Basque Country ◽  
Health System Performance

scholarly journals Contexts and mechanisms that promote access to healthcare for populations experiencing homelessness: a realist review

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e043091
Author(s):  
Rikke Siersbaek ◽  
John Alexander Ford ◽  
Sara Burke ◽  
Clíona Ní Cheallaigh ◽  
Steve Thomas
Keyword(s):  
Health System ◽  
Healthcare Access ◽  
Grey Literature ◽  
Realist Review ◽  
Access To Healthcare ◽  
Staff Retention ◽  
Programme Theory ◽  
Eligibility Criteria ◽  
Ovid Medline ◽  
High Level

ObjectiveThe objective of this study was to identify and understand the health system contexts and mechanisms that allow for homeless populations to access appropriate healthcare when needed.DesignA realist review.Data sourcesOvid MEDLINE, embase.com, CINAHL, ASSIA and grey literature until April 2019.Eligibility criteria for selecting studiesThe purpose of the review was to identify health system patterns which enable access to healthcare for people who experience homelessness. Peer-reviewed articles were identified through a systematic search, grey literature search, citation tracking and expert recommendations. Studies meeting the inclusion criteria were assessed for rigour and relevance and coded to identify data relating to contexts, mechanisms and/or outcomes.AnalysisInductive and deductive coding was used to generate context–mechanism–outcome configurations, which were refined and then used to build several iterations of the overarching programme theory.ResultsSystematic searching identified 330 review articles, of which 24 were included. An additional 11 grey literature and primary sources were identified through citation tracking and expert recommendation. Additional purposive searching of grey literature yielded 50 records, of which 12 were included, for a total of 47 included sources. The analysis found that healthcare access for populations experiencing homelessness is improved when services are coordinated and delivered in a way that is organised around the person with a high degree of flexibility and a culture that rejects stigma, generating trusting relationships between patients and staff/practitioners. Health systems should provide long-term, dependable funding for services to ensure sustainability and staff retention.ConclusionsWith homelessness on the rise internationally, healthcare systems should focus on high-level factors such as funding stability, building inclusive cultures and setting goals which encourage and support staff to provide flexible, timely and connected services to improve access.

scholarly journals An evaluation of the global health security agenda steering group governance interventions

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
N E DeShore ◽  
J A Johnson ◽  
P Malone ◽  
R Greenhill ◽  
W Wuenstal
Keyword(s):  
Global Health ◽  
Health System ◽  
System Performance ◽  
Health System Performance ◽  
Global Health Security ◽  
Member States ◽  
Health Security ◽  
Governance Indicators ◽  
Positive Effect ◽  
Global Health Security Agenda

Abstract Background Member States lack of compliance with 2005 IHR implementation led to the launched of the Global Health Security Agenda. This research will provide an understanding of how the Global Health Security Agenda Steering Group (GHSA SG) governance interventions impact health system performance and global health security. This will enhance the understanding of a Steering Group's governance interventions in complex Global Health initiatives. Research questions: To what extent have GHSA SG governance interventions contributed towards enabling health system performance of WHO Member States? To what extent have GHSA SG governance interventions contributed towards the implementation of global health security among WHO Member States? Methods Correlational analysis using Spearman's rho examined the relationship between governance, health system performance and global health security variables at one point in time. A convenience non-probability sample consisting of eight WHO Member States was used. SPSS Statistics generated the bivariate correlation analyzes. Results Governance and health system performance analysis indicated a statistically significant strong positive effect size in 11 out of 18 and moderate positive effect size in the remaining seven out of 18 health system performance indicators. Governance and global health security analysis concluded three of the governance indicators had strong and moderate positive coefficients. Global health security variables demonstrated weak effects in the remaining three governance indicators. Conclusions This study presents a case for health systems embedding in global health security. Health system performance is only as effective at protecting populations when countries achieve core capacities of preparedness and response to global health threats. The associations provide stakeholders information about key characteristics of governance that influence health system performance and global health security implementation. Key messages This study provides an argument for the continued support of the GHSA 2024 Framework with implementation of global health security capabilities and meeting 2005 IHR requirements. The GHSA SG governance role remains profoundly important in establishing sustainable efforts internationally towards achieving the objectives of the GHSA in support of the 2005 IHR standards.

scholarly journals Using Higher-Order Constructs to Estimate Health-Disease Status: The Effect of Health System Performance and Sustainability

Mathematics ◽  
2021 ◽  
Vol 9 (11) ◽  
pp. 1228
Author(s):  
Alicia Ramírez-Orellana ◽  
María del Carmen Valls Martínez ◽  
Mayra Soledad Grasso
Keyword(s):  
Health System ◽  
Social Services ◽  
System Performance ◽  
Structural Equation ◽  
Disease Incidence ◽  
Disease Status ◽  
Well Being ◽  
Equation Modeling ◽  
Health System Performance ◽  
The Relationship

This article aims to provide information to public agencies and policymakers on the determinants of health systems and their relationships that influence citizens’ health–disease status. A total of 61 indicators for each of 17 Spanish autonomous communities were collected from the Spanish Ministry of Health, Social Services, and Equality between 2008 and 2017. The applied technique was partial least squares structural equation modeling (PLS-SEM). Concerning health–disease status, an influence of sustainability and performance on the health system was hypothesized. The findings revealed that health system sustainability had a negative effect on health–disease status, measured in terms of disease incidence. However, the relationship between health system performance and health–disease status is positive. Furthermore, health system performance mediates the relationship between sustainability and health–disease status. According to our study, if we consider the opposite poles that make up the definition of health–disease status (well-being and disease), this concept is defined more by the incidence of the negative aspect.

Does health system performance reporting stimulate change?

2018 ◽  
Vol 31 (6) ◽  
pp. 235-238 ◽  
Author(s):  
Kira Leeb
Keyword(s):  
Health System ◽  
System Performance ◽  
International Health ◽  
Health System Performance ◽  
Making Sense ◽  
Performance Reporting ◽  
Canadian Institute ◽  
National Organizations ◽  
Health Quality ◽  
Key Aspects

For numerous countries, including Canada, regular health system performance reporting has become increasingly routine if not mandated by legislation. In Canada, the health system performance reporting agenda includes multiple players at all levels from national organizations to provincial health (quality) councils and others. Canada, like many other countries, also participates in international health system performance reporting initiatives. Making sense of what all of these reporting initiatives are telling us about health system performance both within Canada and compared to other countries is becoming increasingly more challenging. For almost 20 years, the Canadian Institute for Health Information has worked with provinces, territories, and other key partners to develop comparable, standardized pan-Canadian performance indicators. Throughout this process, many lessons have been identified including the actionability one can reasonably expect from public reporting initiatives. This article outlines some of the key aspects of these lessons.

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