scholarly journals Innovation, Demand, and Responsibility: Some Fundamental Questions About Health Systems Comment on "What Health System Challenges Should Responsible Innovation in Health Address? Insights From an International Scoping Review"

2019 ◽  
Vol 8 (9) ◽  
pp. 567-569 ◽  
Author(s):  
Harro van Lente
Keyword(s):  
Health System ◽  
Health Systems ◽  
Scoping Review ◽  
Responsible Innovation

In this commentary on the exercise of Lehoux et al (this volume) I argue that in discussions on the current challenges of health systems, a better diagnosis of the health system is required. The cause of responsible innovation in health (RIH) requires a better understanding of the dynamics of health systems, in particular how innovation, demand, and responsibility are manifested. Innovation brings its own dynamic to the health system; demands are linked to historical and social developments; responsibility brings contestations about what counts as good healthcare. Any attempt of RIH should include such reflections.

scholarly journals Innovation Strategies and Health System Guiding Principles to Address Equity and Sustainability in Responsible Innovation in Health Comment on "What Health System Challenges Should Responsible Innovation in Health Address? Insights From an International Scoping Review"

2019 ◽  
Vol 8 (9) ◽  
pp. 570-572 ◽  
Author(s):  
Sandra C. Buttigieg
Keyword(s):  
Health System ◽  
Health Systems ◽  
Scoping Review ◽  
Global Scale ◽  
System Level ◽  
Responsible Innovation ◽  
Policy Makers ◽  
Innovation Strategies ◽  
Sustainability Challenges ◽  
The Right

The insights from an international scoping review provided by Lehoux et al challenge health policy-makers, entrepreneurs/innovators and users of healthcare, worldwide, to be aware of equity and sustainability challenges at system-level when appraising responsible innovation in health (RIH) – purposefully designed to better support health systems.The authors manage to extract no less than 1391 health system challenges with those mostly cited pertaining to service delivery, human resources, leadership and governance. Countries were classified according to the Human Development Index (HDI), while the authors decided not to classify according to the types of health systems justifying this on the basis that the articles reviewed studied a specific setting within a broader national or regional health system. The article presents highly powerful and discerning viewpoints, indeed providing numerous standpoints, yet in a comprehensive manner, thereby putting structure to a somewhat highly complex and multidimensional subject. This commentary brings forth several considerations that are perceived on reading this article. First, although innovation strategies are important for the dynamicity of health systems, one should discuss whether or not RIH can adequately address equity and sustainability on a global scale. Secondly, RIH across countries should also be debated in the context of the principles garnered by the type of health system, thereby identifying whether or not the prevailing political goals support equity and sustainability, and whether or not policy-makers are adequately supported to translate system-level demand signals into innovation development opportunities. As key messages, the commentary reiterates the emphasis made by the authors of the need for international policy-oriented fora as learning vehicles on RIH that also address system-level challenges, albeit the need to acknowledge cultural differences. In addition, the public has not only the right for transparency on how equity and sustainability challenges are addressed in innovation decisions, but also the responsibilities to contribute to overcome these challenges.

scholarly journals What Health System Challenges Should Responsible Innovation in Health Address? Insights From an International Scoping Review

2018 ◽  
Vol 8 (2) ◽  
pp. 63-75 ◽  
Author(s):  
Pascale Lehoux ◽  
Federico Roncarolo ◽  
Hudson Pacifico Silva ◽  
Antoine Boivin ◽  
Jean-Louis Denis ◽  
...  
Keyword(s):  
Service Delivery ◽  
Human Resources ◽  
Health System ◽  
Health Systems ◽  
Scoping Review ◽  
Rural Areas ◽  
Distribution Systems ◽  
Qualitative Content Analysis ◽  
System Level ◽  
Responsible Innovation

Background: While responsible innovation in health (RIH) suggests that health innovations could be purposefully designed to better support health systems, little is known about the system-level challenges that it should address. The goal of this paper is thus to document what is known about health systems’ demand for innovations. Methods: We searched 8 databases to perform a scoping review of the scientific literature on health system challenges published between January 2000 and April 2016. The challenges reported in the articles were classified using the dynamic health system framework. The countries where the studies had been conducted were grouped using the human development index (HDI). Frequency distributions and qualitative content analysis were performed. Results: Up to 1391 challenges were extracted from 254 articles examining health systems in 99 countries. Across countries, the most frequently reported challenges pertained to: service delivery (25%), human resources (23%), and leadership and governance (21%). Our analyses indicate that innovations tend to increase challenges associated to human resources by affecting the nature and scope of their tasks, skills and responsibilities, to exacerbate service delivery issues when they are meant to be used by highly skilled providers and call for accountable governance of their dissemination, use and reimbursement. In countries with a low and medium HDI, problems arising with infrastructure, logistics and equipment were described in connection with challenges affecting procurement, supply and distribution systems. In countries with a medium and high HDI, challenges included a growing demand for drugs and new technology and the management of rising costs. Across all HDI groups, the need for flexible information technologies (IT) solutions to reach rural areas was underscored. Conclusion: Highlighting challenges that are common across countries, this study suggests that RIH should aim to reduce the cost of innovation production processes and attend not only to the requirements of the immediate clinical context of use, but also to the vulnerabilities of the broader system wherein innovations are deployed. Policy-makers should translate system-level demand signals into innovation development opportunities since it is imperative to foster innovations that contribute to the success and sustainability of health systems.

scholarly journals The Co-Constitution of Health Systems and Innovation Comment on "What Health System Challenges Should Responsible Innovation in Health Address? Insights From an International Scoping Review"

2019 ◽  
Vol 8 (11) ◽  
pp. 665-667 ◽  
Author(s):  
Alexander Peine
Keyword(s):  
Health System ◽  
Health Systems ◽  
Scoping Review ◽  
Health Technology ◽  
System Level ◽  
Responsible Innovation ◽  
Future Research ◽  
Technology And Innovation ◽  
Health Innovations ◽  
Potential Risks

Lehoux et al provide a timely and relevant turn on the broad and ongoing discussion around the introduction of health technology and innovation. More specifically, the authors suggest a demand-driven approach to health innovation that starts from identifying challenges and demands at the health system level. In this commentary, I review a number of underlying implications of their study in relation to positions of technology push and techno-optimism, and to the narrow focus on health technology assessment on economic and clinical values. While Lehoux et al’s scoping review provides very relevant insights with the potential to drive further empirical research, it is less clear about its conceptual basis. In particular, the somewhat artificial distinction between health innovations and health systems is worth further scrutiny. I discuss some potential risks of this separation, and propose to more openly address the co-constitution of health, health systems and technology in future research along the lines suggested by Lehoux et al.

scholarly journals Strategies for reducing out of pocket payments in the health system: a scoping review

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Faride Sadat Jalali ◽  
Parisa Bikineh ◽  
Sajad Delavari
Keyword(s):  
Health System ◽  
Health Systems ◽  
Scoping Review ◽  
Health Financing ◽  
Developed Countries ◽  
Vulnerable Groups ◽  
System A ◽  
Out Of Pocket Payments ◽  
Review Study ◽  
Developing And Developed Countries

Abstract Background Direct out-of-pocket payments (OOP) are among the most important financing mechanisms in many health systems, especially in developing countries, adversely affecting equality and leading vulnerable groups to poverty. Therefore, this scoping review study was conducted to identify the strategies involving OOP reduction in health systems. Methods Articles published in English on strategies related to out-of-pocket payments were Searched and retrieved in the Web of Science, Scopus, PubMed, and Embase databases between January 2000 and November 2020, following PRISMA guidelines. As a result, 3710 papers were retrieved initially, and 40 were selected for full-text assessment. Results Out of 40 papers included, 22 (55%) and 18 (45%) of the study were conducted in developing and developed countries, respectively. The strategies were divided into four categories based on health system functions: health system stewardship, creating resources, health financing mechanisms, and delivering health services.As well, developing and developed countries applied different types of strategies to reduce OOP. Conclusion The present review identified some strategies that affect the OOP payments According to the health system functions framework. Considering the importance of stewardship, creating resources, the health financing mechanisms, and delivering health services in reducing OOP, this study could help policymakers make better decisions for reducing OOP expenditures.

scholarly journals What makes health systems resilient against infectious disease outbreaks and natural hazards? Results from a scoping review

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Jennifer B. Nuzzo ◽  
Diane Meyer ◽  
Michael Snyder ◽  
Sanjana J. Ravi ◽  
Ana Lapascu ◽  
...  
Keyword(s):  
Public Health ◽  
Infectious Disease ◽  
Health System ◽  
Natural Hazards ◽  
Health Systems ◽  
Scoping Review ◽  
Disease Outbreaks ◽  
World Health ◽  
Infectious Disease Outbreaks ◽  
System Resilience

Abstract Background The 2014–2016 Ebola outbreak was a wake-up call regarding the critical importance of resilient health systems. Fragile health systems can become overwhelmed during public health crises, further exacerbating the human, economic, and political toll. Important work has been done to describe the general attributes of a health system resilient to these crises, and the next step will be to identify the specific capacities that health systems need to develop and maintain to achieve resiliency. Methods We conducted a scoping review of the literature to identify recurring themes and capacities needed for health system resiliency to infectious disease outbreaks and natural hazards and any existing implementation frameworks that highlight these capacities. We also sought to identify the overlap of the identified themes and capacities with those highlighted in the World Health Organization’s Joint External Evaluation. Sources of evidence included PubMed, Web of Science, OAIster, and the websites of relevant major public health organizations. Results We identified 16 themes of health system resilience, including: the need to develop plans for altered standards of care during emergencies, the need to develop plans for post-event recovery, and a commitment to quality improvement. Most of the literature described the general attributes of a resilient health system; no implementation frameworks were identified that could translate these elements into specific capacities that health system actors can employ to improve resilience to outbreaks and natural hazards in a variety of settings. Conclusions An implementation-oriented health system resilience framework could help translate the important components of a health system identified in this review into specific capacities that actors in the health system could work to develop to improve resilience to public health crises. However, there remains a need to further refine the concept of resilience so that health systems can simultaneously achieve sustainable transformations in healthcare practice and health service delivery as well as improve their preparedness for emergencies.

scholarly journals Health System Resilience: What Are We Talking About? A Scoping Review Mapping Characteristics and Keywords

2019 ◽  
Vol 9 (1) ◽  
pp. 6-16 ◽  
Author(s):  
My Fridell ◽  
Sanna Edwin ◽  
Johan von Schreeb ◽  
Dell D. Saulnier
Keyword(s):  
Health System ◽  
Health Systems ◽  
Scoping Review ◽  
World Health ◽  
Systems Research ◽  
Quality Health ◽  
System Resilience ◽  
Health Organization ◽  
Key Terms

Background: Health systems are based on 6 functions that need to work together at all times to effectively deliver safe and quality health services. These functions are vulnerable to shocks and changes; if a health system is unable to withstand the pressure from a shock, it may cease to function or collapse. The concept of resilience has been introduced with the goal of strengthening health systems to avoid disruption or collapse. The concept is new within health systems research, and no common description exists to describe its meaning. The aim of this study is to summarize and characterize the existing descriptions of health system resilience to improve understanding of the concept. Methods and Analysis: A scoping review was undertaken to identify the descriptions and characteristics of health system resilience. Four databases and gray literature were searched using the keywords "health system" and "resilience" for published documents that included descriptions, frameworks or characteristics of health system resilience. Additional documents were identified from reference lists. Four expert consultations were conducted to gain a broader perspective. Descriptions were analysed by studying the frequency of key terms and were characterized by using the World Health Organization (WHO) health system framework. The scoping review identified eleven sources with descriptions and 24 sources that presented characteristics of health system resilience. Frequently used terms that were identified in the literature were shock, adapt, maintain, absorb and respond. Change and learning were also identified when combining the findings from the descriptions, characteristics and expert consultations. Leadership and governance were recognized as the most important building block for creating health system resilience. Discussion: No single description of health system resilience was used consistently. A variation was observed on how resilience is described and to what depth it was explained in the existing literature. The descriptions of health system resilience primarily focus on major shocks. Adjustments to long-term changes and the element of learning should be considered for a better understating of health system resilience.

scholarly journals The global pool of simulation exercise materials in health emergency preparedness and response: a scoping review with a health system perspective

2019 ◽  
Vol 4 (4) ◽  
pp. e001687
Author(s):  
Geraldine McDarby ◽  
Lindy Reynolds ◽  
Zandile Zibwowa ◽  
Shams Syed ◽  
Ed Kelley ◽  
...  
Keyword(s):  
Health System ◽  
International Development ◽  
Health Systems ◽  
Scoping Review ◽  
Emergency Preparedness ◽  
Building Blocks ◽  
Health Security ◽  
System Perspective ◽  
Emergency Preparedness And Response ◽  
Health System Perspective

Simulation Exercises (SimEx) are an established tool in defence and allied security sectors, applied extensively in health security initiatives under national or international legislative requirements, particularly the International Health Regulations (2005). There is, however, a paucity of information on SimEx application to test the functionality of health systems alongside emergency preparedness, response and recovery. Given the important implications health services resilience has for the protection and improvement of human life, this scoping review was undertaken to determine how the publicly available body of existing global SimEx materials considers health systems, together with health security functions in the event of disruptive emergencies.The global review identified 668 articles from literature and 73 products from institutional sources. Relevant screening identified 51 materials suitable to examine from a health system lens using the six health system building blocks as per the WHO Health System Framework. Eight materials were identified for further examination of their ability to test health system functionality from a resilience perspective.SimEx are an effective approach used extensively within health security and emergency response sectors but is not yet adequately used to test health system resilience. Currently available SimEx materials lack an integrated health system perspective and have a limited focus on the quality of services delivered within the context of response to a public health emergency. The materials do not focus on the ability of systems to effectively maintain core services during response.Without adjustment of the scope and focus, currently available SimEx materials do not have the capacity to test health systems to support the development of resilient health systems. Dedicated SimEx materials are urgently needed to fill this gap and harness their potential as an operational tool to contribute to improvements in health systems. They can act as effective global goods to allow testing of different functional aspects of health systems and service delivery alongside emergency preparedness and response.The work was conducted within the scope of the Tackling Deadly Diseases in Africa Programme, funded by the UK Department for International Development, which seeks to strengthen collaboration between the health system and health security clusters to promote health security and build resilient health systems.

scholarly journals Reimagining community relationships for organizational learning: a scoping review with implications for a learning health system

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Crystal Milligan ◽  
Whitney Berta
Keyword(s):  
Organizational Learning ◽  
Transformative Learning ◽  
Health System ◽  
Health Systems ◽  
Scoping Review ◽  
English Language ◽  
Explicit Knowledge ◽  
Grey Literature ◽  
Specific Patient ◽  
Learning Health System

Abstract Background Communities represent a highly relevant source of knowledge with regard to not only healthcare performance but also sociocultural context, yet their role in learning health systems has not been studied. Situating the learning health system as an organization, this paper explores the phenomenon of organizational learning from or with communities (defined as one of ‘the people,’ such as a town, a specific patient group or another group directly receiving a healthcare service). Methods We conducted a scoping review to determine what is known about organizational learning from or with communities that the organization serves, and to contribute to a more comprehensive evidence base for building and operating learning health systems. In March 2019, we systematically searched six academic databases and grey literature, applying no date limits, for English language materials that described organizational learning in relation to knowledge transfer between an organization and a community. Numerous variables were charted in Excel and synthesized using frequencies and thematic analysis. We updated this search in August 2020. Results In total, 42 documents were included in our analysis. We found a disproportionate emphasis on learning explicit knowledge from community rather than on tacit knowledge or learning in equal partnership with community. Our review also revealed inconsistently defined concepts, tenuously linked with their theoretical and empirical foundations. Our findings provide insight to understand the organization-community learning relationship, including motives and power differentials; types of knowledge to be learned; structures and processes for learning; and transformative learning outcomes. Conclusions Our review makes a singular contribution to organizational learning literatures by drawing from diverse research disciplines such as health services, business and education to map what is known about learning from or with community. Broadly speaking, learning health systems literature would benefit from additional research and theory-building within a sociological paradigm so as to establish key concepts and associations to understand the nature of learning with community, as well as the practices that make it happen.

scholarly journals Educational needs of medical practitioners about medical billing: a scoping review of the literature

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Margaret Faux ◽  
Jon Adams ◽  
Jonathan Wardle
Keyword(s):  
Medical Education ◽  
Health System ◽  
Health Systems ◽  
Scoping Review ◽  
English Language ◽  
World Health ◽  
Review Of The Literature ◽  
Medical Practitioners ◽  
Education Needs ◽  
Medical Billing

Abstract Introduction The World Health Organization has suggested the solution to health system waste caused by incorrect billing and fraud is policing and prosecution. However, a growing body of evidence suggests leakage may not always be fraudulent or corrupt, with researchers suggesting medical practitioners may sometimes struggle to understand increasingly complex legal requirements around health financing and billing transactions, which may be improved through education. To explore this phenomenon further, we undertook a scoping review of the literature to identify the medical billing education needs of medical practitioners and whether those needs are being met. Methods Eligible records included English language materials published between 1 January 2000 and 4 May 2020. Searches were conducted on MEDLINE, PubMed, Google Scholar, CINAHL, LexisNexis and Heinonline. Results We identified 74 records as directly relevant to the search criteria. Despite undertaking a comprehensive, English language search, with no country restrictions, studies meeting the inclusion criteria were limited to three countries (Australia, Canada, US), indicating a need for further work internationally. The literature suggests the education needs of medical practitioners in relation to medical billing compliance are not being met and medical practitioners desire more education on this topic. Evidence suggests education may be effective in improving medical billing compliance and reducing waste in health systems. There is broad agreement amongst medical education stakeholders in multiple jurisdictions that medical billing should be viewed as a core competency of medical education, though there is an apparent inertia to include this competency in medical education curricula. Penalties for non-compliant medical billing are serious and medical practitioners are at risk of random audits and investigations for breaches of sometimes incomprehensible, and highly interpretive regulations they may never have been taught. Conclusion Despite acknowledged significance of waste in health systems due to poor practitioner knowledge of billing practices, there has been very little research to date on education interventions to improve health system efficiency at a practitioner level.

scholarly journals Public Health and Health Systems Impacts of SARS-CoV-2 Variants of Concern: A Rapid Scoping Review

2021 ◽  
Author(s):  
Janet A Curran ◽  
Justine Dol ◽  
Leah Boulos ◽  
Mari Somerville ◽  
Bearach Reynolds ◽  
...  
Keyword(s):  
Public Health ◽  
Health System ◽  
Health Systems ◽  
Scoping Review ◽  
Grey Literature ◽  
Current Evidence ◽  
Risk Of Death ◽  
Health Measures ◽  
Guidance Documents ◽  
The Impact

Background: As of April 2021, three SARS-CoV-2 variants of concern (VOC: B.1.1.7, B.1.351 and P.1) have been detected in over 132 countries. Increased transmissibility of VOC has implications for public health measures and health system arrangements. This rapid scoping review aims to provide a synthesis of current evidence related to public health measures and health system arrangements associated with VOC. Methods: Rapid scoping review. Seven databases were searched up to April 7, 2021 for terms related to VOC, transmission, public health and health systems. A grey literature search was conducted up to April 14, 2021. Title, abstracts and full text were screened independently by two reviewers. Data were double extracted using a standardized form. Studies were included if they reported on at least one of the VOC and public health or health system outcomes. Results: Of the 2487 articles and 59 grey literature sources retrieved, 37 studies and 21 guidance documents were included. Included studies used a wide range of designs and methods. Most of the studies and guidance documents reported on B.1.1.7, and 18 studies and 4 reports provided data for consideration in relation to public health measures. Public health measures, including lockdowns, physical distancing, testing and contact tracing, were identified as critical adjuncts to a comprehensive vaccination campaign. No studies reported on handwashing or masking procedures related to VOC. For health system arrangements, 17 studies were identified. Some studies found an increase in hospitalization due to B.1.1.7 but no difference in length of stay or ICU admission. Six studies found an increased risk of death ranging from 15-67% with B.1.1.7 compared non-B.1.1.7, but three studies reported no change. One study reported on the effectiveness of personal protective equipment in reducing VOC transmission in the hospital. No studies reported on screening staff and visitors, adjusting service provisions, or adjusting patient accommodations and shared spaces, which is a significant gap in the literature. Guidance documents did not tend to cite any evidence and were thus assumed to be based on expert opinion. Conclusion: While the findings should be interpreted with caution as most of the sources identified were preprints, findings suggest a combination of non-pharmaceutical interventions (e.g., masking, physical distancing, lockdowns, testing) should be employed alongside a vaccine strategy to improve population and health system outcomes. While the findings are mixed on the impact of VOC on health system arrangements, the evidence is trending towards increased hospitalization and death.

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