scholarly journals "There’s Not Enough Bodies to Do the Demand:" An Exploration of Key Stakeholder Views on the Role of Health Service Capacity in Shaping Cancer Outcomes in 7 International Cancer Benchmarking Partnership Countries

2020 ◽  
Author(s):  
Maureen Seguin ◽  
Melanie Morris ◽  
Martin McKee ◽  
Ellen Nolte
Keyword(s):  
Health System ◽  
Health Systems ◽  
Cancer Care ◽  
Cancer Survival ◽  
System Capacity ◽  
Multidisciplinary Teams ◽  
Specialist Care ◽  
Cancer Outcomes ◽  
Patient Journey

Background: Differences in cancer survival are shaped by differences in health system capacity in workforce and infrastructure. Part of the International Cancer Benchmarking Partnership (ICBP), this study explored stakeholders’ perceptions of the role of health system capacity necessary for cancer care in influencing cancer survival in 7 high-income countries. Methods: We conducted semi-structured interviews with 79 key informants from national, regional, and local tiers of health systems, professional bodies, patient associations, and academic experts in Australia, Canada, Denmark, Ireland, New Zealand, Norway, and the United Kingdom. Data collection was guided by a conceptual model linking characteristics of health systems and cancer survival along the cancer patient journey, from recognition of symptoms at pre-diagnostic stages through to survivorship or death. Data were analysed using a thematic approach. Results: We identified 3 themes as important in shaping cancer outcomes: primary care and access to diagnostic evaluation, specialist care and access to treatment, and workforce pertaining to diagnostic and treatment phases. Improved infrastructure for diagnosis and treatment had improved cancer outcomes in all jurisdictions. However, this was seen as insufficient if staffing was inadequate. Consolidation of services and greater surgical specialisation was important in some jurisdictions if accompanied by a reconfiguration of services, in particular the creation of specialist multidisciplinary teams, along with supporting capacity in the wider health system. Staff shortages were commonly cited as reasons why some jurisdictions lagged behind others. Conclusion: Continued improvement in cancer outcomes will require sustained investment in plans to deliver and maintain the workforce engaged in cancer care and in the infrastructure on which they depend. However, strategic plans must recognise that systems for cancer care do not work in isolation from the rest of the health system and a whole systems approach is essential if we are to improve outcomes for an ageing, increasingly multimorbid population.

scholarly journals Clinical and policy contexts for cancer care: Evidence from Denmark, Ireland and Ontario (Canada)

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
M Morris ◽  
S Landon ◽  
M McKee ◽  
E Nolte
Keyword(s):  
Health System ◽  
Health Care Providers ◽  
Cancer Care ◽  
Cancer Survival ◽  
Care Providers ◽  
Patient Journey ◽  
Patient Organisations ◽  
Policy And Strategy ◽  
Cancer Services ◽  
Document Review

Abstract Background We know there are large differences in cancer survival between countries. We know much less about why they exist and persist. In the International Cancer Benchmarking Partnership, we are seeking to understand the influences on patient journey in different countries. In this study we explore how health system factors impact on cancer care in Denmark, Ireland, and Ontario (Canada) to identify common themes, national specificities, and messages for other health care providers. Methods We systematically analysed (i) cancer policy and strategy documents from the three jurisdictions, published between 1995-2014 (n = 20) and (ii) interviews with key informants representing government, health services providers, professional bodies and patient organisations (n = 25). We thematically analysed both datasets using NVivo. Results Five themes emerged from the document review and were confirmed by interview: governance, quality assurance, service delivery, infrastructure and workforce. All three jurisdictions introduced a designated organisation to lead, monitor and, in Ontario, fund cancer services. Reducing wait times was prioritized, with the expansion of diagnostic capacity from the 2000s, for example. Concentrating services into fewer specialist centres was widely viewed as crucial for improving survival for some cancers. Yet policy intent was not always successfully realised on the ground, with lack of sustained investment, organisational barriers or logistical challenges impeding implementation. Jurisdictions face particular challenges maintaining and upgrading infrastructure and equipment, and recruiting and retaining critical staff, specifically in radiology and primary care. Conclusions Cancer care is complex and understanding the interrelationships between factors acting at different levels of the health system is important to improve outcomes. Continued investment in infrastructure and people will be essential. Key messages Countries face common challenges in creating health systems that optimise cancer outcomes. Sustained investment in equipment and human resources will be critical to optimise cancer care and survival.

scholarly journals What Makes Health Systems Resilient? A Qualitative Analysis of The Perspectives of Swiss NGOs

2021 ◽  
Author(s):  
Pauline Yongeun Grimm ◽  
Kaspar Wyss
Keyword(s):  
Global Health ◽  
Health System ◽  
Human Resource Development ◽  
Health Systems ◽  
Knowledge Exchange ◽  
Innovative Solutions ◽  
System Resilience ◽  
State Actors

Abstract Background: Resilience has become relevant than ever before with the advent of increasing and intensifying shocks on the health system and its amplified effects due to globalization. Using the example of non-state actors based in Switzerland, the aim of this study is to explore how and to what extent NGOs with an interest in global health have dealt with unexpected shocks on the health systems of their partner countries and to reflect on the practical implications of resilience for the multiple actors involved. Consequently, this paper analyses the key attributes of resilience that targeted investments may influence, and the different roles key stakeholders may assume to build resilience. Methods: This is a descriptive and exploratory qualitative study analysing the perspectives on health system resilience of Swiss-based NGOs through 20 in-depth interviews. Analysis proceeded using a data-driven thematic analysis closely following the framework method. An analytical framework was developed and applied systematically resulting in a complete framework matrix. The results are categorised into the expected role of the governments, the role of the NGOs, and practical future steps for building health system resilience. Results: The following four key ‘foundations of resilience’ were found to be dominant for unleashing greater resilience attributes regardless of the nature of shocks: ‘realigned relationships,’ ‘foresight,’ ‘motivation,’ and ‘emergency preparedness.’ The attribute to ‘integrate’ was shown to be one of the most crucial characteristics of resilience expected of the national governments from the NGOs, which points to the heightened role of governance. Meanwhile, as a key stakeholder group that is becoming inevitably more powerful in international development cooperation and global health governance, non-state actors namely the NGOs saw themselves in a unique position to facilitate knowledge exchange and to support long-term adaptations of innovative solutions that are increasing in demand. The strongest determinant of resilience in the health system was the degree of investments made for building long-term infrastructures and human resource development which are well-functioning prior to any potential crisis. Conclusions: Health system resilience is a collective endeavour and a result of many stakeholders’ consistent and targeted investments. These investments open up new opportunities to seek innovative solutions and to keep diverse actors in global health accountable. Strong governance, a bi-directional knowledge exchange, and the focus on leveraging science for impact can draw greater potential of resilience in the health systems. Governments and the NGOs have unique points of contribution in this journey towards resilience and may support governments to prioritise investing in the key ‘foundations of resilience’ in order to activate greater attributes of resilience.

scholarly journals Regional process redesign of lung cancer care: a learning health system pilot project

2018 ◽  
Vol 25 (1) ◽  
pp. 59 ◽  
Author(s):  
M. Fung-Kee-Fung ◽  
D.E. Maziak ◽  
J.R. Pantarotto ◽  
J. Smylie ◽  
L. Taylor ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Health System ◽  
Cancer Care ◽  
Initial Treatment ◽  
Best Practice ◽  
System Optimization ◽  
Transformation Model ◽  
Patient Journey ◽  
Ottawa Hospital ◽  
Learning Health System

 Background The Ottawa Hospital (toh) defined delay to timely lung cancer care as a system design problem. Recognizing the patient need for an integrated journey and the need for dynamic alignment of providers, toh used a learning health system (lhs) vision to redesign regional diagnostic processes. A lhs is driven by feedback utilizing operational and clinical information to drive system optimization and innovation. An essential component of a lhs is a collaborative platform that provides connectivity across silos, organizations, and professions.Methods To operationalize a lhs, we developed the Ottawa Health Transformation Model (ohtm) as a consensus approach that addresses process barriers, resistance to change, and conflicting priorities. A regional Community of Practice (cop) was established to engage stakeholders, and a dedicated transformation team supported process improvements and implementation.Results The project operationalized the lung cancer diagnostic pathway and optimized patient flow from referral to initiation of treatment. Twelve major processes in referral, review, diagnostics, assessment, triage, and consult were redesigned. The Ottawa Hospital now provides a diagnosis to 80% of referrals within the provincial target of 28 days. The median patient journey from referral to initial treatment decreased by 48% from 92 to 47 days.Conclusions The initiative optimized regional integration from referral to initial treatment. Use of a lhs lens enabled the creation of a system that is standardized to best practice and open to ongoing innovation. Continued transformation initiatives across the continuum of care are needed to incorporate best practice and optimize delivery systems for regional populations.

scholarly journals The role of tobacco and alcohol use in the interaction of social determinants of non-communicable diseases in Nepal: a systems perspective

2020 ◽  
Author(s):  
Sudesh Raj Sharma ◽  
Anna Matheson ◽  
Danielle Lambrick ◽  
James Faulkner ◽  
David W Lounsbury ◽  
...  
Keyword(s):  
Data Analysis ◽  
Alcohol Use ◽  
Health System ◽  
Health Systems ◽  
Social Determinants ◽  
Economic Status ◽  
Non Communicable Diseases ◽  
Causal Loop ◽  
Socio Economic Status

Abstract Background: Tobacco and alcohol use are major behavioural risks in developing countries like Nepal, which are contributing to a rapid increase in non-communicable diseases (NCDs). This causal relationship is further complicated by the multi-level social determinants such as socio-political context, socio-economic factors and health systems. The systems approach has potential to facilitate understanding of such complex causal mechanisms. The objective of this paper is to describe the role of tobacco and alcohol use in the interaction of social determinants of NCDs in Nepal. Method: The study was a qualitative study design guided by the Systemic Intervention methodology. The study involved key informant interviews (n=63) and focus group discussions (n=12) at different levels (policy, district and/or community) and was informed by the adapted Social Determinants of Health Framework . The data analysis involved case study-based thematic analysis using framework approach and development of causal loop diagrams. The study also involved three sense-making sessions with key stakeholders. Results: Three key interacting themes emerged during the data analysis. Widespread availability of tobacco and alcohol products contributed to the use and addiction of tobacco and alcohol. Low focus on prevention by health systems and policy influence of tobacco and alcohol companies were the major contributors to the problem. Gender and socio-economic status of families/communities were identified as key social determinants of tobacco and alcohol use. These interacting themes were utilised to develop causal loop diagrams and system archetypes. Conclusion: Tobacco and alcohol use facilitated interaction of the social determinants of NCDs in the context of Nepal. Socio-economic status of families was both driver and outcome of tobacco and alcohol use. Health system actions to prevent NCDs were delayed mainly due to lack of system insights and policy influence. A multi-sectoral response led by the health system is urgently needed.

scholarly journals The role of tobacco and alcohol use in the interaction of social determinants of non-communicable diseases in Nepal: a systems perspective

2020 ◽  
Author(s):  
Sudesh Raj Sharma ◽  
Anna Matheson ◽  
Danielle Lambrick ◽  
James Faulkner ◽  
David W Lounsbury ◽  
...  
Keyword(s):  
Data Analysis ◽  
Alcohol Use ◽  
Health System ◽  
Health Systems ◽  
Social Determinants ◽  
Economic Status ◽  
Non Communicable Diseases ◽  
Causal Loop ◽  
Socio Economic Status

Abstract Background: Tobacco and alcohol use are major behavioural risks in developing countries like Nepal, which are contributing to a rapid increase in non-communicable diseases (NCDs). This causal relationship is further complicated by the multi-level social determinants such as socio-political context, socio-economic factors and health systems. The systems approach has potential to facilitate understanding of such complex causal mechanisms. The objective of this paper is to describe the role of tobacco and alcohol use in the interaction of social determinants of NCDs in Nepal. Method: The study adopted a qualitative study design guided by the Systemic Intervention methodology. The study involved key informant interviews (n=63) and focus group discussions (n=12) at different levels (national, district and/or community) and was informed by the adapted Social Determinants of Health Framework. The data analysis involved case study-based thematic analysis using framework approach and development of causal loop diagrams. The study also involved three sense-making sessions with key stakeholders. Results: Three key themes and causal loop diagrams emerged from the data analysis. Widespread availability of tobacco and alcohol products contributed to the use and addiction of tobacco and alcohol. Low focus on primary prevention by health systems and political influence of tobacco and alcohol industries were the major contributors to the problem. Gender and socio-economic status of families/communities were identified as key social determinants of tobacco and alcohol use. Conclusion: Tobacco and alcohol use facilitated interaction of the social determinants of NCDs in the context of Nepal. Socio-economic status of families was both driver and outcome of tobacco and alcohol use. Health system actions to prevent NCDs were delayed mainly due to lack of system insights and commercial influence. A multi-sectoral response led by the health system is urgently needed.

scholarly journals The Role of Telemedicine on Ecuador During COVID-19 Crisis: A Perspective from a Volunteer Physician

2020 ◽  
Author(s):  
Bryan Nicolalde
Keyword(s):  
Public Health ◽  
Health System ◽  
Health Systems ◽  
Latin American ◽  
Call Center ◽  
Point Of View ◽  
Public Health Systems ◽  
Psychological Point ◽  
The Government

Ecuador is one of the most affected countries of COVID-19 in Latin American. The government invited physicians to become a volunteer to attend call center and practice telemedicine in order to relief an oversaturated health system. Due lack of availability and digital illiteracy the government implement just standard calls. The difficulties that can be faced are secondary to establishing the severity of a patient only with subjective measures and to achieving effective coordination of telemedicine with public health systems. The role played by the doctor during this crisis is fundamental from the educational, preventive and psychological point of view.  

scholarly journals The role of tobacco and alcohol use in the interaction of social determinants of non-communicable diseases in Nepal: a systems perspective

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Sudesh Raj Sharma ◽  
Anna Matheson ◽  
Danielle Lambrick ◽  
James Faulkner ◽  
David W. Lounsbury ◽  
...  
Keyword(s):  
Data Analysis ◽  
Alcohol Use ◽  
Health System ◽  
Health Systems ◽  
Social Determinants ◽  
Economic Status ◽  
Non Communicable Diseases ◽  
Causal Loop ◽  
Socio Economic Status

Abstract Background Tobacco and alcohol use are major behavioural risks in developing countries like Nepal, which are contributing to a rapid increase in non-communicable diseases (NCDs). This causal relationship is further complicated by the multi-level social determinants such as socio-political context, socio-economic factors and health systems. The systems approach has potential to facilitate understanding of such complex causal mechanisms. The objective of this paper is to describe the role of tobacco and alcohol use in the interaction of social determinants of NCDs in Nepal. Method The study adopted a qualitative study design guided by the Systemic Intervention methodology. The study involved key informant interviews (n = 63) and focus group discussions (n = 12) at different levels (national, district and/or community) and was informed by the adapted Social Determinants of Health Framework. The data analysis involved case study-based thematic analysis using framework approach and development of causal loop diagrams. The study also involved three sense-making sessions with key stakeholders. Results Three key themes and causal loop diagrams emerged from the data analysis. Widespread availability of tobacco and alcohol products contributed to the use and addiction of tobacco and alcohol. Low focus on primary prevention by health systems and political influence of tobacco and alcohol industries were the major contributors to the problem. Gender and socio-economic status of families/communities were identified as key social determinants of tobacco and alcohol use. Conclusion Tobacco and alcohol use facilitated interaction of the social determinants of NCDs in the context of Nepal. Socio-economic status of families was both driver and outcome of tobacco and alcohol use. Health system actions to prevent NCDs were delayed mainly due to lack of system insights and commercial influence. A multi-sectoral response led by the health system is urgently needed.

scholarly journals Regional Multiteam Systems in Cancer Care Delivery

2016 ◽  
Vol 12 (11) ◽  
pp. 1059-1066 ◽  
Author(s):  
Katia Noyes ◽  
John R.T. Monson ◽  
Irfan Rizvi ◽  
Ann Savastano ◽  
James S.A. Green ◽  
...  
Keyword(s):  
Health Care ◽  
Cancer Care ◽  
Care Delivery ◽  
Health Care Systems ◽  
Treatment Options ◽  
High Volume ◽  
Future Research ◽  
Multidisciplinary Teams ◽  
Real Patient ◽  
Patient Journey

Teamwork is essential for addressing many of the challenges that arise in the coordination and delivery of cancer care, especially for the problems that are presented by patients who cross geographic boundaries and enter and exit multiple health care systems at various times during their cancer care journeys. The problem of coordinating the care of patients with cancer is further complicated by the growing number of treatment options and modalities, incompatibilities among the vast variety of technology platforms that have recently been adopted by the health care industry, and competing and misaligned incentives for providers and systems. Here we examine the issue of regional care coordination in cancer through the prism of a real patient journey. This article will synthesize and elaborate on existing knowledge about coordination approaches for complex systems, in particular, in general and cancer care multidisciplinary teams; define elements of coordination derived from organizational psychology and human factors research that are applicable to team-based cancer care delivery; and suggest approaches for improving multidisciplinary team coordination in regional cancer care delivery and avenues for future research. The phenomenon of the mobile, multisystem patient represents a growing challenge in cancer care. Paradoxically, development of high-quality, high-volume centers of excellence and the ease of virtual communication and data sharing by using electronic medical records have introduced significant barriers to effective team-based cancer care. These challenges urgently require solutions.

scholarly journals The role of tobacco and alcohol use in the interaction of social determinants of non-communicable diseases in Nepal: a systems perspective

2020 ◽  
Author(s):  
Sudesh Raj Sharma ◽  
Anna Matheson ◽  
Danielle Lambrick ◽  
James Faulkner ◽  
David W Lounsbury ◽  
...  
Keyword(s):  
Data Analysis ◽  
Alcohol Use ◽  
Health System ◽  
Health Systems ◽  
Social Determinants ◽  
Economic Status ◽  
Non Communicable Diseases ◽  
Causal Loop ◽  
Socio Economic Status

Abstract Background: Tobacco and alcohol use are major behavioural risks in developing countries like Nepal, which are contributing to a rapid increase in non-communicable diseases (NCDs). This causal relationship is further complicated by the multi-level social determinants such as socio-political context, socio-economic factors and health systems. The systems approach has potential to facilitate understanding of such complex causal mechanisms. The objective of this paper is to describe the role of tobacco and alcohol use in the interaction of social determinants of NCDs in Nepal. Method: The study adopted a qualitative study design guided by the Systemic Intervention methodology. The study involved key informant interviews (n=63) and focus group discussions (n=12) at different levels (national, district and/or community) and was informed by the adapted Social Determinants of Health Framework . The data analysis involved case study-based thematic analysis using framework approach and development of causal loop diagrams. The study also involved three sense-making sessions with key stakeholders. Results: Three key themes and causal loop diagrams emerged from the data analysis. Widespread availability of tobacco and alcohol products contributed to the use and addiction of tobacco and alcohol. Low focus on primary prevention by health systems and political influence of tobacco and alcohol industries were the major contributors to the problem. Gender and socio-economic status of families/communities were identified as key social determinants of tobacco and alcohol use. Conclusion: Tobacco and alcohol use facilitated interaction of the social determinants of NCDs in the context of Nepal. Socio-economic status of families was both driver and outcome of tobacco and alcohol use. Health system actions to prevent NCDs were delayed mainly due to lack of system insights and commercial influence. A multi-sectoral response led by the health system is urgently needed.

Cancer care in the time of COVID-19: A conceptual framework to improve cancer outcomes during a pandemic.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18628-e18628
Author(s):  
Vivienne Milch ◽  
Cleola Anderiesz ◽  
Debra Hector ◽  
Scott Turnbull ◽  
Melissa Austen ◽  
...  
Keyword(s):  
Decision Making ◽  
Health System ◽  
Conceptual Framework ◽  
Cancer Patients ◽  
Cancer Care ◽  
Cancer Outcomes ◽  
System Planning ◽  
Screening Programs ◽  
Cancer Management ◽  
Health System Planning

e18628 Background: At the start of the COVID-19 pandemic, a plan for cancer management during a pandemic did not exist. It soon became clear that without proper planning, cancer outcomes would worsen. Cancer patients are at increased risk of COVID-19 infection, morbidity, and mortality. Health sectors internationally reduced or paused non-urgent cancer care to protect cancer patients from COVID-19. However, disproportionate delays in screening, diagnosis, and treatment can unduly impact cancer outcomes, and backlogs can further burden a strained health system. Tailored approaches to cancer management are required which balance health resource availability along with the risks of exposure and benefits of treatment. Australia’s relatively low COVID-19 case numbers afforded Cancer Australia an opportunity to proactively plan for optimal cancer management during this, and future, pandemics. Methods: Cancer Australia’s Cancer care in the time of COVID-19: A conceptual framework for the management of cancer during a pandemic (the framework) maps evidence-based cancer care considerations in relation to a health system’s capacity across acute and recovery pandemic phases, in relation to steps of the cancer care pathway. The framework promotes infection control and resource prioritisation in the context of innovative care models, triaging approaches and individualised treatment plans, underpinned by effective communication and shared decision-making. Results: The framework supports health system planning and risk-stratified approaches to guide decision-making and improve cancer outcomes. Many aspects of cancer care are recommended to continue (to varying degrees) in most pandemic phases, with modifications or pauses in some aspects of care as the pandemic curve approaches or exceeds health system capacity. Principles of the framework were employed during the second wave of COVID-19 in the Australian state of Victoria, with continuation of cancer screening programs, diagnostic investigations, and treatments wherever it was safe to do so. This resulted in reductions in cancer services and treatment being relatively smaller than in the first wave. Conclusions: Cancer management in a pandemic is not a one-size-fits-all. Countries and jurisdictions need to tailor cancer care according to the risk of the health system becoming overwhelmed. The framework guides optimal cancer care to improve outcomes for people with cancer, while minimising COVID-19 infection. As further evidence becomes available from this pandemic or in future pandemics, this framework can be refined to inform ongoing and future pandemic health system planning.

Sign in / Sign up

Export Citation Format

Share Document