scholarly journals Health system reforms in mature welfare states: tales from the north

2018 ◽  
Vol 31 (4) ◽  
Author(s):  
Jean-Louis Denis ◽  
Susan Usher ◽  
Johanne Preval ◽  
Élizabeth Côté-Boileau
Keyword(s):  
Health System ◽  
Health Systems ◽  
Large Scale ◽  
Medical Profession ◽  
Welfare States ◽  
System Reform ◽  
The North ◽  
Challenges And Opportunities ◽  
Canadian Health ◽  
Canada Data

Objective: This article has the objective show an essay on emerging themes in health system reforms, based on experience in Canada. Data synthesis: Reforms are the privileged mode of social change used by modern democratic societies. Persistent dysfunction and failure to adapt to emerging health needs and priorities within health systems in Canada provide a strong policy rationale to search for alternative strategies that might produce much-needed reforms. Three persistent challenges and opportunities for reform in Canadian health systems are discussed: the design of effective governance arrangements, the large-scale development and implementation of improvement and transformative capacities, and the leadership and engagement of the medical profession in working toward broad system goals. In exploring these challenges, we identify tensions that seem relevant to better understanding health system reform in mature welfare states. Conclusion: Addressing these tensions will require both a reinforcement of state and government capacities and stronger capacities at all levels of the health system to design and support change.

scholarly journals Assessing health system challenges and opportunities for better noncommunicable disease outcomes: the case of Mauritius

2019 ◽  
Author(s):  
Laurent Musango ◽  
Maryam TIMOL ◽  
Premduth BURHOO ◽  
Faisal SHAIKH ◽  
Philippe DONNEN ◽  
...  
Keyword(s):  
Risk Factors ◽  
Health System ◽  
Health Systems ◽  
Community Empowerment ◽  
Noncommunicable Disease ◽  
Coordination Mechanism ◽  
World Health ◽  
Health Management Information System ◽  
Malignant Neoplasms ◽  
Challenges And Opportunities

Abstract Background This study provides an overview of NCD mortality, morbidity and risk factors; rates coverage of core population NCD interventions and individual NCD services in Mauritius; assesses health systems challenges and opportunities for better NCD outcomes; and recommends priority action areas to accelerate gains in NCD outcomes in Mauritius. Methods The Mauritius country assessment applied the guidelines developed by the World Health Organization Regional Office for Europe for systematically assessing health system challenges and opportunities for improving NCD outcomes. The assessment used mixed approaches to provide a fuller picture of the health system. Results In 2016, Mauritius sustained a total of 10 022 deaths from all causes. About 8,893 (88.7%) were from NCDs. Of the deaths due to NCDS, 6,935 (78%) were caused by cardiovascular diseases (CVD), diabetes and malignant neoplasms (cancers). Majority of NCDs are attributed to alcohol abuse, tobacco use, physical inactivity, and unhealthy diet. Of the 24-core population-based interventions for addressing these risk factors, 16.7% were rated extensive, 37.5% moderate and 45.8% limited. Three (20%), 8 (53%) and 4 (27%) of the 15 individual/personal CVD, diabetes and cancer services were rated extensive, moderate and limited respectively. Some of the challenges hindering NCD intervention scale-up include: lack of a government-led coordination mechanism; limited community empowerment for behavioural change; inefficient primary health care; insufficiently integrated health management information system; lack of explicit processes for prioritizing public health expenditures; and weak health workforce management. Conclusion There is urgent need to establish a high-level multisectoral/multistakeholder committee to oversee implementation of multisectoral activities for strengthening national health systems and other systems that address NCD risk factors and social determinants of health.

System change in the spirit of reconciliation in action: The All Nations Health Partnership

2019 ◽  
Vol 33 (2) ◽  
pp. 61-64
Author(s):  
Ray J. Racette
Keyword(s):  
Health Disparities ◽  
Health Outcomes ◽  
Health System ◽  
Health Systems ◽  
System Change ◽  
Health District ◽  
System Reform ◽  
Health Partnership ◽  
Working Together ◽  
Improve Health

The urgency for reforming our health systems to improve health outcomes and service pathways is pressing and must be championed by leaders. Coalitions of the willing must be created to lead this movement. The All Nations Health Partners in Kenora, Ontario, have formed to lead health system reform in the Kenora Health District and are doing so in the spirit of Reconciliation in Action. All nations and organizations working together to reduce health disparities and improve health outcomes for all people.

scholarly journals The complexity of scaling up an mHealth intervention: the case of SMS for Life in Tanzania from a health systems integration perspective

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Carmen Sant Fruchtman ◽  
Selemani Mbuyita ◽  
Mary Mwanyika-Sando ◽  
Marcel Braun ◽  
Don de Savigny ◽  
...  
Keyword(s):  
Health System ◽  
Health Systems ◽  
Large Scale ◽  
Digital Health ◽  
Health Sector ◽  
Building Blocks ◽  
Scaling Up ◽  
Stock Management ◽  
Study Approach

Abstract Background SMS for Life was one of the earliest large-scale implementations of mHealth innovations worldwide. Its goal was to increase visibility to antimalarial stock-outs through the use of SMS technology. The objective of this case study was to show the multiple innovations that SMS for Life brought to the Tanzanian public health sector and to discuss the challenges of scaling up that led to its discontinuation from a health systems perspective. Methods A qualitative case-study approach was used. This included a literature review, a document review of 61 project documents, a timeline of key events and the collection and analysis of 28 interviews with key stakeholders involved in or affected by the SMS for Life programme. Data collection was informed by the health system building blocks. We then carried out a thematic analysis using the WHO mHealth Assessment and Planning for Scale (MAPS) Toolkit as a framework. This served to identify the key reasons for the discontinuation of the programme. Results SMS for Life was reliable at scale and raised awareness of stock-outs with real-time monitoring. However, it was discontinued in 2015 after 4 years of a national rollout. The main reasons identified for the discontinuation were the programme’s failure to adapt to the continuous changes in Tanzania’s health system, the focus on stock-outs rather than ensuring appropriate stock management, and that it was perceived as costly by policy-makers. Despite its discontinuation, SMS for Life, together with co-existing technologies, triggered the development of the capacity to accommodate and integrate future technologies in the health system. Conclusion This study shows the importance of engaging appropriate stakeholders from the outset, understanding and designing system-responsive interventions appropriately when scaling up and ensuring value to a broad range of health system actors. These shortcomings are common among digital health solutions and need to be better addressed in future implementations.

The state-of-play in physician health systems leadership research

2019 ◽  
Vol 32 (4) ◽  
pp. 620-643
Author(s):  
Betty Onyura ◽  
Sara Crann ◽  
Risa Freeman ◽  
Mary-Kay Whittaker ◽  
David Tannenbaum
Keyword(s):  
Health System ◽  
Health Systems ◽  
Leadership Practices ◽  
Future Research ◽  
System Reform ◽  
Physician Leadership ◽  
Content Type ◽  
Physician Participation ◽  
System Leadership ◽  
Systems Leadership

Purpose This paper aims to review a decade of evidence on physician participation in health system leadership with the view to better understand the current state of scholarship on physician leadership activity in health systems. This includes examining the available evidence on both physicians’ experiences of health systems leadership (HSL) and the impact of physician leadership on health system reform. Design/methodology/approach A state-of-the-art review of studies (between 2007 and 2017); 51 papers were identified, analyzed thematically and synthesized narratively. Findings Six main themes were identified in the literature as follows: (De)motivation for leadership, leadership readiness and career development, work demands and rewards, identity matters: acceptance of self (and other) as leader, leadership processes and relationships across health systems and leadership in relation to health system outcomes. There were seemingly contradictory findings across some studies, pointing to the influence of regional and cultural contextual variation on leadership practices as well entrenched paradoxical tensions in health system organizations. Research limitations/implications Future research should examine the influence of varying structural and psychological empowerment on physician leadership practices. Empirical attention to paradoxical tensions (e.g. between empowerment and control) in HSL is needed, with specific attention to questions on how such tensions influence leaders’ decision-making about system reform. Originality/value This review provides a broad synthesis of diverse papers about physician participation in health system leadership. Thus, it offers a comprehensive empirical synthesis of contemporary concerns and identifies important avenues for future research.

Innovation in the Canadian health system

2020 ◽  
Vol 34 (1) ◽  
pp. 5-8
Author(s):  
Tom Noseworthy
Keyword(s):  
Health System ◽  
Chronic Diseases ◽  
Health Systems ◽  
System Model ◽  
System Innovation ◽  
Learning Health System ◽  
Clinical Innovation ◽  
Canadian Health ◽  
High Level ◽  
Level Performance

The essence of human ingenuity is creation and novel ideas that result in collective and desired impact. Indeed, innovation is foundational to life in a changing world. In no situation today is this more relevant than in health systems, whether they be challenged to maintain population health, threatened by impending disasters, or expected to respond to the ever-expansive demand and inexorable course of those with chronic diseases. This article discusses health system innovation and its trajectory. It focuses on clinical innovation as a means of achieving high-level performance within a learning health system model. Examples of innovation in Canada are used to illustrate successful approaches worthy of broader consideration and pan-Canadian attention.

scholarly journals The implementation of large-scale health system reform in identification, access and treatment of eating disorders in Australia

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Sarah Maguire ◽  
Danielle Maloney
Keyword(s):  
Eating Disorders ◽  
Service Delivery ◽  
Health System ◽  
Large Scale ◽  
Hospital Admissions ◽  
Strategic Change ◽  
Development Program ◽  
System Reform ◽  
Health System Reform ◽  
Positive Effects

Abstract Background It seems to be a truth universally acknowledged that pathways to care for people with eating disorders are inconsistent and difficult to navigate. This may, in part, be a result of the complex nature of the illness comprising both mental and medical ill-health across a broad range of severity. Care therefore is distributed across all parts of the health system resulting in many doors into the system, distributed care responsibility, without well developed or integrated pathways from one part of the system to another. Efforts in many parts of the world to redesign health service delivery for this illness group are underway, each dependent upon the local system structures, geographies served, funding sources and workforce availability. Methods In NSW—the largest populational jurisdiction in Australia, and over three times the size of the UK—the government embarked six years ago on a program of whole-of-health system reform to embed identification and treatment of people with eating disorders across the lifespan and across the health system, which is largely publicly funded. Prior to this, eating disorders had not been considered a ‘core’ part of service delivery within the health system, meaning many patients received no treatment or bounced in and out of ‘doorways’. The program received initial funding of $17.6 million ($12.5 million USD) increasing to $29.5 million in phase 2 and the large-scale service and workforce development program has been implemented across 15 geographical districts spanning almost one million square kilometres servicing 7.75 million people. Conclusions In the first five years of implementation there has been positive effects of the policy change and reform on all three service targets—emergency departments presentations, hospital admissions and community occasions of service as well as client hours. This paper describes the strategic process of policy and practice change, utilising well documented service design and change strategies and principles with relevance for strategic change within health systems in general.

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