Students of Change: Health Policy in Action

Background and Objectives: Health policy is more impactful for public health than many other strategies as it can improve health outcomes for an entire population. Yet in the “see one, do one, teach one” environment of medical school, most students never get past the “see one” stage in learning about the powerful tools of health policy and advocacy. The University of New Mexico School of Medicine mandates health policy and advocacy education for all medical students during their family medicine clerkship rotation. The aim of this project is to describe a unique health policy and advocacy course within a family medicine clerkship. Methods: We analyzed policy briefs from 265 third-year medical students from April 2016 through April 2019. Each brief is categorized by the level of change targeted for policy reform: national, state, city, or university/school. Implemented policies are described. Results: Slightly less than one-third of the policies (30%) relate to education, 36% advocate for health system change by addressing cost, access, or quality issues, and 34% focus on public health issues. Fourteen policies have been initiated or successfully enacted. Conclusions: This curriculum gives each medical student a health policy tool kit with immediate opportunities to test their skills, learn from health policy and advocacy experts, and in some cases, implement health policies while still in medical school. A 1-week family medicine policy course can have impact beyond the classroom even during medical school, and other schools should consider this as a tool to increase the impact of their graduates.

The contribution of political skill to the implementation of health services change: a systematic review and narrative synthesis

Background The implementation of strategic health system change is often complicated by informal ‘politics’ in healthcare organisations. Leadership development programmes increasingly call for the development and use of ‘political skill’ as a means for understanding and managing the politics of healthcare organisations. The primary purpose of this review is to determine how political skill contributes to the implementation of health services change, within and across organisations. The secondary purpose is to demonstrate the conceptual variations within the literature. Methods The article is based upon a narrative synthesis that included quantitative, qualitative and mixed methods research papers, review articles and professional commentaries that deployed the concept of political skill (or associated terms) to describe and analyse the implementation of change in healthcare services. Results Sixty-two papers were included for review drawn from over four decades of empirically and conceptually diverse research. The literature is comprised of four distinct literatures with a lack of conceptual coherence. Within and across these domains, political skill is described as influencing health services change through five dimensions of leadership: personal performance; contextual awareness; inter-personal influence; stakeholder engagement, networks and alliances; and influence on policy processes. Conclusion There is a growing body of evidence showing how political skill can contribute to the implementation of health services change, but the evidence on explanatory processes is weak. Moreover, the conceptualisation of political skill is variable making comparative analysis difficult, with research often favouring individual-level psychological and behavioural properties over more social or group processes.

Inequality in Pay Ranks Among Factors Impacting Job Satisfaction Among Female Physicians

Job satisfaction has fallen among doctors, and beyond lack of pay parity that averages 25%, female physician job satisfiers differ from male colleagues. Health systems can build upon female physicians' confidence in their abilities to communicate with patients, show empathy, build trust, and elicit patient compliance with treatment plans. Systems must attend to work conditions for young and female cohorts, thereby retaining half of the workforce offering critical care to 7.8 billion people. Ordinal logistic regression was used to analyze data gathered in the U.S. by the Center for Studying Health System Change. Data were used to build a predictive statistical model in concert with independent variables linked to generational and job satisfaction literature. This study revealed statistically significant correlations between factors not only by gender, but also by generational membership. Statistically significant factors affecting job satisfaction among female physicians include provision of quality care to all patients, adequate time spent with patients and income.

METHODOLOGICAL PRINCIPLES FOR EVALUATION OF EFFICIENCY OF PUBLIC MANAGEMENT OF MEDICAL SYSTEM TRANSFORMATION IN UKRAINE

The concept of efficiency of a health care institution and identifies the features of its calculation in this area, where the effectiveness of each solution is determined in accordance with the degree of satisfaction of consumer interests are considered in the article. The directions of evaluation of indicators of efficiency of functioning of medical system are described. The components of the general efficiency of the transformation of the medical system in Ukraine, in particular medical, social and economic efficiency, are determined. The calculation of the total value of the effectiveness of public administration of the medical system of the country is proposed to be based on an integrated indicator. Taking into account the peculiarities of the transformation process of the medical sector in the country, to determine its effectiveness it is recommended to use the assessment of key indicators that characterize social, medical and economic performance, which depend on government conditions at the state, region, local government, economy, legislation base and innovation policy of the state, scientific and technological progress, political, demographic, natural and other factors. In order to calculate certain indicators, in addition to the available data of statistical reports, it is necessary to improve the data collection system, in particular the number of days spent in hospitals, the number of days in hospitals and the introduction of innovations and technological processes in medical institutions is determined. It is emphasized that the proposed method of assessing the effectiveness of public administration helps to identify which components of the medical system are “weak” and need immediate improvement, and therefore based on the results of the analysis, we can identify key priorities of public health system change management. Ways to increase the efficiency of the health care system of Ukraine are given.

The contribution of political skill to the implementation of health services change: a systematic review and narrative synthesis

Background The implementation of strategic health system change is often complicated by informal ‘politics’ in healthcare organisations. Leadership development programmes increasingly call for the development and use of ‘political skill’ as a means for understanding and managing the politics of healthcare organisations. The primary purpose of this review is to determine how political skill contributes to the implementation of health services change, within and across organisations. The secondary purpose is to demonstrate the conceptual variations within the literature.Methods The article is based upon a narrative synthesis that included quantitative, qualitative and mixed methods research papers, review articles and professional commentaries that deployed the concept of political skill (or associated terms) to describe and analyse the implementation of change in health care services.Results 62 papers were included for review drawn from over four decades of empirically and conceptually diverse research. The literature is compromised of four distinct literatures with a lack of conceptual coherence. Within and across these domains, political skill is described as influencing health services change through six dimensions of leadership: personal performance, contextual awareness, inter-personal influence, stakeholder engagement, networking and policy influence.Conclusion There is a growing body of evidence showing how political skill can contribute to the implementation of health services change, but the evidence on explanatory processes is weak. Moreover, the conceptualisation of political skill is variable making comparative analysis difficult, with research often favouring individual-level psychological and behavioural properties over more social or group processes.

Teaching Students to Transform: The Health Innovations Scholars Program 6 Years Later

Training in leadership and health system transformation is increasingly important in undergraduate medical education in order to develop a pipeline of engaged physicians dedicated to transforming health care. Despite this growing need, it is unclear whether current leadership training methods have long-term impact on students’ career trajectory. The authors analyzed career outcomes from 6 years of the Health Innovations Scholars Program (HISP) to better understand how the program affected the 46 graduates’ future involvement in health system transformation and leadership. Eighty-eight percent of the graduates remained involved in quality improvement, 70% held leadership positions, 31% participated in health innovation, and 15% participated in patient safety initiatives. Project involvement of the graduates represented both primary and secondary catalysts for health system change, leading to 28 unique catalyst events. HISP is a model for directing trainees’ career trajectory toward engagement in health system leadership and redesign.

1.F. Workshop: The barriers to effective hypertension care: a focus on the patient's journey

Millions of people across the world depend on health systems that simply do not work. They struggle to find someone who can help and, when they do, can face catastrophic bills for often substandard care. But we fail to listen to those whose needs, desires, and expectations are most unmet. We assume their understanding of health and illness is the same as ours and we ignore the coping strategies developed over years that they use to overcome the barriers that those who design health systems place in their way. They live their lives unseen and unheard by those who make the decisions that will determine whether they live or die. This workshop explores issues that arise when researchers actively engage with disadvantaged populations. It reports our experiences from the RESPOND project (Responsive and Equitable Health Systems - Partnership for Non-Communicable Diseases), working with disadvantaged communities in Malaysia and the Philippines to view the health system from the perspective of people whose health depends on a long-term relationship with it. We use a mixed methods approach, involving household surveys, in-depth interviews and digital diaries, where participants use mobile phones to record their experiences of living with chronic conditions and seeking care for it. The aim of this workshop is to demonstrate why it is important to listen to those in disadvantaged populations, in order to understand the barriers they face and the ways that they seek to overcome them as they seek care for a chronic disorder. We will illustrate this by achieving five objectives: To show why we need to look beyond the biomedical approach to illness;To recognise the many different journeys that patients follow;To understand the economic consequences of the choices that they make;To describe the theoretical and technical innovations developed as part of the RESPOND project to do this; andTo illustrate how bringing such insights together can be used to implement equitable health system change. The workshop will be chaired and moderated by Dina Balabanova and Martin McKee, two globally recognised leaders researching chronic conditions and health system reforms in low- and middle-income countries. The first three presentations will introduce people living with chronic conditions from the study communities, and will examine the challenges they face, their options and the choices they make to treat it. All five presentations, but particularly the remaining two, will describe the theoretical and technical innovations developed as part of the RESPOND project used to capture the voices and lived experiences of disadvantaged populations so that they may be better represented in the planning of health systems and services. The remaining 30 minutes will be devoted to guided interactive discussion with the audience on how we are using this people-centred evidence to implement change in each country, and how these approaches may be applied in other settings. Key messages Designing effective and responsive health systems that leave no one behind must account for the lived experiences of all beneficiaries, including those groups whose voices often go unheard. We present evidence from Malaysia and the Philippines from studies that used innovative methods to capture the lived experiences of disadvantaged populations seeking care for chronic conditions.

Mental health system change

Mental health is the psychological wellness of a person. Currently, mental health illnesses are treated by hospital and community. Due to the transition of this system from psychiatric institutes, the hospital and community are not necessarily well connected. It is essential that the hospital and community are connected since patients need to feel supported by their community at all stages of their recovery in order to make a network of wellness. In order to tackle the problem of connecting the hospital and community for the personal recovery of people with severe mental illness, my team, Re-MIND London, proposed an innovative solution suite, involving: a liaison between community and hospital; a shared menu of resources; information sharing through education and samplers; having patients engage on community outings; and providing peer mentor support. In installing this solution, we have re-kindled connection between Parkwood Institute for Mental Health and the Canadian Mental Health Association in London, ON, at an administrative level, as well as staffer and patient level. Patients report that they need to feel like they in the community to have hope towards a proper discharge plan. In installing sections of this innovative solution, our team learned self-empowerment to challenge the existing system, regardless of our position. We are connecting, at many levels, diverse individuals and organizations to leverage their strengths to form a strong and sustainable partnership that will insulate people with mental illness in a community throughout treatment.