Improving Health Services: Background, Method and Applications.

Abstract

IMPROVING HEALTH SERVICES: BACKGROUND, METHOD AND APPLICATIONS Walter Holland 2013 Edward Elgar Publishing ISBN: 978 1 78347 018 1; eISBN: 978 1 78347 019 8 Pages: 272It is difficult to conceive of the discipline of Health Services Research (HSR) predating the 1970 creation of Walter Holland's Social Medicine and Health Services Research Unit at St Thomas' Hospital Medical School.However, as this fascinating journey of the history of HSR reveals, population based studies were undertaken in the United States dating from the first decade of the 20th century. Holland points to major differences between the US and UK. One was the role of private foundations in supporting HSR in the US, the Carnegie Foundation, Milbank Memorial Fund, Rockefeller Foundation, the Commonwealth Fund and the W.R. Kellogg Foundation to name a few.The Milbank Memorial Fund, founded in 1905, had a substantial impact, not only in the selection of topics chosen for analysis but, more importantly, for the development of a 'publication that provided a respected forum for the publication and dissemination of the results of the HSR'. By comparison in the UK public funding directly supported much of the early research.Having 'dipped his lid' to the birth of HSR in the US, Holland's' book focuses on what he knows best and was incredibly influential in the development of HSR in viz the UK. Given the similarities between UK and Australia, it is this development, which most influenced the discipline's growth in Australia.Holland's prime motivation over the past five decades has been the use of evidence to assist the development of health policy and planning and evaluation of health practice.This focus inevitably leads to the interconnection of health politics and policy and the book is resplendent in describing such clashes.The work initially undertaken at St Thomas' Hospital were questions initiated by the NHS administration and hence the immediate link between the HSR and national policy was established. Within the hospital, John WynnOwenwas appointed as a health service manager jointly by the administration and the research unit. In subsequent years as Director General of NSW Health, Wynn Owen continued the emphasis on promoting HSR to aid policy formation.Holland's mentors and, no doubt, aided by being a St Thomas' graduate, contributed greatly to Holland's skills developments! At the London School of Hygiene and Tropical Medicine, Sir Richard Doll and Professor Donald Reid over sighted his epidemiology training followed by a stint at the Department of Epidemiology at Johns Hopkins School of Hygiene.The waxing and waning during the 1970s and 1980s of support for funding HSR within governments, and Holland's involvement in these debates, is beautifully described through a series of quotes from key players of the day. …