Transforming towards sustainable health and wellbeing systems - Eight guiding principles based on the experiences of nine Dutch Population Health Management initiatives

Abstract

IntroductionPopulation Health management (PHM) initiatives are increasingly introduced, aiming to transform towards sustainable health and wellbeing systems. However, the initiatives are struggling with this development. In order to be able to act upon the complexity of such system change, understanding which strategies to implement at which moment of the development would be valuable. Based on the experiences of nine Dutch PHM initiatives, this study provides guiding principles with insights into which strategies to use, why, and when.Methods We used the realist evaluation approach for understanding the relationships between context, mechanisms and outcomes when PHM strategies were implemented. Data was based on quarterly updates of PHM developments and three interview rounds between 2014 and 2017 with different stakeholders of the Dutch PHM initiatives from health care, social care, public health, community , education, and business (n=207). Strategy-context-mechanism- outcome configurations were coded and clustered within the Collaborative Adaptive Health Network (CAHN) framework into guiding principles for PHM development.Results Based on the different experiences in PHM development across the Dutch cases, eight guiding principles for PHM development were identified, focusing on: 1. Shared commitment for a PHM-vision; 2. Mutual understanding and trust; 3. Accountability; 4. Aligning politics and policy; 5. Financial incentives; 6. A learning cycle based on a data-infrastructure; 7. Community input and involvement; and 8. Stakeholder representation and leadership. DiscussionsThe eight guiding principles are in line with the themes within international literature, and additionally provide detailed knowledge in the links between strategies, the contexts they are implemented in, the mechanisms that are triggered and its’ outcomes. Furthermore this study gained insights in which guiding principles are especially relevant during the first phases of development.Conclusion Developing to sustainable health and wellbeing systems is experienced as complex and time-consuming. The success of this development is influenced by the implementation of all the eight guiding principles, as well as applying the right strategies at the right moment in the development. Lessons learned• PHM initiatives vary in their development progress due to different strategies used.• Eight guiding principles reveal when, why and how to implement strategies.• Commitment, trust and leadership are of main importance in first development phases.LimitationsAs the current PHM initiatives have not yet fully developed towards sustainable health and wellbeing systems, the guiding principles provide insights in the first phases of development. Several international PHM initiatives are further developed and hereby provide a relevant base for future research in uncovering the suitable strategies in these contexts.Suggestions for future researchIn this study mainly experiences from CEO level representatives are retrieved. Little insights have been retrieved from health-care and care professionals or citizens themselves. Based on the experiences in this study and international literature, we expect that for further development of the PHM initiatives delegated leadership is of high relevance. Therefore additional understanding of the experiences of the health and care professionals and citizens will be valuable.