Health System Experience Research Articles

Correlates of lengthy stay in a mental health hospital

PurposeThe purpose of this paper is to study the role of social factors that determine the length of stay in a mental hospital and also understand the main factors leading to the phenomena as a step to solve it.Design/methodology/approachA case-control cross-sectional observational study is performed which studies correlates for the lengthy stay in a mental hospital. The study population consists of two groups: Group A (94 patients), taken from the patients hospitalized for more than one year, further subdivided into schizophrenia and schizoaffective inpatient group and bipolar affective inpatient group; and Group B (94 patients), receiving their treatment at the outpatient clinic after being admitted for less than six months, this group was further subdivided into same categories as Group A.FindingsThe study showed that the positive score in positive and negative symptoms scale (PANSS) showed highly statistically significant (p<0.01) correlation with the length of hospital stay for the schizophrenic and schizoaffective patients in the inpatient group. The results showed no statistically significant difference (p>0.05) between the inpatient schizophrenic cases and the inpatient affective cases regarding the length of hospital stay.Research limitations/implicationsThe linear regression model was used to understand the predictors of increased length of hospital stay. The linear regression analyzing the scale data of schizophrenic and schizoaffective patients found that the length of hospital stay for the schizophrenic and schizoaffective patients depends on the patient’s age and his positive PANSS score. On the other hand, linear regression model for bipolar affective patients in the study found no statistically significant attributes of the length of hospital stay.Practical implicationsThe study found that the length of hospital stay for schizophrenic and schizoaffective patients depends on the patient’s age and his positive PANSS score.Social implicationsThe need for this study stems from the large numbers of mental inpatients who have been lengthily admitted in mental health hospitals in Egypt, while trying to understand main factors leading to the phenomena as a step to solve it. The study found that there is a highly significant difference between inpatient group and outpatient group regarding the marital status, education level, and psychosocial class, with inpatient group having more single, illiterate, and very low social class cases.Originality/valueResearch in the area of chronic psychiatric hospitalization and its effect on the course and prognosis of mental illness is still scarce, especially in the Arab world; therefore, the research will open the door for further research efforts in the future with a larger sample of patients to study the pros and cons of deinstitutionalization taking into account the past experience of health systems in other countries.

Patient and Health System Experience With Implementation of an Enterprise-Wide Telehealth Scheduled Video Visit Program: Mixed-Methods Study.

BackgroundReal-time video visits are increasingly used to provide care in a number of settings because they increase access and convenience of care, yet there are few reports of health system experiences.ObjectiveThe objective of this study is to report health system and patient experiences with implementation of a telehealth scheduled video visit program across a health system.MethodsThis is a mixed methods study including (1) a retrospective descriptive report of implementation of a telehealth scheduled visit program at one large urban academic-affiliated health system and (2) a survey of patients who participated in scheduled telehealth visits. Health system and patient-reported survey measures were aligned with the National Quality Forum telehealth measure reporting domains of access, experience, and effectiveness of care.ResultsThis study describes implementation of a scheduled synchronous video visit program over an 18-month period. A total of 3018 scheduled video visits were completed across multiple clinical departments. Patient experiences were captured in surveys of 764 patients who participated in telehealth visits. Among survey respondents, 91.6% (728/795) reported satisfaction with the scheduled visits and 82.7% (628/759) reported perceived quality similar to an in-person visit. A total of 86.0% (652/758) responded that use of the scheduled video visit made it easier to get care. Nearly half (46.7%, 346/740) of patients estimated saving 1 to 3 hours and 40.8% (302/740) reported saving more than 3 hours of time. The net promoter score, a measure of patient satisfaction, was very high at 52.ConclusionsA large urban multihospital health system implemented an enterprise-wide scheduled telehealth video visit program across a range of clinical specialties with a positive patient experience. Patients found use of scheduled video visits made it easier to get care and the majority perceived time saved, suggesting that use of telehealth for scheduled visits can improve potential access to care across a range of clinical scenarios with favorable patient experiences.

Increased hospitalizations for decompensated heart failure and acute myocardial infarction during mild winters: A seven-year experience in the public health system of the largest city in Latin America

BackgroundIn high-income temperate countries, the number of hospitalizations for heart failure (HF) and acute myocardial infarction (AMI) increases during the winter. This finding has not been fully investigated in low- and middle-income countries with tropical and subtropical climates. We investigated the seasonality of hospitalizations for HF and AMI in Sao Paulo (Brazil), the largest city in Latin America.MethodsThis was a retrospective study using data for 76,474 hospitalizations for HF and 54,561 hospitalizations for AMI obtained from public hospitals, from January 2008 to April 2015. The average number of hospitalizations for HF and AMI per month during winter was compared to each of the other seasons. The autoregressive integrated moving average (ARIMA) model was used to test the association between temperature and hospitalization rates.FindingsThe highest average number of hospital admissions for HF and AMI per month occurred during winter, with an increase of up to 30% for HF and 16% for AMI when compared to summer, the season with lowest figures for both diseases (respectively, HF: 996 vs. 767 per month, p<0.001; and AMI: 678 vs. 586 per month, p<0.001). Monthly average temperatures were moderately lower during winter than other seasons and they were not associated with hospitalizations for HF and AMI.InterpretationThe winter season was associated with a greater number of hospitalizations for both HF and AMI. This increase was not associated with seasonal oscillations in temperature, which were modest. Our study suggests that the prevention of cardiovascular disease decompensation should be emphasized during winter even in low to middle-income countries with tropical and subtropical climates.

Using Theories of Change to inform implementation of health systems research and innovation: experiences of Future Health Systems consortium partners in Bangladesh, India and Uganda

BackgroundThe Theory of Change (ToC) is a management and evaluation tool supporting critical thinking in the design, implementation and evaluation of development programmes. We document the experience of Future Health Systems (FHS) Consortium research teams in Bangladesh, India and Uganda with using ToC. We seek to understand how and why ToCs were applied and to clarify how they facilitate the implementation of iterative intervention designs and stakeholder engagement in health systems research and strengthening.MethodsThis paper combines literature on ToC, with a summary of reflections by FHS research members on the motivation, development, revision and use of the ToC, as well as on the benefits and challenges of the process. We describe three FHS teams’ experiences along four potential uses of ToCs, namely planning, communication, learning and accountability.ResultsThe three teams developed ToCs for planning and evaluation purposes as required for their initial plans for FHS in 2011 and revised them half-way through the project, based on assumptions informed by and adjusted through the teams’ experiences during the previous 2 years of implementation. All teams found that the revised ToCs and their accompanying narratives recognised greater feedback among intervention components and among key stakeholders. The ToC development and revision fostered channels for both internal and external communication, among research team members and with key stakeholders, respectively. The process of revising the ToCs challenged the teams’ initial assumptions based on new evidence and experience. In contrast, the ToCs were only minimally used for accountability purposes.ConclusionsThe ToC development and revision process helped FHS research teams, and occasionally key local stakeholders, to reflect on and make their assumptions and mental models about their respective interventions explicit. Other projects using the ToC should allow time for revising and reflecting upon the ToCs, to recognise and document the adaptive nature of health systems, and to foster the time, space and flexibility that health systems strengthening programmes must have to learn from implementation and stakeholder engagement.

Ethics capacity building in low-income countries: Ethiopia as a case study

Ethical dilemmas are part of everyday clinical practice, and doctors worldwide must make value-based decisions. In low-income countries with very limited resources, healthcare personnel and policymakers face ethical challenges. Ethiopian policies aim to improve the ethical decision-making competence of healthcare personnel. But what are the dilemmas experienced by Ethiopian doctors and how can training and professional development equip them to deal with the ethical challenges they face? In this text, we illustrate ethical challenges that doctors experience in a resource-constrained health and welfare system. Our discussion is based upon our own empirical data from Ethiopia, our experience as healthcare workers in low-income countries, as well as relevant literature. We will describe the challenges and opportunities that lie in education, guidance and facilitation of ethical decision-making in a low-income country like Ethiopia.

PrediCTC, liquid biopsy in precision oncology: a technology transfer experience in the Spanish health system.

Management of metastatic disease in oncology includes monitoring of therapy response principally by imaging techniques like CT scan. In addition to some limitations, the irruption of liquid biopsy and its application in personalized medicine has encouraged the development of more efficient technologies for prognosis and follow-up of patients in advanced disease. PrediCTC constitutes a panel of genes for the assessment of circulating tumor cells (CTC) in metastatic colorectal cancer patients, with demonstrated improved efficiency compared to CT scan for the evaluation of early therapy response in a multicenter prospective study. In this work, we designed and developed a technology transfer strategy to define the market opportunity for an eventual implementation of PrediCTC in the clinical practice. This included the definition of the regulatory framework, the analysis of the regulatory roadmap needed for CE mark, a benchmarking study, the design of a product development strategy, a revision of intellectual property, a cost-effectiveness study and an expert panel consultation. The definition and analysis of an appropriate technology transfer strategy and the correct balance among regulatory, financial and technical determinants are critical for the transformation of a promising technology into a viable technology, and for the decision of implementing liquid biopsy in the monitoring of therapy response in advanced disease.

Elizabethkingia anophelis: Clinical Experience of an Academic Health System in Southeastern Wisconsin.

In late 2015 and early 2016, 11 patients were identified with cultures positive for Elizabethkingia anophelis in our health system. All patients had positive blood cultures upon admission. Chart review showed that all had major comorbidities and recent health care exposure. The attributable mortality rate was 18.2%.

Management of bone health in postmenopausal women on aromatase inhibitors (AIs): a single health care system experience.

Aromatase inhibitors (AIs) are the preferred therapy for postmenopausal women with early-stage estrogen receptor-positive breast cancers. However, their use causes bone loss and increased risks of osteoporosis and fractures. This is a retrospective review of all postmenopausal women with breast cancer diagnosed and treated with AI between 2010 and 2015. Of the 564 women identified, 319 were eligible. The median age at AI initiation was 65years (range 51-85years), and the median duration of AI therapy was 28months (1-72months). The median number of DEXA scans per woman was 1 (0-4), performed at a median frequency of 24months (1-48months). Recommendations for calcium and vitamin D were in 66 and 59% of women, respectively. There were 52 (16%) women who received antiresorptive treatments with bisphosphonates (69%), denosumab (25%), or both drugs (6%). Based on guideline recommendations from six societies, starting antiresorptive treatment was unnecessary in 15-54% of women. In this single health system experience, women start antiresorptive drugs that are unnecessary in 15-52%. These results highlight the nonuniformity in guideline recommendations, and this has implications for quality of care, cost-effectiveness, and value-of-care analyses for preventing fractures.

Greenville health system (GHS) experience with risk reduction endocrine therapy for women diagnosed with breast lobular carcinoma in situ (LCIS).

e13041 Background: LCIS is associated with a 1% annual risk of developing invasive breast cancer, twice that of the general population. Endocrine therapy for chemoprevention has been shown to decrease this risk by 56% in women with LCIS. Barriers include failure to offer endocrine therapy and failure to tolerate it. This study examined a population of women with LCIS and their experience with endocrine therapy for breast cancer risk reduction. Methods: 337 patients with LCIS from 2010-2015 at the GHS were retrospectively identified through electronic health record review. Median age was 55.5 years; 303 underwent breast-conserving surgery and 34 mastectomy. Chart review assessed the documented recommendations for endocrine therapy, duration of adherence, and presence of side effects. Results: Endocrine therapy was prescribed in 155 (46%), refused in 33 (10%), and not recommended in 120 (36%). Of the 146 women who were started on endocrine therapy for risk reduction and followed for six months, 75% adhered to the endocrine therapy. Of the 94 followed for 2 years, 71% adhered. The rate of documented side effects was 14% and was the most commonly cited reason for discontinuation (78%). Conclusions: The number of women with LCIS that were not prescribed endocrine therapy in the absence of absolute contraindications was substantial (36%). Under documentation in the medical record may account for a portion of this. The rate of side effects of those started on endocrine therapy (14%) is lower than expected, although this may represent underreporting. With a low refusal rate (10%) and a high adherence rates (75% at 6 months and 71% at 2 years) in the treated population, improving the number of women with LCIS that are offered endocrine therapy has considerable potential for reducing breast cancer risk. Controlling side effects can increase the benefit further.

Clinical training and trainee follow-up systems to improve access to long-acting reversible contraception in conflict settings

Abstract Background Long-acting contraceptive methods (LARC)—intra-uterine device (IUDs) and contraceptive implants—are highly effective in the prevention of unintended pregnancy. However, access to LARC is limited, especially in developing countries where access is dependent on availability of medical doctors and midwives. Pre-service training for nurses does not usually include counselling about LARC methods, or insertion and removal of IUDs and implants. We aimed to improve access and availability of LARC in North Kivu, Democratic Republic of the Congo, by implementing a clinical training programme for nurses who had clinical experience in the public health system. The programme was implemented in collaboration with the Ministry of Health. The purpose of the programme was to increase access to all modern contraceptive methods, including LARC, at health centre level and to improve nurses' clinical skills in family planning counselling and insertion and removal of IUDs and implants. Methods From July, 2011, we delivered contraceptive commodities, installed data collection systems, and obtained approval to train nurses and midwives (mid-level health-care providers). Seventy-one nurses and midwives received competency-based clinical training for 3 weeks at a district hospital in Goma. The training curricula included counselling, practicum on anatomical models, and, finally, service provision to clients under observation and supervision by facilitators. Facilitators were mostly Congolese medical doctors who had received the 3-week clinical training and a certification on how to facilitate clinical trainings (trainers of training) at a centre managed by Marie Stopes Society in Kenya. Each health-care provider received trainee follow up, mentoring, and frequent supportive supervision by clinical supervisors throughout the implementation period. The programme was monitored via a monthly review of client data, supportive supervision reports, client exit interviews, and provider log books. Findings From January, 2012, to December, 2013, the number of clients seeking modern contraceptive methods increased by 54% (from 8301 in 2012 to 12 830 in 2013). The percent change of clients seeking IUDs was 127% (from 440 to 999) and the number of clients who had contraceptive implants increased by 46% (from 5124 to 7499). Client exit interviews of 415 women at 23 clinics showed a satisfaction rate of 80–90%. Interpretation Competency-based clinical training is feasible in a conflict setting such as the Democratic Republic of the Congo, and can be effective in improving provider skills and availability and use of LARC. Attention to the partnership with the Ministry of Health and establishment of clinical training centres at the start of the programme were crucial for success. Funding Donation from an anonymous private foundation that does not have commercial interests in the study topic. The donor did not participate in the design of the study, data analysis, or the interpretation of findings.

Episode-Based Payment and Direct Employer Purchasing of Healthcare Services: Recent Bundled Payment Innovations and the Geisinger Health System Experience.

One significant driver of the disjointed healthcare often observed in the United States is the traditional fee-for-service payment model which financially incentivizes the volume of care delivered over the quality and coordination of care. This problem is compounded by the wide, often unwarranted variation in healthcare charges that purchasers of health services encounter for substantially similar episodes of care. The last 10 years have seen many stakeholder organizations begin to experiment with novel financial payment models that strive to obviate many of the challenges inherent in customary quantity-based cost paradigms. The Patient Protection and Affordable Care Act has allowed many care delivery systems to partner with Medicare in episode-based payment programs such as the Bundled Payments for Care Improvement (BPCI) initiative, and in patient-based models such as the Medicare Shared Savings Program. Several employer purchasers of healthcare services are experimenting with innovative payment models to include episode-based bundled rate destination centers of excellence programs and the direct purchasing of accountable care organization services. The Geisinger Health System has over 10 years of experience with episode-based payment bundling coupled with the care delivery reengineering which is integral to its ProvenCare® program. Recent experiences at Geisinger have included participation in BPCI and also partnership with employer-purchasers of healthcare through the Pacific Business Group on Health (representing Walmart, Lowe's, and JetBlue Airways). As the shift towards value-focused care delivery and patient experience progresses forward, bundled payment arrangements and direct purchasing of healthcare will be critical financial drivers in effecting change.

It's complicated: why do tuberculosis patients not initiate or stay adherent to treatment? A qualitative study from South Africa.

BackgroundIndividuals who test positive for active tuberculosis (TB) but do not initiate treatment present a challenge to TB programmes because they contribute to ongoing transmission within communities. To better understand why individuals do not initiate treatment, or are adherent after initiating treatment, South African respondents were approached to obtain insights as to which factors enabled and inhibited the treatment process.MethodsThis qualitative work was nested in a larger study investigating initial loss to follow-up (LTFU) amongst new smear positive TB patients across five provinces of South Africa. In-depth interviews were done with 41 adherent and initial LTFU respondents.ResultsKey issues contributing to initial LTFU appeared to be a poor knowledge, or low awareness of TB treatment; stigma around TB including its connection to HIV; immediate problems in the respondents’ lives particularly poverty, lack of access to transport and the need to continue working; and problems in the healthcare facilities including under resourced facilities, poor functioning health systems and negative staff attitudes. In contrast the reasons given for being adherent related to the level of illness, support received at home and healthcare facilities, a belief in the health system and positive experiences in the health service including positive attitudes from staff.ConclusionsKey changes need to be made to the healthcare system to enable patients to initiate treatment and remain adherent, but the six month regimen of daily observed treatment presents real practical and personal challenges to patients. Alternative strategies to DOTS at facility level should be investigated to bring services closer to communities to encourage patients to access care, initiate and adhere to treatment.

Elizabethkingia anophelis: Experience of an Academic Health System in Southeastern Wisconsin

Elizabethkingia anophelis: Experience of an Academic Health System in Southeastern Wisconsin

Peer interviewers in mental health services research

Purpose Inclusion of members of the target population in research is an increasing priority in the social sciences; however, relatively few studies employ approaches that involve persons with lived experience of the mental health system in mental health services research, particularly in the USA. The purpose of this paper is to describe one such approach, the employment of peer interviewers in the evaluation of a peer respite program. Design/methodology/approach The paper describes how peer interviewers were recruited, hired, trained, and supervised. The authors discuss some benefits and challenges associated with the approach. Findings Peer interviewer benefits and challenges: the shared lived experience between the peer interviewers and study participants contributed to increased comfort and a high response rate overall. The study opened up professional opportunities for peers, but inconsistent work hours were a challenge and resulted in turnover and difficulty filling vacant positions. The lead evaluator and supervisors worked closely with peer interviewers to ensure conflict of interest was mitigated to reduce bias. Originality/value This paper adds to the limited literature describing peer representation in research, outlining one avenue for partnering with peers to align research with the values of the intervention under study without compromising – and perhaps increasing – scientific rigor. The authors expect that even more peer involvement in the oversight, analysis, and interpretation of results would have improved the overall quality of the evaluation. Future efforts should build upon and incorporate the approach alongside more comprehensive efforts to partner with service users.

Increasing compliance with the World Health Organization Surgical Safety Checklist—A regional health system's experience

BackgroundIn 2009, NorthShore University HealthSystem adapted the World Health Organization Surgical Safety Checklist (SSC) at each of its 4 hospitals. Despite evidence that SSC reduces intraoperative mistakes and increase patient safety, compliance was found to be low with the paper form. In November 2013, NorthShore integrated the SSC into the electronic health record (EHR). The aim was to increase communication between operating room (OR) personnel and to encourage best practices during the natural workflow of surgeons, anesthesiologists, and nurses. The purpose of this study was to examine the impact of an electronic SSC on compliance and patient safety. MethodsAn anonymous OR observer selected cases at random and evaluated the compliance rate before the rollout of the electronic SSC. In June 2014, an electronic audit was performed to assess the compliance rate. Random OR observations were also performed throughout the summer in 2014. Perioperative risk events, such as consent issues, incorrect counts, wrong site, and wrong procedure were compared before and after the electronic SSC rollout. A perception survey was also administered to NorthShore OR personnel. ResultsCompliance increased from 48% (n = 167) to 92% (n = 1,037; P < .001) after the SSC was integrated into the electronic health record. Surgeons (91% vs 97%; P < .001), anesthesiologists (89% vs 100%; P < .001), and nurses (55% vs 93%; P < .001) demonstrated an increase in compliance. A comparison between risk events in the pre- and post-rollout period showed a 32% decrease (P < .01). Hospital-wide indicators including length of stay and 30-day readmissions were lower. In a survey to assess the OR personnel's perceptions of the new checklist, 76% of surgeons, 86% of anesthesiologists, and 88% of nurses believed the electronic SSC will have a positive impact on patient safety. ConclusionsThe World Health Organization SSC is a validated tool to increase patient safety and reduce intraoperative complications. The electronic SSC has demonstrated an increased compliance rate, a reduced number of risk events, and most OR personnel believe it will have a positive impact on patient safety.

Comparing the Health Care System of Iran with Various Countries

Background: Gaining health is an inalienable right of every human being; therefore, governments are required to provide a minimum of health care services for all people who live in the society. Objectives: This study was conducted to compare the health care system of Iran and some selected countries around the world. Methods: This was a descriptive-comparative study, which was conducted to compare the health care system of Iran and a number of selected countries with a focus on the service provider and payment method. In this research, nine countries including Norway, Australia, United States of America, Germany, Italy, Canada, England, Denmark and Japan were selected and studied based on the availability of data. These data were compared to that of Iran. The required information from selected countries was collected in 2014 using the “health system review: health system in transition”, and “international profiles of health care systems”, as well as well-known websites such as the world health organization, the world bank and the health department. Results: The findings of this study showed that in most selected countries, primary care services were provided by the private sector and the public sector has been mostly functioning as a supervisor in this area, but in Iran, primary care services were provided by the government. The findings of this study also showed that hospital services in Iran and selected countries (second and third level services) were provided by both public and private sectors, yet the public sector had a bigger share. Moreover, payment in primary health care (PHC) in the majority of the selected countries was mostly capitation and FFS payments, or a combination of the two. Payment in hospital care (secondary and tertiary levels) in most of the studied countries and even Iran was mostly through governmental budgets. Conclusions: According to the findings of this comparative study indicating the successful experiences of health systems around the world, it seems that the implementation of the process of decentralization of the government in some sections and different levels of health care is the best option for the health care system of Iran.

Interdisciplinary Shared Governance in Ambulatory Care: One Health System's Journey.

The implementation of shared governance structures in acute care has illustrated the positive relationship between shared decision making and nurse empowerment and positive nurse and patient outcomes. Little is known, however, about interdisciplinary shared governance, and even less is known about shared governance in ambulatory care. This article details one health system's experience with the implementation of an interdisciplinary shared governance structure in ambulatory care over a 4-year period. The authors report lessons learned, positive health system outcomes that resulted including improved communication, better preparedness for accreditation visits, improved assessment of fall risk, and a streamlined documentation system. Also discussed are mechanisms to enhance sustainability of the structure and discussion of future opportunities and challenges.

THE MEDICARE ANNUAL WELLNESS VISIT AS AN OPPORTUNITY FOR IMPROVING DETECTION OF COGNITIVE IMPAIRMENT: THE EXPERIENCE OF A LARGE MIDWESTERN HEALTH SYSTEM

THE MEDICARE ANNUAL WELLNESS VISIT AS AN OPPORTUNITY FOR IMPROVING DETECTION OF COGNITIVE IMPAIRMENT: THE EXPERIENCE OF A LARGE MIDWESTERN HEALTH SYSTEM

Cancer characteristics of male BRCA mutation carriers in a Cancer Genetics Clinic database: The Beaumont Health System experience.

e13007Background: BRCA mutations are associated with an increased risk of breast and ovarian cancers in women. The cancer characteristics of men with BRCA 1 and 2 mutations are less well studied. We reviewed data on male patients diagnosed with BRCA 1 or 2 mutations in our clinical database and described their unique cancer characteristics. Methods: After IRB approval, we performed a retrospective chart review on male patients seen at the Nancy and James Grosfeld Cancer Genetics Center from January 2004 to December 2014, who tested positive for a BRCA 1 or 2 mutation. Results: A total of 103 male patients were identified who tested positive for a BRCA1 or 2 deleterious mutation. Of these 103 patients, 32 (31%) had a diagnosis of cancer either prior to testing (12 pts) or after genetic testing was performed (20 pts). Of these 32 patients with cancer, the majority (18 pts) were found to carry a BRCA 2 mutation. Median age of cancer diagnosis was 65 years (range 35-75 years). Of the 32 patients diagnosed wit...

Protecting health workers from infectious disease transmission: an exploration of a Canadian-South African partnership of partnerships.

BackgroundHealth workers are at high risk of acquiring infectious diseases at work, especially in low and middle-income countries (LMIC) with critical health human resource deficiencies and limited implementation of occupational health and infection control measures. Amidst increasing interest in international partnerships to address such issues, how best to develop such collaborations is being actively debated. In 2006, a partnership developed between occupational health and infection control experts in Canada and institutions in South Africa (including an institute with a national mandate to conduct research and provide guidance to protect health workers from infectious diseases and promote improved working conditions). This article describes the collaboration, analyzes the determinants of success and shares lessons learned.MethodsSynthesizing participant-observer experience from over 9 years of collaboration and 10 studies already published from this work, we applied a realist review analysis to describe the various achievements at global, national, provincial and hospital levels. Expectations of the various parties on developing new insights, providing training, and addressing service needs were examined through a micro-meso-macro lens, focusing on how each main partner organization contributed to and benefitted from working together.ResultsA state-of-the-art occupational health and safety surveillance program was established in South Africa following successful technology transfer from a similar undertaking in Canada and training was conducted that synergistically benefitted Northern as well as Southern trainees. Integrated policies combining infection control and occupational health to prevent and control infectious disease transmission among health workers were also launched. Having a national (South-South) network reinforced by the international (North–south) partnership was pivotal in mitigating the challenges that emerged.ConclusionsHigh-income country partnerships with experience in health system strengthening – particularly in much needed areas such as occupational health and infection control – can effectively work through strong collaborators in the Global South to build capacity. Partnerships are particularly well positioned to sustainably reinforce efforts at national and sub-national LMIC levels when they adopt a “communities of practice” model, characterized by multi-directional learning. The principles of effective collaboration learned in this “partnership of partnerships” to improve working conditions for health workers can be applied to other areas where health system strengthening is needed.