Health System Innovation Research Articles

Community health workers: A sustainable health system innovation or just an emergency response?

Community health workers: A sustainable health system innovation or just an emergency response?

Diabetic foot in primary and tertiary (DEFINITE) Care: A health services innovation in coordination of diabetic foot ulcer (DFU) Care within a healthcare cluster - 18-month results from an observational population health cohort study.

Diabetic Foot in Primary and Tertiary (DEFINITE) Care is an inter-institutional and multi-disciplinary team (MDT) health systems innovation programme at a healthcare cluster in Singapore. We aim to achieve coordinated MDT care across primary and tertiary care for patients with diabetic foot ulcers (DFU), within our public healthcare cluster - an integrated network of seven primary care polyclinics and two acute care tertiary hospitals (1700-bed and 800-bed) with a total catchment population of 2.2 million residents. Results from prospective DEFINITE Care is referenced against a retrospective 2013-2017 cohort, which was previously published. Cardiovascular profile of the study population is compared against the same population's profile in the preceding 12 months. Between June 2020 and December 2021, there were 3475 unique patients with DFU with mean age at 65.9 years, 61.2% male, mean baseline HbA1c at 8.3% with mean diabetes duration at 13.3 years, mean diabetes complication severity index (DCSI) at 5.6 and mean Charlson Comorbidity Index (CCI) at 6.8. In the 12-months preceding enrolment to DEFINITE Care, 35.5% had surgical foot debridement, 21.2% had minor lower extremity amputation (LEA), 7.5% had major LEA whilst 16.8% had revascularisation procedures. At 18-months after the implementation of DEFINITE Care programme, the absolute minor and major amputation rates were 8.7% (n=302) and 5.1% (n=176), respectively, equating to a minor and major LEA per 100000 population at 13.7 and 8.0, respectively. This represents an 80% reduction in minor amputation rates (P < .001) and a 35% reduction in major amputation rates (P=.005) when referenced against a retrospective 2013-2017 cohort, which had minor and major LEA per 100000 population at 68.9 and 12.4, respectively. As compared to the preceding 12 months, there was also a significant improvement in cardiovascular profile (glycemic and lipid control) within the DEFINITE population, with improved mean HbAc1 (7.9% from 8.4%, P < .001), low-density lipoprotein (LDL) levels (2.1 mmol/L from 2.2, P < .001), total cholesterol (3.9 mmol/L from 4.1, P < .001) and triglycerides levels (1.6 mmol/L from 1.8, P=.002). Multivariate analysis revealed a history of minor amputation in the preceding 12 months to be an independent predictor for major and minor amputation within the study period of 18 months (Hazard Ratio 3.4 and 1.8, respectively, P < .001). In conclusion, within DEFINITE care, 18-month data showed a significant reduction of minor and major LEA rates, with improved medical optimisation and cardiovascular profile within the study population.

Adoption and scale-up of the cardiovascular Polypill: a realist institutional analysis.

Efforts to promote the adoption and scale-up of health system innovations must contend with the existing institutional context. But there are no commonly used frameworks to ensure that the insights of actors involved in such institutional efforts connect to one another. To test and modify a potential framework-the 'four-by-four' framework-we interviewed researcher-entrepreneurs involved in the unfolding story of the cardiovascular Polypill. The framework has four types/levels of institutions that affect adoption and scale-up: (1) informal institutions (L1, e.g.social norms), (2) formal institutions (L2, e.g.government policies and regulation), (3) organizational structures (L3, e.g.organizational boards and mission) and (4) everyday exchange (L4, e.g.service delivery), vis-à-vis four potential entrepreneurial strategies in response: (1) abide by existing institutions, (2) evade them, (3) alter them and/or (4) exit entrepreneurial action. Using this framework, we conducted a realist-informed analysis to understand how context (i.e. institutions) and mechanism (i.e.entrepreneurial strategies) influence each other to shape outcomes (i.e.adoption and scale-up). We found that researcher-entrepreneurs began with efforts to abide with existing institutions but encountered institutional obstacles at each level. Efforts to abide were followed by seeking to evade and/or alter unfavourable institutions, with greater success evading and/or altering lower (L3 and L4) than upper (L1 and L2) institutions. Exit considerations followed the failure of the evade or alter strategy. Shifts between strategies were propelled by 'learning'. The 'four-by-four' framework can be used as a scaffold to generate narratives of adoption or scale-up efforts, a sensitizing tool to prospectively map out contingencies and a matrix to synthesize narratives and experiences across multiple innovations or settings. Used in these ways, the 'four-by-four' framework can help to optimize the transferability and cumulation of insights on how to promote the adoption and scale-up of health system innovations.

Health System Shock Frameworks Between Theory, Application, and Assessment Comment on "The COVID-19 System Shock Framework: Capturing Health System Innovation During the COVID-19 Pandemic".

The COVID-19 System Shock Framework (CSSF) tested the resilience of service providers throughout the coronavirus disease 2019 (COVID-19) pandemic in Australia. In this commentary, we tackle the topic of the CSSF applicability in less mature health systems and propose elements or dimensions that could be added to provide comprehensive response to future shocks. We acknowledge the fact that information systems, telehealth, and standard operation procedures constitute important pillars of system shock frameworks. However, there are doubts on the applicability of such pillars in middle- and low-income countries where the infrastructure is weaker compared to high-income countries and the digital divide is wider. Moreover, while it provided a paramount solution to deliver health services during the pandemic, the negative impact of telehealth should be addressed. In addition, we propose that CSSF should consider focusing on the continuity of the other medical conditions, which may have been affected due to the mitigation policies. Finally, we propose adding a dimension on the evaluation of CSSF to provide quantifiable and comparable assessment with other providers or systems.

Toplam Kalite Yönetimi ve İnovasyonun Hastanelerin Performansına Etkisi: Ankara İlinde Özel Hastaneler Örneği

ABSTRACTAim: Everything in the world began to change radically. The health service provision within the health sector is one of the sectors that have been most affected by this change and transformed. The aim of the study is to examine Total Quality Management practices affect the performance of hospitals and innovations in health systems affect the performance of health institutions.Method: Research data were obtained by collecting questionnaires from private hospital managers in Ankara between 29.08.2018 - 31.12.2018. Simple and multiple regression analysis was used, including a literature review.Result: A total of 155 managers from 33 private hospitals, It was planned to reach all the managers included in the research, but 137 of them voluntarily participated in survey and agreed to contribute. Accordingly, the sample of the study represents 88.3% of the study population. The findings obtained as a result of the research were determined at the 95% confidence level.Conclusion: In the century when technology has entered health services with digitalization and combined with artificial intelligence, rapid developments are experienced, and it seems that innovation, which has a key determinant role in providing competitive advantage in health service delivery, will continue to be the main character and increase its importance. While Total Quality Management practices focus on customer satisfaction in health services, innovation both facilitates the work of hospital staff and points out that it provides high performance by increasing the efficiency and effectiveness of the health service provided, and by providing the efficiency at the maximum level.

Strategic Clinical Network Teams Improve Effectiveness, Team and Leadership Processes and Inputs: Theory-Based Longitudinal Survey.

Strategic Clinical Networks (SCNs) in Alberta include multidisciplinary teams that work toward health system innovation and improvement; however, what contributes to team effectiveness is unclear. This theory-informed longitudinal survey (n = 826) evaluated team effectiveness within SCNs and predictors of effectiveness. Satisfaction, inter-team relationships and seven predictors including team inputs and team and leadership processes improved over two years. Attitudinal outputs were predicted by the same factors over time, whereas performance outputs were predicted by different factors. This innovative study emphasizes that SCN teams and their effectiveness evolve over time and that team-based research can refine network evaluations.

Health Care Science—Why another journal and why we will be different?

<i>Health Care Science</i>—Why another journal and why we will be different?

Tribal Public Health Law in Tenganan Pegringsingan-Bali: An Emergency Preparedness and Response to Covid 19 Pandemic

Public health law is a legal concept not only regulating the provision of health services but also improving the quality of life and extending access to the service for the public members. Covid-19 opens access to health services for the people, and it serves as an indispensable part in the survival of the people, including the vulnerable people of adat law. This research aims to analyze the degree of success in implementing public health law in Tenganan Pegrisingan village-Bali in the scope of preparedness or response to the pandemic. This research employed socio-legal methods involving interviews, observation, and focus group discussion (FGD). Primary data were collected from interviews and FGD, involving the participation of the traditional chief, village head, and other adat figures in Tenganan Pegringsingan-Bali. The research analysis required a descriptive-qualitative approach. This research sees how the tenganan Pagringsingan tribe clings on to their sovereignty to survive and respond to the Covid-19 pandemic without leaving their framework governed by international and national laws. It leads to the research result revealing that the public health law in Tenganan Pegrisingan adat village combines traditional and modern elements and spiritual and science. This approach can set a model for other village communities. The leadership role of adat people that are inherent, strong, and obeyed has made public health law more properly managed and more effective in dealing with the pandemic. The supportive policy framework that is harmonized at all international, national, and regional levels and all over adat villages is a prerequisite to help maximize the potential of tribal public health system innovation.

HIV Digital Vaccine Strategy: Proposal for Applying Blockchain in Preventing the Spread of HIV.

BackgroundThe HIV epidemic imposes a heavy burden on societal development. Protection of susceptible populations is the most feasible method for eliminating the spread of HIV. In the absence of a biological vaccine, the definitive solution is enabling susceptible populations to recognize and avoid high-risk sexual behavior.ObjectiveThe objective of this study is to use specific technologies and strategies to establish a system by which high-HIV-risk individuals can determine the HIV infection status of one another anonymously, conveniently, and credibly.MethodsThis study proposes an HIV digital vaccine (HDV) strategy, a decentralized application (Dapp) based on blockchain for use by individuals with a high risk of HIV and accredited testing agencies (ATAs). Following testing, only the HIV-negative results (or linked information) are uploaded to the blockchain, which results in high-risk individuals being able to determine the HIV-negative status of each other anonymously, conveniently, and credibly.ResultsFuture work includes the following: (1) a survey of the willingness to use Dapps among high-HIV-risk populations, (2) a larger framework containing both HDV and people living with HIV (PLH) and discussing the influence of HDV on PLH and its possible solutions, and (3) coordinating with the blockchain development team, ATAs, community-based organizations, and third-party organizations to raise funds, develop the Dapp, formulate detailed plans, and publicize and promote it. The exact timeline for achieving these objectives cannot be determined at present.ConclusionsThe HDV strategy may reduce the occurrence of high-risk sexual behavior and effectively protect susceptible populations; combined with current strategies, it is a promising solution to prevent the spread of HIV. The included concepts of decentralized surveillance and surveillance as intervention may spark a change in current infectious disease prevention and control modes to introduce beneficial innovations in public health systems globally.International Registered Report Identifier (IRRID)PRR1-10.2196/37133

Centralization and innovation: Competing priorities for health systems?

Over the last 15 years, there has been a trend in Canada to centralise the provision of health services that were previously administratively and fiscally decentralised. Canadian policy rhetoric on centralisation often identifies improved innovation as an anticipated outcome. This paper challenges the assumed relationship between centralisation and innovation. We incorporate evidence from the management literature into the debate on the structure of health systems to explore the effects that centralisation is likely to have on innovation in health systems. The findings of this paper will be of interest to international policymakers, who are currently grappling with the prospect of maintaining a decentralised approach or adopting a more centralised health system structure in the future.

Strategic Public-Private Partnerships to Transform Cardiovascular Health

The study, Strategic Public-Private Partnerships to Transform Cardiovascular Health, was developed under the guidance of Professor Rifat Atun, Professor of Global Health Systems at Harvard University and Director of the Health Systems Innovation Lab and implemented by a team consisting of Dr Ché L. Reddy, Associate Director Health Systems Innovation Lab, Harvard University, Dr Lindsay M. Murphy and Dr Carlo Ross, Research Assistants at Health Systems Innovation Lab, Harvard University. The ideas, insights and frameworks in the report are drawn from earlier research at the Health System Innovation Lab combined with a systematic literature review and interviews with leaders involved in the development and implementation of strategic Public-Private Partnerships to transform Cardiovascular Health.

Strategizing Research for Impact.

In its Strategic Plan 2021-2026, the Canadian Institutes of Health Research - Institute of Health Services and Policy Research (IHSPR) convincingly expresses its desire to expand capacity for applied health services and policy research (HSPR) and better mobilize research results for health system transformation geared toward the Quadruple Aim and health equity for all (CIHR IHSPR 2021). These strategic priorities echo views widely shared within the HSPR community, and we commend IHSPR for its leadership and vision. Recognizing the systemic challenges ahead of us, this commentary considers the HSPR community's capacity to achieve the promise of learning health systems, given the obstacles likely to hinder their rapid scale-up over the next five years. Next, we consider the spread of virtual care during the pandemic to illustrate the embedded and negotiated nature of innovation in health systems and the need for vigilance as to the social distribution of their benefits and costs. Finally, a critical review of the strategic plan provides insights into how research is governed in the HSPR field. Based on this analysis, it appears essential to reconsider health system transformation as social system transformation and strengthen interdisciplinary and comparative research. Looking forward, developing a science of science to better understand the conditions associated with high-impact research should be a cross-cutting priority for Canada's HSPR community.

The Mining Method of Ideological and Political Elements in University Public Mental Health Courses Based on Artificial Intelligence Technology.

Artificial intelligence technology has become an important part of the development of Internet technology. Artificial intelligence technology can help colleges and universities optimize the network ideological and political teaching system. Artificial intelligence technology provides more accurate data resources and rich and reliable educational technology means for online public mental health education in colleges and universities. This paper comprehensively uses a variety of methods such as qualitative and quantitative analysis, case and empirical analysis, literature analysis, and artificial intelligence technology. Artificial intelligence technology has been closely integrated with online public mental health education in colleges and universities. The model systematically analyzes the optimization methods of artificial intelligence technology methods for the online public mental health education system in colleges and universities, and constructs an innovation system for online public mental health education in colleges and universities. Based on the comprehensive analysis of artificial intelligence and public health in colleges and universities, this paper further proposes the application of artificial intelligence technology in online public mental health education in colleges and universities. On this basis, the model conducts an in-depth analysis of artificial intelligence technology and the online public mental health innovation system. The model supports the development of ideological and political teaching in colleges and universities through various forms such as idea innovation, path innovation, carrier innovation, and mechanism innovation.

Developing indicators and measures of high-quality for Australian general practice.

Rising health costs and health inequity are major challenges in Australia, as internationally. Strong primary health care is well evidenced to address these challenges. Primary Health Networks (PHNs) work with general practices to collect data and support quality improvement; however, there is no consensus regarding what defines high quality. This paper describes the development of an evidence-based suite of indicators and measures of high-quality general practice for the Australian context. We reviewed the literature to develop a suitable framework and revise quality assurance measures currently in use, then reviewed these in three workshops with general practitioners, practice managers, nurses, consumers and PHN staff in western Sydney. We used a descriptive qualitative research approach to analyse the data. A total of 125 evidence-based indicators were agreed to be relevant, and 80 were deemed both relevant and feasible. These were arranged across a framework based on the Quadruple Aim, and include structure, process and outcome measures. The agreed suite of indicators and measures will be further validated in collaboration with PHNs across Australia. This work has the potential to inform health systems innovation both nationally and internationally.

Supporting people living with dementia and care partners throughout the COVID‐19 pandemic: Health service directions from the first wave in Calgary, Alberta

BackgroundThe emergence of COVID‐19 (SARS‐CoV‐2) as a novel coronavirus in late 2019 necessitated public health measures that have impacted the provision of care for people living with dementia and their families. The rapid shift to virtual care across health and social care sectors meant that providers did not have the opportunity to benefit from an evidence‐based understanding about how and which services can safely and effectively be delivered virtually prior to public health measures being implemented. Additionally, isolation resulting from social distancing may be harming well‐being for families as formal and informal supports become less accessible.MethodTo understand lived experiences and necessary changes in models of care delivery for people living with dementia during the COVID‐19 pandemic in Canada, we remotely interviewed 20 dyads of people living with dementia and their care partners who normally attend a dementia specialty clinic in Calgary, Alberta, during a period where essential businesses were closed and health care had abruptly transitioned to telemedicine. Participants were 50% female and a majority of clinic patients in the dyad had a diagnosis of Alzheimer’s Disease (75%). A reflexive thematic analysis was used to analyze the interview and field note data.ResultThemes regarding virtual service provision emerged through the iterative qualitative data analysis: (1) continuation of community‐based services for care partners and families delivered in innovative ways to meet support needs during the pandemic; (2) guidance in adapting to technology to enable accessible and effective treatment in a virtual care environment; (3) adapting the process and structure of virtual appointments to operationalize critical information provision while maintaining dignity for the person living with dementia.ConclusionThe rapid move to virtual healthcare has influenced how and when people access health services. Health system innovation in the way we structure service models and care provision can mitigate barriers to maintaining high quality virtual health care for people living with dementia. In‐depth understandings of how health systems can provide high‐quality care in new virtual settings is key to maintaining quality of life for community‐dwelling people living with dementia and care partners in times of public health emergencies.

ENHANCING HEALTH AWARENESS THROUGH COMMUNITY PARTICIPATION

This Integrated Health System Innovation in Rahayu Village is an integrated and sustainable health program involving several stakeholders and related agencies. This program deals with health by integrating clean water programs as a health solution, agricultural programs for food self-sufficiency and nutrition improvement, and goat farming programs to support medicinal plant farming programs and organic vegetables. The study of the impact program using a qualitative approach, through FGDs and in-depth interviews, also observation and desk study on secondary data. This program has succeeded in raising awareness of healthy living and independence in solutions to the problems of the clean water crisis, health problems for children &amp; families, and independence in fulfilling children's and family's nutrition.

Typology of Indigenous health system governance in Canada

AbstractOriginally established as an expression of self‐determination, Indigenous‐governed health systems now play an important role in shaping the delivery of health programs and services in Canada. Operating in very diverse geographic, political and social contexts, these Indigenous health systems are highly heterogeneous. To better understand these differences, a typology is constructed based on three areas of decision‐making space: governance rules, financing and accountability mechanisms. The nature of the relationship and in particular, the degree of control exercised by Indigenous communities over their respective health systems in relation to federal, provincial and territorial governments, is also assessed. The resulting five‐level typology organizes Indigenous health systems into broad and strong control to moderate and narrow control. Although this typology is based on current governance arrangements, it nevertheless presents a baseline for the study of future innovations in Indigenous health systems as well as new types of provincial and territorial government engagement by Indigenous governments and organizations.

The COVID-19 System Shock Framework: Capturing Health System Innovation During the COVID-19 Pandemic.

Coronavirus disease 2019 (COVID-19) has resulted in over 2 million deaths globally. The experience in Australia presents an opportunity to study contrasting responses to the COVID-19 health system shock. We adapted the Hanefeld et al framework for health systems shocks to create the COVID-19 System Shock Framework (CSSF). This framework enabled us to assess innovations and changes created through COVID-19 at the Sydney Children's Hospitals Network (SCHN), the largest provider of children's health services in the Southern hemisphere. We used ethnographic methods, guided by the CSSF, to map innovations and initiatives implemented across SCHN during the pandemic. An embedded field researcher shadowed members of the emergency operations centre (EOC) for nine months. We also reviewed clinic and policy documents pertinent to SCHN's response to COVID-19 and conducted interviews and focus groups with stakeholders, including clinical directors, project managers, frontline clinicians, and other personnel involved in implementing innovations across SCHN. The CSSF captured SCHN's complex response to the pandemic. Responses included a COVID-19 assessment clinic, inpatient and infectious disease management services, redeploying and managing a workforce working from home, cohesive communication initiatives, and remote delivery of care, all enabled by a dedicated COVID-19 fund. The health system values that shaped SCHN's response to the pandemic included principles of equity of healthcare delivery, holistic and integrated models of care, and supporting workforce wellbeing. SCHN's resilience was enabled by innovation fostered through a non-hierarchical governance structure and responsiveness to emerging challenges balanced with a singular vision. Using the CSSF, we found that SCHN's ability to innovate was key to ensuring its resilience during the pandemic.

Tracing Non-linearity between Economic Freedom and National Health Innovation System Efficiency

Economic freedom, i.e., the freedom of companies to pursue their business activities, is a vital determinant of societal health, wealth, and economic progress. Despite the high societal and economic relevance, the relationship between economic freedom and the performance of national health innovation systems (NHIS) is poorly understood. While prior studies assume direct linear effects between economic freedom and innovation performance, we argue that economic freedom is only beneficial to a certain extent. We theorize on the costs and benefits of economic freedom and examine potential non-linearity in the relationship between economic freedom and NHIS efficiency. Moreover, we propose a contingency perspective and argue that the relationship between economic freedom and NHIS efficiency is depended on the volatility of the level of economic freedom over time. Varying levels of economic freedom require constant adjustments to the regulatory environment, which ultimately affects the costs and benefits of economic freedom so that under high volatility, the peak NHIS efficiency is lower. Using a panel dataset of 70 countries over ten years, we combine data envelopment analysis and regression analysis. Our results support our theorizing showing an inverted U-shaped relationship between economic freedom and NHIS efficiency and provide initial evidence on the associated boundary conditions.

Logic model for mental health interventions: the recovery College Model in Quebec, Canada

The Recovery College (RC) model represents a worldwide innovation in health systems. First appeared in England and now established in five continents, the RC model proposes a mental health educational approach in the community, emphasizingco-production, co-learning, and equity between theoretical/clinic knowledge and experiential knowledge (1-3). All participants(individuals with or without mental health challenges, their relatives, mental health professionals, health and education service providers, citizens) have access to mental health, recovery, and well-being training(4). Both participants and trainers collectively learn and reflect on their mental health attitudes, behaviors, and practices. This article reports on the co-construction process followed by Quebec's RC team, the first to have developed a RC logic model. The logic model conception followed six steps/strategies: 1) Participant observations, 2) Analysis of administrative documents, 3) Informal interviews and meetings with stakeholders (trainers, health service managers, and partner organizations) to better understand the implicit assumptions of the intervention, 4) Review of the literature related to the recovery college model, 5) Co-construction of causal links between resources, activities, and outcomes, 6) Validation and synthesis of the logic model. Finally, the logic model was disseminated, highlighting the relationships between the strategic resources needed for the key activities of the intervention to produce the expected outcomes.