Health System Improvement Research Articles

Lived experiences of women during induction of labour at a tertiary hospital in Ghana: A qualitative study.

Induction of labour (IOL) has become a major and vital maternal health intervention to facilitate childbirth and minimize the rising caesarean section rates globally. However, there is limited information to facilitate appropriate client counselling, birth preparedness and informed decision making although the procedure has inherent tendency for adverse maternal/perinatal outcomes. Given the need for optimal client education and shared decision making in maternal health, this study explored women's knowledge and their lived experiences of IOL. This qualitative study used in-depth interviews, conducted at the largest teaching hospital in Ghana. Purposive sampling was used to recruit the study participants. Data analysis was performed based on thematic content using inductive framework synthesis. We included 17 women who had undergone IOL, delivered and discharged. Most participants(52.9%) were ≥30 years old, married(88.2%), and 41.1% had no previous childbirth experience. The main indications of IOL were postdate(47%), pre-eclampsia(29%) and gestational diabetes mellitus(11.8%). Data synthesis resulted in three broad themes: women's knowledge on IOL, women's experiences of care and women's difficult experiences including coping mechanisms. We determined mixed responses concerning the themes explored: adequate versus inadequate knowledge; positive versus negative experiences of care and satisfaction. Nearly all women mentioned vaginal examination as their most difficult experience due to severe pain, extreme discomfort, and being psychologically traumatic. The main coping strategy the women developed to navigate the traumatic vaginal examination was by "psyching" themselves. Our study indicates women encounter significant negative and positive experiences during IOL and childbirth in Ghana with vaginal examination cited as the most painful experience. Appropriate antenatal counselling, women empowerment and pre-labour education on childbirth processes and expectations are recommended to enhance birth preparedness and complication awareness. Health system improvement and regular refreshers courses for health workers are urgently required to promote positive women's experiences of care during labour induction and childbirth.

A State-Wide Initiative to Improve Health System Responses to People With Borderline Personality Disorder Symptoms in Crisis: A Retrospective Audit.

Gold Card SA is a four-session structured psychological intervention offered soon after an acute crisis presentation to people with symptoms characteristic of borderline personality disorder. This study describes individual and system-level outcomes from a large-scale health-care improvement initiative to implement Gold Card SA across South Australia. An uncontrolled pre-post study design was utilized examining service user (n = 332) patient-reported outcome measures and hospital service utilization records (6 months before and after Gold Card SA). Mixed-effects negative binomial regression analysis revealed a significant decrease in rates of service utilization across emergency department presentations (63%), mental health-related inpatient admissions (65%), and bed days (82%). Linear mixed-effect regression indicated large reductions in borderline symptoms and nonspecific psychological distress, and small to moderate improvements in psychosocial functioning. People presenting with or experiencing borderline personality disorder symptoms may benefit from a brief crisis intervention embedded within a stepped care model.

Improving Health System Employees’ Knowledge and Self-Confidence With Structured Diabetes Training

Improving Health System Employees’ Knowledge and Self-Confidence With Structured Diabetes Training

Financing COVID-19-related health care costs in the Dutch competitive health system during 2020 and 2021: Overall experiences and policy recommendations for improving health system resilience

The Dutch health system is based on the principles of managed (or regulated) competition, meaning that competing risk bearing insurers and providers negotiate contracts on the price, quantity and quality of care. The COVID-19 pandemic caused a huge external shock to the health system which potentially distorted the conditions required for fair competition. Therefore, an important question is to what extent was the competitive Dutch health system resilient to the financial shock caused by the pandemic? Overall, the Dutch competitive health system proved to be sufficiently flexible and resilient at absorbing the financial shock caused by the COVID-19 pandemic in 2020 and 2021 due to an effective combination of regulatory and self-regulatory measures. However, based on the overall experiences in the Netherlands, from the health policy perspective improvements are needed aimed at (i) refining the catastrophic costs clause included in the Health Insurance Act, (ii) reducing the vulnerability of the Dutch risk equalisation system to distortions due to unforeseen catastrophic health care costs, and (iii) establishing more equal financial risk sharing between health insurers and health care providers. These improvements are also relevant for other countries with a health system based on the principles of managed (or regulated) competition.

Contributing to health system resilience during pandemics via purchasing and supply strategies: an exploratory system dynamics approach

BackgroundHealth systems worldwide struggled to obtain sufficient personal protective equipment (PPE) and ventilators during the COVID-19 pandemic due to global supply chain disruptions. Our study’s aim was to create a proof-of-concept model that would simulate the effects of supply strategies under various scenarios, to ultimately help decision-makers decide on alternative supply strategies for future similar health system related crises.MethodsWe developed a system dynamics model that linked a disease transmission model structure (susceptible, exposed, infectious, recovered (SEIR)) with a model for the availability of critical supplies in hospitals; thereby connecting care demand (patients’ critical care in hospitals), with care supply (available critical equipment and supplies). To inform the model structure, we used data on critical decisions and events taking place surrounding purchase, supply, and availability of PPE and ventilators during the first phase of the COVID-19 pandemic within the English national health system. We used exploratory modelling and analysis to assess the effects of uncertainties on different supply strategies in the English health system under different scenarios. Strategies analysed were: (i) purchasing from the world market or (ii) through direct tender, (iii) stockpiling, (iv) domestic production, (v) supporting innovative supply strategies, or (vi) loaning ventilators from the private sector.ResultsWe found through our exploratory analysis that a long-lasting shortage in PPE and ventilators is likely to be apparent in various scenarios. When considering the worst-case scenario, our proof-of-concept model shows that purchasing PPE and ventilators from the world market or through direct tender have the greatest influence on reducing supply shortages, compared to producing domestically or through supporting innovative supply strategies. However, these supply strategies are affected most by delays in their shipment time or set-up.ConclusionWe demonstrated that using a system dynamics and exploratory modelling approach can be helpful in identifying the purchasing and supply chain strategies that contribute to the preparedness and responsiveness of health systems during crises. Our results suggest that to improve health systems’ resilience during pandemics or similar resource-constrained situations, purchasing and supply chain decision-makers can develop crisis frameworks that propose a plan of action and consequently accelerate and improve procurement processes and other governance processes during health-related crises; implement diverse supplier frameworks; and (re)consider stockpiling. This proof-of-concept model demonstrates the importance of including critical supply chain strategies as part of the preparedness and response activities to contribute to health system resilience.

Exploring effective implementation pathways to become an excellent chief financial officer in public hospital: a qualitative comparative analysis (QCA) from China

BackgroundHospital chief financial officer (CFO) contributes to improving health system performance. However, how to become an excellent hospital CFO has rarely been considered from a holistic perspective. This paper aims to identify competencies required by hospital CFO to fulfil the position’s responsibilities and explore effective implementation pathways to generate high performance and improve healthcare service.MethodsWe conducted 61 semi-structured interviews with individuals in key leadership positions in China’s hospitals and researchers focusing on healthcare system management to identify core competencies necessary for hospital CFO. Interviews were analysed through a multi-stage review process and modified via expert vetting using a national panel of 23 professors. Subsequently, interviews were conducted with 32 hospital CFOs from 14 provinces throughout September 2021 to May 2022. We scored the performance of 32 hospital CFOs in various aspects of competency and used the fuzzy-set qualitative comparative analysis to explore the competency configurations of excellent CFOs.ResultsWe identify seven core competencies necessary for a hospital CFO to fulfil management practices, including personal morality, resource management, strategy management, learning ability, negotiating skill, leadership skill, and financial management. The findings indicate that a single competency factor is not a necessary condition to become an excellent hospital CFO. The results of qualitative comparative analysis then make it possible to propose four configurational paths, namely, supportive, interpersonal, all-around development, and technical, to become an excellent hospital CFO and achieve effective managerial performance.ConclusionsThe responsibilities of hospital CFOs are complex and varied, hence, a better understanding of competencies required by CFO is essential to implement their responsibilities effectively. The identification in this study of the four effective implementation pathways to becoming an excellent hospital CFO enriches the literature on hospital management and provides implications for China’s hospitals and their CFOs.

Unsung heroes in Ghana’s healthcare system: the case of community health volunteers and community health management committee

BackgroundIn Ghana, the community-based health planning and services (CHPS) policy highlights the significance of both community health management committees (CHMCs) and community health volunteers (CHVs) in the Ghanaian health system. However, research into their specific effects on health system improvement is scarce. Some research has focussed on the roles of the CHMCs/CHVs in implementing specific targeted health interventions but not on improving the overall health system. Therefore, this research aims to examine the role of the CHMCs and CHVs in improving the Ghanaian health system.MethodsThe study was conducted in three districts in the Ashanti region of Ghana. A total of 35 participants, mainly health service users and health professionals, participated in the study. Data were collected using semi-structured individual in-depth interviews. Participants were selected according to their patient–public engagement or community health activity roles. Data were transcribed and analysed descriptively using NVIVO 12 Plus.ResultsWe found that the effectiveness of CHMCs and CHVs in health systems improvement depends largely on how members are selected. Additionally, working through CHMC and CHVs improves resource availability for community health services, and using them in frontline community health activities improves health outcomes.ConclusionsOverall, we recommend that, for countries with limited healthcare resources such as Ghana, leveraging the significant role of the CHMCs and CHVs is key in complementing government’s efforts to improve resource availability for healthcare services. Community health management committees and CHVs are key in providing basic support to communities with limited healthcare personnel. Thus, there is a need to strengthen their capacities to improve the overall health system.

A ‘training of trainers’ programme for operational research: increasing capacity remotely

ABSTRACT Background Operational research (OR) is a process to improve health system capacity by evaluating interventions to improve health delivery and outcomes. The World Health Organization (WHO) Structured Operational Research Training Initiative (SORT-IT) programme promotes how OR contributes to improved health care delivery and health outcomes. A partnership project between the International Institute of Primary Health Care (IPHCE) in Ethiopia and The University of Queensland (UQ) in Australia modified the SORT-IT programme to deliver a hybrid Training of Trainers programme and improve OR capacity. Objective This study was performed to develop and evaluate the effectiveness of Train-the Trainers approach in building capability to expand the capacity of the IPHCE to deliver the SORT-IT programme. Methods Recruitment of participants and training were aligned with the principles of the SORT-IT programme. Training was face-to-face for the first session with subsequent training sessions delivered via Zoom over a 13-week period. Participants were required to complete all activities in line with SORT-IT deliverables. Slide decks supporting the SORT-IT training videos were developed and adapted to the Ethiopian context. Results Participants had diverse experience from programme directors to research officers. All training sessions were recorded and available for participants to watch and review when required. All participants completed OR protocols to the draft stage. Course evaluation revealed participants found the content and format of the training useful, pertinent, and interesting. Conclusion A hybrid model (face-to-face and video platform) for OR training was implemented. Managing contextual challenges such as information technology were managed easily by programme staff. Translating course requirements at a management level proved challenging with data collection for the protocols but provided insight into potential future challenges. This OR Training of Trainers course demonstrated that sharing of skills and knowledge can occur through a hybrid delivery model and contribute to developing capacity.

Medical tourism among Indonesians: a scoping review

BackgroundInternational medical travel or medical tourism is not a new phenomenon in many countries, including among Indonesians. Indonesia is reported as a major source of patients from the lower, middle, to upper classes for its neighbouring countries. This scoping review aims to synthesise evidence on supporting factors for Indonesians taking medical tourism and what needs to be improved in Indonesia’s health system.MethodsWe conducted a scoping review guided by a framework provided by Arksey and O’Malley. We systematically searched existing literature from 5 databases, including MEDLINE, PubMed, Scopus, ProQuest, and Wiley. Data were extracted based on study details, study design, characteristics of participants and results. Analysis followed the three-stage procedure outlined by Thomas and Harden: (1) coding the text line by line, interpreting the data and identifying concepts or themes; (2) developing descriptive themes by grouping similar concepts in theme and subtheme and (3) generating analytical themes by reviewing preliminary themes and discussing the addition or revision of themes.ResultsA total of 25 articles were included in this review. The review highlights a broad range of facilitators for medical tourism among Indonesians: (i) availability of health services, medical specialities, and person-centred care, (ii) region adjacency, transport, and health agency, (iii) affordability of medical treatment, (iv) religious and socio-cultural factors, and (v) reasons patients reported distrust in Indonesian doctors.ConclusionThe findings indicate improvements in the Indonesian health system are necessary if the increasing rates of international medical tourism by Indonesian people are to change. Addressing the factors identified in this scoping review through avenues including policy may increase people’s satisfaction and trust towards health care and treatment in Indonesia, thereby reducing the number of Indonesian people taking medical tourism.

Ambitions and realities: Are Global Fund investments designed to achieve resilient and sustainable systems for health? Findings from the Global Fund Prospective Country Evaluation.

Strengthening resilient and sustainable systems for health (RSSH) is central to the Global Fund's strategy, however questions persist about the Global Fund's role in the health systems strengthening space, and the extent to which investments are designed to achieve strengthening objectives, or just fill in gaps in the system. This paper reports on findings from the Prospective Country Evaluations (PCE), a multi-country multi-year evaluation of Global Fund support. We adapted a framework from Chee et al. (2013) to assess whether Global Fund investments were designed to strengthen or support the health system. Per this framework, 'systems support' refers to improvements in health systems functioning primarily driven by increases in inputs, whereas 'systems strengthening' refers to activities that drive changes in how the health system operates (often related to policies, regulations, governance structures, behavior change, and resource optimization). In the 2017 and 2019 funding cycles, we found that despite calls from the Global Fund to invest more strategically to strengthen health systems, a high proportion of RSSH funding was directed toward activities that support the health system. Factors underlying this pattern include limitations imposed by the three-year grant cycle, a lack of clear guidance on how to design strengthening investments, a persistent need for funding to address input gaps, and minimal feedback during the funding request process related to RSSH design. For the Global Fund, and indeed other global health initiatives, to contribute to sustained strengthening of health systems, is likely to require enhanced guidance and technical assistance, as well as improved measurement of outputs and outcomes.

Evaluating health systems' efficiency towards universal health coverage: A data envelopment analysis.

To estimate the technical efficiency of health systems toward achieving universal health coverage (UHC) in 191 countries. We applied an output-oriented data envelopment analysis approach to estimate the technical efficiency of the health systems, including the UHC index (a summary measure that captures both service coverage and financial protection) as the output variable and per capita health expenditure, doctors, nurses, and hospital bed density as input variables. We used a Tobit simple-censored regression with bootstrap analysis to observe the socioeconomic and environmental factors associated with efficiency estimates. The global UHC index improved from the 2019 estimates, ranged from 48.4 (Somalia) to 94.8 (Canada), with a mean of 76.9 (std. dev.: ±12.0). Approximately 78.5% (150 of 191) of the studied countries were inefficient (ϕ < 1.0) with respect to using health system resources toward achieving UHC. By improving health system efficiency, low-income, lower-middle-income, upper-middle-income, and high-income countries can improve their UHC indices by 4.6%, 5.5%, 6.8%, and 4.1%, respectively, by using their current resource levels. The percentage of health expenditure spent on primary health care (PHC), governance quality, and the passage of UHC legislation significantly influenced efficiency estimates. Our findings suggests health systems inefficiency toward achieving UHC persists across countries, regardless of their income classifications and WHO regions, as well as indicating that using current level of resources, most countries could boost their progress toward UHC by improving their health system efficiency by increasing investments in PHC, improving health system governance, and where applicable, enacting/implementing UHC legislation.

Primary health care as a key component of the Global Public Health architecture

Modern challenges associated with a sharp increase in morbidity and mortality in the world (non-communicable diseases, COVID-19, etc.), predetermine the improvement of public health systems and the strengthening of international cooperation in the field of medicine. The purpose of the study was to study health indicators of the population and the potential of PHC in Bishkek. Studies have shown that the PHC reforms carried out in Bishkek have not achieved their goals and have led to a deterioration in the quality and accessibility of medical care. Based on the conclusions, it is recommended to conduct point-based comprehensive scientific research of primary health care in Bishkek with a strategic analysis of the results obtained for the development of programs to improve the quality and accessibility of medical services, taking into account benchmarking international experience in the development and implementation of effective models of primary health care.

Population-based overall and net survival of childhood leukemia at 1-, 5-, and 10-years of follow-up in three regions of Colombia.

Childhood leukemia (CL) is the most common type of childhood cancer worldwide and in Colombia. Thanks to therapeutic innovations and improved access, the survival of children and adolescents with leukemia has increased considerably worldwide, especially in high-income countries. In Colombia, a middle-income country, survival has also been observed to increase in big cities. However, the survival rate in intermediate cities is still unknown. This study aimed to assess short- and long-term survival rates of children with leukemia coming from three intermediate Colombian cities as well as to compare overall survival (OS) rates versus relative survival (RS) rates of this population of children. Data from population-based cancer registries in three Colombian cities (Bucaramanga metropolitan area, Manizales and Pasto) were analyzed. OS and RS of up to 10 years were estimated for children who were diagnosed with leukemia at ages 0-18 years between 1998 and 2018 and followed up for vital status. RS was calculated using the Pohar-Perme method. We performed a separate survival analysis by gender and by period of diagnosis (before and after 2010). We included data from 507 children and adolescents diagnosed with leukemia. RS at 1, 5 and 10 years after diagnosis were similar between the populations for the respective timeframes (RS Bucaramanga 86.5%, 66.9% and 52.5%; Manizales 81.1%, 62.8% and 61.1%; Pasto 81.7% at 1 year, 66.2% at 5 years and 59.4% at 10 years). OS and RS were very similar for all estimates and periods. There were no clear differences in RS between genders across the three population-based cancer registries and there was an improvement in RS after 2010, particularly in Bucaramanga and Pasto. Our study reports similar 5-year survival rates for CL in these Colombian cities compared to rates documented in other Latin American countries and larger Colombian cities. These are far below what is reported in high-income settings. This highlights opportunities for improvement in the Colombian health system, where numerous barriers persist in terms of suspicion, diagnosis and continuity of treatment for CL.

COVID-19 Pandemic: From Population Need to Professional Nursing Competence.

Nursing has proven to be an essential healthcare profession, especially in the face of the COVID-19 pandemic crisis. In this chapter, it shows the essential aspects of the discipline of care and its application in the face of the pandemic from an Informatics Nursing approach. The conceptual bases include the conception of care and its historical evolution. Thus, the Personal Care Knowledge Model, the clinical care sequence and its standardized languages allow Taxonomic Triangulation to be developed. Taxonomic Triangulation is a technique created by nurses that allows managing information and that served to extract knowledge from documents and clinical experiences. The application of this vision of care and its knowledge management models have been tested in different situations: from the identification of care diagnoses in a World Health Organization clinical guide to the design of a care plan manual in a hospital. On the other hand, a secondary result is the resilience shown by the nurses. A resilience based on theoretical models centered on the person and on a language that can represent life from care. In addition, nursing includes a comprehensive perspective that addresses the emotional and spiritual area. In conclusion, nurses and their specialization with skills in knowledge management allow giving visibility to care. A professional care whose purpose is to improve health systems through solutions based on care so that people can achieve their best health situation.

Evidence – Informed Policy Formulation and Implementation: A case study of ‘Clean Air Policy’ in Punjab, Pakistan

Background: There has been an accelerating momentum globally, for the use of scientific research evidence to support public health policy formulation and implementation. Policymakers, nonetheless use a variety of information over and above research evidence in the process. A case study of ‘the Clean Air policy’ was undertaken to explore the Policy makers practices related to Evidence Informed Policy in Punjab, Pakistan. Objective: The objective of this study was to investigate policy makers’ perceptions regarding ‘evidence’ and how it is gathered and used in policy formulation and implementation processes Methods: The empirical data was collected by qualitative research techniques. Document review and semi-structured in-depth interviews were conducted with 87 purposively selected policymakers between December’22-October’23. Data Analysis was guided by principals of grounded theory. A conceptual model for Evidence Informed Policy Formulation and Implementation (derived from the Frameworks of Bowen and Zwi and Dodson et al.) was experientially applied to organize the data. Results: The case study of the ‘Clean Air Policy’ of the Govt. of Punjab highlighted that the policy had been formulated in a structured manner with incorporation of relevant evidence (research and other) at all stages of policy formulation. Policy makers considered ‘evidence’ as an expansive concept not limited to research evidence. Overall, the use of evidence for policy-making and implementation is rooted in complexities inherent to the local context, policymakers understanding and organizational culture and processes. Conclusion: The study contributed to understanding the arena of Evidence Informed policy practices in Pakistan. Addressing the highlighted challenges can inform strategies for enhancing evidence use in policy processes for improving health system performance.

Health Models – Financing and Effects: a Comparative Study of the Models in Poland and Italy

The purpose of the article. The study brings a comparative analysis between health systems in Poland and Italy. It is aimed at fulfilling the subject literature using economic comparative analyses between different health systems as well as straight comparisons between Polish and Italian health systems. Moreover, another aim of the study is to find out some weak points and to point out some good practices of each of the analyzed health systems. The research question for the purpose of this study is as follows: what changes can be implemented to improve the efficiency of each of the analyzed health systems?&#x0D; Methodology. The study is carried out on the background of health systems' theory. The critical literature review is conducted. A comparative analysis using such indicators as percentage of GDP and GDP per capita spent on financing health systems, healthcare spending components, life-expectancy data or Euro Health Consumer Index indicators are applied and analysed in the study.&#x0D; Results of the research. Health systems in Poland and Italy in the latest decades were transformed in a completely different way. Healthcare in Poland is based mainly on health insurance premiums whereas in Italy financing of healthcare is based mainly on taxes. Among similarities between the systems a high level of responsibility designated to local authorities may be mentioned. The comparative analysis indicates that the situation of the Italian health system seems to be much better as compared to its Polish counterpart. Though, some solutions, aimed at improving health system efficiency, can be transferred from one system to another in case of both analyzed systems.

Assessment of a technological solution for helping elderly to monitor and mitigate frailty: case study of frAAgiLe project.

frAAgiLe is a health focused, digital based project that aims at becoming a holistic system for monitoring and dealing with the symptoms of frailty in senior users around Europe. Throughout the last 2 years, the digital solution has been tested in different healthcare and wellbeing centres in Europe. The users´feedback has been positive and the implementation of AI algorithms has become possible after the creation of the necessary databases. The algorithm allows for unification within personalisation, this is a key step in the harmonization of treatments in the European Union. Just as COVID 19 showed how there is a lack of coordination in the data collection process in the EU when it comes to health issues, frAAgiLe is showing how this can be translated to other non-COVID related health situations. In this case, frailty is monitored through a series of tests that rely on international scientific consensus and aim at creating a standard based on extensive testing. The combination and selection of weights for each of the scales within the final algorithm is a major contribution from the research teams involved. The tests have been divided in 3 sets: cognitive, nutritional and physical, each set has been given a specific weight in the formula for the final frailty score, and with each set, each test, depending on how holistic and relevant its content is, has been given a weight as well. Apart from this, an initial assessment has been created in order to harmonize the inclusion and exclusion criteria and how it is met.&#x0D; Apart from contributing to the European panorama of digital solutions, especifically for health and wellbeing, frAAgiLe also contributes to the improvement of health and health systems. By aiming at early diagnosis and prevention of frailty, the platform is fighting against a burden that represents the previous step to serious health deterioration, dependency, and sometimes, death. frAAgiLe, therefore is key as a community service designed to enable self-management, as it is a tablet-based platform that anyone can use from home, thanks to the various co-creation sessions carried out. One of its main aims is to avoid hospitalisation, and future implementation will focus on this aspect. We expect more than 500 senior users to start dealing with their frailty in the near future, through the frAAgiLe solution in combination with traditional therapy and monitoring systems. This number of users, together with the perspectives for growth, will ensure the necessary impact on the European health systems as well as, together with the activities carried out for the digital development and the improvement of the AI system, the alignment with 2 of the main pillars of integrated care.&#x0D;

Designing meaningful surveys: Engaging experts-by-lived experience in the development of a patient-reported experience measure (PREM) of integrated home and community care.

Background: People want to live well in their homes and communities for as long as possible. To support this, some home care services in Ontario, Canada are restructuring to integrate medical and personal care, with community-based social care and services (e.g., friendly visiting, meals, and transportation). Measures of client experience, referred to as ‘patient-reported experience measures’ (PREMs) are important for guiding health system improvements in a way that is meaningful to clients. A current challenge is that existing PREMS are insufficient for measuring client experience of new models of home and community care.&#x0D; Aims: This study engaged clients, family/friend caregivers, and health and social care providers in a participatory process to develop relevant items for a PREM for integrated home and community care. This engagement process aimed to provide opportunities for client feedback to support integrated care and ensure the new PREM will collect data that can inform health system improvements in ways that are most meaningful to clients and caregivers.&#x0D; Methods: Guided by Streiner et al.’s (2015) approach, we engaged experts-by-lived experience in content and face validity testing of an item pool matrix to determine relevance and coverage of domains and items. The matrix consisting of 3 domains, 14 categories, and 72 items was based on a literature review of home and community PREMs (32 PREMs with 550+ items) and interviews with healthcare leader experts (n=6). To conduct content and face validity testing we held three focus groups with home care recipients and family/friend caregivers (n=17) as well as individual interviews with health and social care providers working in home care (n=15). We analyzed transcripts line-by-line to generate themes related to face and content validity of each item. &#x0D; Results: Participants agreed that client experience of innovative home and community care is well captured by three domains: equity, continuity, and life care. They also agreed the corresponding 72 proposed items had face validity. Suggestions to improve content validity included that items be adapted to recognize the role of caregivers; the role of primary providers and/or coordinators in delivering well organized care; and shifting from a focus on self-management to having needed supports to stay in the home, and collaboratively developing care plans. Participants excluded several items due to being vague or not meaningful, such as asking, “my providers understood my needs”. Based on feedback, 22 items were removed from the matrix.&#x0D; Learnings: Engaging experts-by-lived experience in development of PREMs helps ensure the data generated from PREMs will be meaningful and useful for guiding health system improvements that matter to clients. Relying on existing literature and traditional expert opinion alone did not guarantee relevance or coverage of items. &#x0D; Next steps: The feedback from participants will be used to further refine and scale the PREM items. Clients of home care and family/friend caregivers will then be re-engaged in cognitive testing to identify issues related to answering the questions on the scale. Once complete, the PREM will undergo psychometric testing.&#x0D;

The DYNAMO Initiative – Improving health system resilience through dynamic modelling of integrated health and care pathways in response to systemic shocks

Background: Unexpected systemic shocks such as pandemics or natural disasters challenge the absorptive capacity of health and care systems to maintain adequate service levels.[1] Strategies have focused on better coordination between services, with multi-disciplinary care pathways being one instrument to achieve coordinated responses.[2] But the co-design process for this type of pathways tends to be too long and involved for fast response required by crises.&#x0D; Targeted community and stakeholder engagement: Health and care service planners and providers, service payers, public health and civil protection agencies as well as regional and municipal governments are affected by this problem. They need methods and tools to support ad-hoc design and instantiation of cross-sectoral pathways to address different types of crises. The DYNAMO initiative has brought together an initial group of stakeholders from five countries to start a multi-staged co-design programme that will also include further stakeholders.&#x0D; Explanation of the initiative: DYNAMO will develop an innovative software tool enabling stakeholders to jointly adapt existing service delivery processes to systemic shocks and structural changes. This includes sharing and integrating cross-sectoral data to accurately forecast possible outcomes and impacts of alternative pathway configurations. By means of a public tendering process, the participating care providers are developing the software package together with commercial technology providers. Up to now, local pathway modelling groups have been set up at each site. These have identified several ""high pressure"" service scenarios (e.g. future pandemics widespread internet/power outages, recurrent heat waves). For each scenario, alternative pressure points were identified that could have a notable impact on the performance of current health and care systems (e.g. resource or staff shortages). In the next project phase, several technology providers will be selected to co-develop prototype solutions that meet the requirements of the "high-pressure" service scenarios.&#x0D; Achieved and expected impacts: The definition of the high pressure scenarios and associated pressure points are a first outcome and showed that priorities for disaster readiness vary considerably between regions. With the software tools and methodologies to be developed, DYNAMO expects to significantly improve the response time and quality of health care ecosystems to a wide variety of systemic threats.&#x0D; Learnings for an international audience: DYNAMO is in its early stages and there are as yet no formalized learnings. Experiences and observations shared between projects participants however highlighted two key issues: 1) Responses to universal threats still happen in a haphazard and uncoordinated manner and awareness of the precise issue of multi-disciplinary pathways to respond to such threats is still too low. 2) While DYNAMO focusses on the development of a software tool, there is agreement among participating regions that this needs to be embedded into a regional cooperation culture and structure (a kind of “readiness community”) in order to achieve its intended impacts.&#x0D; [1] Adger WN, Brown K, Fairbrass J. et al. Governance for sustainability: towards a ‘thick’ analysis of environmental decision making. Environ Plan A. 2003;35(6):1095–1110. doi: 10.1068/A35289.&#x0D; [2] Lewis, L. and N. Ehrenberg (2020). Realising the true value of integrated care: Beyond COVID-19. https://integratedcarefoundation.org/publications/realising-the-true-value-of-integrated-care-beyond-covid-19-2#report&#x0D; &#x0D;

Putting Patient Experience Data into Action! A Workshop to Explore the Collection and Use of Patient Experience Data in Practice

Health systems globally are in pursuit of the quintuple aim – better population health, improved patient and caregiver experiences, improved clinician experiences, sustainable per capita costs1 and greater health equity. Patients and their care partners (family and friends who provide care) have unique insights on the quality of healthcare delivery, yet, few organizations are poised to meaningfully integrate these voices into care delivery transformation efforts. Patient experience (PE) data comes in many forms including (and not limited to) structured and unstructured survey data, narratives of patient and family complaints or accolades, adverse event reporting, or qualitative interviews and focus groups. These data are often temporally lagging the patient’s interaction with the health system, rarely includes the voices of equity deserving groups (i.e, individuals who have been historically marginalized and underrepresented in research) and are seldom used for improving care.&#x0D; To meet the expectations of patients and care partners, we require a comprehensive, systematic, and sustainable approach to integrating patient and care partner voices into how we reform, design and deliver care.&#x0D; Through a scoping review and stakeholder engagements we have highlighted that methods for the collection and implementation of PE data should be multidimensional and have identified four components of a PE Tool-kit (PET) to move from knowledge to action: 1) engage the community meaningfully; 2) identify and curate multiple forms of PE data; 3) aggregate and synthesize PE data; and 4) integrate PE data into quality improvement efforts.&#x0D; We are conducting this workshop to further explore domains within our proposed Patient Experience Tool-Kit that resonates with an international audience and identify gaps and implementation considerations.&#x0D; The workshop will be grounded by a brief theory burst about the challenges the PET and its components aim to address followed by interactive sessions in small groups to address the following questions:&#x0D; 1)How will the proposed components support the link between the collection and use of PE data into health system improvement efforts? What tool-kit components are missing?&#x0D; 2)What are the barriers and facilitators to implementing the PE Tool-Kit?&#x0D; Note: we will direct participants to use a sociotechnical systems approach when identifying barriers and facilitators which consists of: people, environment (macro/micro), tools (i.e., technology), and tasks (i.e., process).&#x0D; 3)What are the considerations/adaptations to consider that will support the Tool-Kit’s adoption across different sectors of the integrated care system?&#x0D; &#x0D; Introduction to Workshop/ Overview of Activities – 5 mins&#x0D; Presentation of Patient Experience Tool-Kit Components- 10 mins&#x0D; Small group discussions to address the three questions (each table to start with a different question)- 30 mins&#x0D; Large group activity to report back and synthesis small group discussion, including the l use Mentimeter to capture core insights). The facilitators will summarize key insights and highlight core themes captures in the discussion at the end of the activity – 20 minutes&#x0D; Wrap up to assess interest in developing a community of practice for continued learning and sharing- 5 mins&#x0D; &#x0D;