Health systems

1. 31st August 2007 Domains and Dimensions of Health Systems
Research
Health Systems Research:
Purpose and Scope
Stiofan de Burca
Health Systems Research Centre, UL

2. 31st August 2007 Domains and Dimensions of Health Systems
Research
Health
• Status & Needs:
– Origins, problems, environmental ecology
• Services
– Determinants and orientation
– Limitations in complexity
• For All (WHO/ Alma Ata, 1978)
– Diversity of stakeholders and inputs
– Primary health care approach …individuals & communities … at
the centre of attention
• System
– Community, Delivery System & Environment
– Compatibility of these elements?

3. 31st August 2007 Domains and Dimensions of Health Systems
Research
IDRC

4. 31st August 2007 Domains and Dimensions of Health Systems
Research
IDRC

5. 31st August 2007 Domains and Dimensions of Health Systems
Research
What focus?
• Research
– Health problems & technologies
• Services Research
– Operation & modes of delivery
– Needs, provision and performance / impact
• Systems Research
– Philosophy .. Timely, policy relevant, R&D link, collaborative,
participative
– Mode of working.. Totality explored, multidisciplinary and multi-
sectoral
– Field .. Systems, recognises and addresses complexity of issues
and interventions

6. 31st August 2007 Domains and Dimensions of Health Systems
Research
Health Systems Research
• Purpose
– Inform policy, management and professional practice to …
– Empower decision-makers to
– Improve people’s health & well-being through optimal use of resources
and opportunities to
– Enable participation & contribution … social and economic life
• Context
– Complexity of health sector issues, policies & programmes
• Orientation
– Problem-solving, action-oriented, timely and relevant
– Multi-disciplinary, participative
• Perspectives
– Levels, functions and roles that normally connect
– Multi-disciplinary and trans-disciplinary teamworking and understanding

7. 31st August 2007 Domains and Dimensions of Health Systems
Research
Consequences of Limiting Participation
• Decision-makers
–Limited to post-study .. “shelved”
• Staff / community
–Limited to data collection or response …
motivation for accuracy
• Researchers
–No role in implementation … feasibility
of Recs?

8. 31st August 2007 Domains and Dimensions of Health Systems
Research
HSyR General Topics
• Comparative performance
– Comparability of health care systems!
• Effectiveness
– Theory, measurement, evaluation and outcomes
– Clinical & population perspectives
• Efficiency
– Allocative and production
– Derived demand function for medical care
• Equity
– Sociology & behavioural model
– Substantive & procedural
– Characteristics of community variations
• Policy analysis
– Rational comprehensive
– Problem of allocative processes … cost utility
– Informed democratic decisions, veil of ignorance

9. 31st August 2007 Domains and Dimensions of Health Systems
Research
Health Systems Research Centre
• DoHC / HSE support
• Policy Advisory Group
• External Academic Advisory Group
• Management Committee
• Stakeholder Groups

10. 31st August 2007 Domains and Dimensions of Health Systems
Research
Current projects
1. Experience of ageing in the community
2. Community mental health teams:
determinants of effectiveness
3. Customised QI Frameworks for Clinical
Directorates (Pilot)

11. 31st August 2007 Domains and Dimensions of Health Systems
Research
Experience of Ageing in the Community
• Problem / policy context
– Consequences of variability in health and socio-economic status
in local neighbourhoods (Limerick cluster: 4 parishes)
• Objectives
– Understanding of causes & consequences of variation
• inform policies & practice
• improve expectancy & quality of life in reducing disparities between
local communities
– Inform & develop a forum & continuing partnership with older
people
• active citizens & consumers ..
• enabling independence & self-(health) management
– Identify areas for improvement in provision ..
• Design, delivery & coordination ..
• Changes relating to individuals, communities, services and systems

12. 31st August 2007 Domains and Dimensions of Health Systems
Research
Experience of Ageing in the Community
• Complexity
– Multiple lifetime and current variables & contexts that affect
health status in older people ..
– Result … dependency / independence status
– Levels & categories of current interventions & outcomes by
whom & for whom?
– Connecting objective & subjective health status indicators with
ecological factors!
• Team composition
– Thomond Cluster (parish & older people)
– Public and voluntary sector stakeholders (HSE, LA, PAUL, WLR)
– Research Team .. HSyRC, Sociology, Dept of Medicine for Older
People, MWRH (HSE West)

13. 31st August 2007 Domains and Dimensions of Health Systems
Research
Community Mental Health Teams:
Determinants of Effectiveness
• Problem / Policy Context
– Reported performance of multidisciplinary teams in
mental health services after more than 20 years of
change & implications for service users
• Objectives
– Profile the functioning of CMHTs & factors affecting
their performance
– Explore the determinants of and barriers to team
effectiveness
– How to improve team working?
– Translation & adoption strategies to ensure outcomes
influence practice

14. 31st August 2007 Domains and Dimensions of Health Systems
Research
Community Mental Health Teams:
Determinants of Effectiveness
• Complexity
– Context of Total System Reform & delivery of a major multi-
method study of key stakeholders (user, provider, system)
– Systemic, intrinsic and professional constraints
– Clinical teams in embedded influencing context (e.g.
externalities)
– Problem of causality & attribution in complex dynamic
environments
• Team composition
– Mental Health Directorate HSE
– HSyRC & Strategic Health Management Research Group UL
– Expert Panel incl. User Rep and Professionals
– CMHT Liaison and HSE MH Network

15. 31st August 2007 Domains and Dimensions of Health Systems
Research
Customised QI Frameworks for
Clinical Directorates
• Problem / policy context
– Reliability in the service delivery system ..
– Summative statement of performance …
– Achievement of optimal outcomes, role of clinicians in
management & clinical governance
• Objectives
– Map current policy, procedures, practices, recording
& reporting … espoused theory and theory in use, &
preferred theory
– Create an effective partnership to move to reflective
adoptive, implementing and evaluative phases

16. 31st August 2007 Domains and Dimensions of Health Systems
Research
Customised QI Frameworks for
Clinical Directorates
• Complexity
– Context of Total System Reform & adopted
embedded strategies
– Early stage development of CD and / or QI
programmes
– Concurrent developments and demands
– Prior exposure to organisational research
• Team Composition
– W&C Directorate, HR, Q&R GUH
– Liaison Group
– HSyRC, Enterprise Research Centre & Strategic
HMR Group UL