Health Systems Research: Purpose and Scope

1
Health Systems Research Purpose and Scope

• Stiofan de Burca
• Health Systems Research Centre, UL

2
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
IDRC
4
IDRC
5
What focus?

• Research
• Health problems technologies
• Services Research
• Operation modes of delivery
• Needs, provision and performance / impact
• Systems Research
• Philosophy .. Timely, policy relevant, RD link,
  collaborative, participative
• Mode of working.. Totality explored,
  multidisciplinary and multi-sectoral
• Field .. Systems, recognises and addresses
  complexity of issues and interventions

6
Health Systems Research

• Purpose
• Inform policy, management and professional
  practice to
• Empower decision-makers to
• Improve peoples 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
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
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
Health Systems Research Centre

• DoHC / HSE support
• Policy Advisory Group
• External Academic Advisory Group
• Management Committee
• Stakeholder Groups

10
Current projects

• Experience of ageing in the community
• Community mental health teams determinants of
  effectiveness
• Customised QI Frameworks for Clinical
  Directorates (Pilot)

11
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
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
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
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
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
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
• WC Directorate, HR, QR GUH
• Liaison Group
• HSyRC, Enterprise Research Centre Strategic HMR
  Group UL