Health Systems Research: Purpose and Scope

Stiofan de Burca

Health Systems Research Centre, UL

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?

IDRC

IDRC

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

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

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?

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

Health Systems Research Centre

• DoHC / HSE support

• Policy Advisory Group

• External Academic Advisory Group

• Management Committee

• Stakeholder Groups

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)

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

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)

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

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

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

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