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Health Systems Research: Purpose and Scope

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)

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Health Systems Research: Purpose and Scope

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

  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? Domains and Dimensions of Health Systems Research

  3. IDRC Domains and Dimensions of Health Systems Research

  4. IDRC Domains and Dimensions of Health Systems Research

  5. 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 Domains and Dimensions of Health Systems Research

  6. 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 Domains and Dimensions of Health Systems Research

  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? Domains and Dimensions of Health Systems Research

  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 Domains and Dimensions of Health Systems Research

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

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

  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 Domains and Dimensions of Health Systems Research

  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) Domains and Dimensions of Health Systems Research

  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 Domains and Dimensions of Health Systems Research

  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 Domains and Dimensions of Health Systems Research

  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 Domains and Dimensions of Health Systems Research

  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 • W&C Directorate, HR, Q&R GUH • Liaison Group • HSyRC, Enterprise Research Centre & Strategic HMR Group UL Domains and Dimensions of Health Systems Research

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