Health Research Policy and Systems最新文献

Background: Shared decision-making (SDM) is widely endorsed in international guidelines for the treatment of valvular heart disease (VHD). Despite evidence that the process improves outcomes and does not increase the burden of consultations, SDM has not been adopted as a standard of care across regions and diverse health systems.

Methods: We conducted a 3-phase study co-led by clinicians and people with lived experience using an integrated knowledge translation approach guided by the knowledge-to-action framework. In a preparatory phase, we conducted exploratory semi-structured interviews with 19 international and diverse experts to identify barriers and enablers to SDM in VHD; we used thematic analysis to identify the major issues to inform project development. We convened an in-person meeting of patients and patient advocates (n = 9), clinicians (n = 11) and researchers (n = 3) from 10 countries to build joint recommendations. Lastly, we conducted a series of local and international meetings to validate the findings and inform future initiatives.

Results: Challenges identified included (1) concerns about clinicians' availability and time requirements, (2) uncertainty about how to practice SDM and (3) absence of regional data to evaluate SDM in VHD. The joint recommendations clustered on five global areas of focus and six sets of recommendations tailored to regional contexts and cultural norms. Final recommendations on (1) preparing patients and carers, (2) training healthcare teams and (3) creating a supportive system were further enhanced by VHD knowledge users' input in various regional settings.

Conclusions: This first report co-led by diverse stakeholders offers a practice and policy-ready roadmap to strengthen the implementation and evaluation of SDM in VHD.

Background: There is a need to critically examine both how research infrastructures interact with the populations they serve and the perceived effects of these interactions. This paper reports on a contribution analysis-informed study of a research infrastructure and its place-based approach to working with local communities - the National Institute for Health and Care Research Applied Research Collaboration East of England (NIHR ARC EoE). The aims were (1) to understand the perceived impact of the NIHR ARC EoE place-based approach and (2) to explore its processes and challenges.

Methods: From April-June 2023, we interviewed 11 research staff from the infrastructure (NIHR ARC EoE) and nine community-based partners who had worked with NIHR ARC EoE since 2019. The interviews explored experiences of developing research partnerships, learnings, outcomes and challenges. The interviews were audio-recorded, transcribed and subject to a thematic analysis. The findings were subsequently mapped onto a Research Contributions Framework.

Results: The place-based approach was characterized as relationships-driven and community-focused in building research infrastructure, which improved motivation and commitment to local involvement in research. Three perceived impacts were highlighted: working with underserved communities, cross-sector relationship development and building skills and research capacity. Key barriers included differing expectations of research timescales, a fear of problematizing communities, and intensive resource requirements for developing foundational level relationships.

Conclusions: The place-based approach enabled opportunities to work with (rather than do to) communities previously underserved by research and where the development of trusting relationships was key. However, strategic efforts to dismantle bureaucratic barriers must be developed to maximize reach and potential. The findings present an effective approach to understanding the impact of a place-based approach to working with communities. The value of a place-based approach is widely applicable to any research infrastructure aiming to collaborate, involve and engage communities in research.

Objective: This study investigates operational efficiency in public general hospitals using a system dynamics (SD) model, focusing on resource allocation, patient flow and policy interventions. It explores the interactions between human resources, financial subsidies and patient visitation rates and their impact on hospital performance.

Methods: An SD model was developed to simulate various scenarios, incorporating data on hospital capacity, staffing and financial inputs, along with patient flow dynamics. Key performance metrics, including bed occupancy rate (BOR), average length of stay (ALOS), average cost per visit and workload index, were analysed under different policy scenarios.

Results: Simulation of four policy scenarios revealed that increased fiscal subsidies (scenario 2) consistently improved operational efficiency by reducing ALOS, staff workload and cost per visit. In contrast, scenarios involving human resource cuts or rapid patient growth triggered adverse feedback loops that undermined performance.

Conclusions: The SD model effectively captures the dynamic interactions within hospital operations and enables assessment of policy interventions over time. Enhanced government funding contributes most positively to efficiency, while demand surges and resource reductions introduce system strain and performance trade-offs.

Background: Health systems worldwide are increasingly influenced by rapid and complex changes across various domains. Anticipating and responding to these changes is critical to ensuring the sustainability and effectiveness of health systems. Future-oriented research plays a key role in informing policy and planning, especially in the face of emerging global health challenges. This study aimed to identify and synthesize the emerging trends and mega-trends shaping the future of health system research across different contexts and countries.

Methods: A scoping review was conducted in 2024 following the Joanna Briggs Institute (JBI) methodology. Systematic searches were performed in three major databases - PubMed, Web of Science and Scopus - up to 8 November 2024. Inclusion criteria focussed on English-language articles that addressed future trends or priorities in health systems research. Data were analysed qualitatively and categorized using the Social, Technological, Economic, Environmental, Political, and Values (Legal) (STEEPV) framework .

Results: From 5414 initially retrieved records and after 3 phases of screening, 22 studies met the eligibility criteria. The analysis revealed six major categories influencing future health systems research: sociocultural, technological, economic, environmental, political and values (legal) factors. Sociocultural and economic dimensions were the most frequently cited drivers. Key issues identified included ageing populations, technological innovations (e.g. artificial intelligence (AI), telemedicine), climate change, rising healthcare costs, political decision-making and legal-regulatory frameworks.

Conclusions: The future of health systems research is multifaceted and shaped by intersecting global trends. Understanding these dimensions can guide policymakers and researchers in setting priorities, designing adaptive strategies and enhancing the resilience and responsiveness of health systems. Comprehensive and coordinated planning at the macro level is essential for addressing upcoming challenges and optimizing health outcomes.

Background: This study aimed to evaluate a participatory system dynamics group model building (GMB) process for local obesity prevention and policy.

Methods: GMB workshops with n = 9 to n = 31 participants were held with local stakeholders involved in child health in a community setting in Amsterdam, the Netherlands. The traditional number of two GMB workshops was expanded to a total of five workshops to facilitate the process of system understanding (workshop 1 and 2) and leverage point and action development (workshops 3-5). Also, four thematic sub-groups were installed to work on systems change. We triangulated different data sources to evaluate the outcomes, including stakeholder interviews at two time points.

Results: The GMB workshops resulted in a casual loop diagram (CLD) with 30 mechanisms explaining the obesity problem, five potential leverage points for change and 16 action ideas; which were subsequently classified using the intervention level framework. Action ideas targeted system elements (n = 3); feedback and delay (n = 4); structure (n = 8); and goals (n = 1). Interviews revealed the challenge in pushing beyond superficial solutions and instead developing initiatives that can achieve fundamental changes in the underlying system dynamics.

Conclusions: Our study is one of the first providing insight into how system understanding can be translated into actionable leverage points and action ideas targeting different system levels. Achieving tangible systems change at system goals or paradigm level requires substantial stakeholder involvement and a dedicated process.

Background: Clinical practice guidelines (CPGs) are essential for enhancing healthcare quality and informing evidence-based clinical practices. Despite the availability of strategies, their implementation remains challenging due to the complexities of managing translation CPGs into practice, such as barriers to change, resource limitations and high costs. This study examines management mechanisms that offer valuable insights into how healthcare organizations can manage CPG implementation at the organizational level to optimise high-quality care.

Methods: This qualitative study examines the management of CPG implementation using interview data (n = 33) from healthcare managers and clinicians in Finnish public primary care. The data were collected through seven focus group interviews across nine public primary care organizations. The interview transcripts were analysed using thematic analysis with a multidisciplinary approach.

Results: CPGs are considered important tools for improving care quality and promoting shared evidence-based practices. The obstacles to managing implementation included dissemination difficulties, motivation challenges and information overload. Managers and clinicians had contrary views on their roles and responsibilities in CPG implementation. To lead the knowledge translation processes, managers emphasised unit managers' support, dissemination and communication channels, whereas clinicians viewed CPG implementation as a grassroots effort and the responsibility of each individual. The results illustrate the need for enhancing shared views on CPGs and managing social implementation activities within organizations.

Conclusions: Successful CPG implementation requires active managerial efforts and clinician dialogue to transform new evidence into locally viable practices. To inform more effective knowledge translation, the five identified management mechanisms included instructions; accountability structures; motivation, goal setting and feedback; communication strategies and participatory practices. In managing CPG implementation, a focus on interaction processes, motivation and feedback is essential for ensuring collective knowledge formation. This study improves the understanding of critical organizational knowledge translation processes by drawing attention to the previously underrepresented managerial aspects in CPG implementation studies. Future researchers, guideline developers, and policymakers should integrate managerial activities and clinician engagement in CPG implementation to ensure effective practices and healthcare quality.

Background: The ongoing impacts of the COVID-19 pandemic on Canada's healthcare workforce and service delivery necessitate focused health system planning and delivery that prioritizes coordination, collaboration, and evidence-based strategies. A rapid evidence synthesis was commissioned by Health Canada to determine the impacts of the pandemic on the healthcare workforce and to identify promising strategies and innovations that mitigate these challenges.

Methods: Two, sequential rapid evidence syntheses were conducted between October 2022 and March 2023 using methodologies aligned with Preferred Reporting Items for Systematic reviews and Meta-Analyses literature search extension (PRISMA-S) guidelines. The first review (October-November 2022) focused on the impacts of COVID-19 on Canadian healthcare workers and mitigation strategies, while the second (November 2022-March 2023) broadened the scope to international interventions. Findings were organized by impact level (individual, organizational, system). Quality assessment of sources was not performed.

Results: We included 176 and 31 sources, respectively in the analysis. Sources identifying impacts of the COVID-19 pandemic described significant mental health impacts on healthcare workers, alongside changes in demand and supply of services, physical health challenges, and shifts in scopes of practice or care models. Interventions were primarily targeted at the individual or organizational level and included mental health support, training and upskilling, enhanced organizational communication and workforce planning initiatives. System-level interventions were less common, and most interventions lacked robust evaluation or evidence-informed design.

Conclusions: This review highlights a significant gap in literature regarding evaluated interventions to address healthcare workforce challenges during the pandemic. While numerous sources document the adverse impacts on healthcare workers, detailed reports on specific interventions are scarce. Most interventions focus on workforce planning, education, practice scopes, recruitment and technology integration. The research underscores the need for comprehensive recommendations addressing social and mental health support, workplace safety, organizational communication and pandemic preparedness. These recommendations are vital for developing future workforce strategies, thus enabling policymakers and healthcare leaders to effectively respond to current and future healthcare challenges. This strategic approach will enhance system resilience and improve healthcare delivery across Canada.

Aim: We sought to distinguish, clarify and define the development process, concepts, attributes, types, prerequisites and consequences of organizational resilience, ultimately with the aim of improving relevant nursing strategies.

Design: Rodgers and Knafl's evolutionary concept was applied to the concept analysis.

Methods: Five databases (MEDLINE, CINAHL, Web of Science, PubMed and Embase) were searched from 1973 to 2023 to identify relevant sources. Thematic analysis was used to form the conceptual connotation of organizational resilience.

Results: A total of 45 articles were included for synthesis. Alternative and related terms (mentioned in the literature) that share attributes with organizational resilience include crisis management and change management. Six antecedents of organizational resilience were identified: Resource, Communication, Social Networks, Infrastructure, Organizational Structure and People. Nine attributes of organizational resilience include: robustness, redundancy, rapidity, resourcefulness, diversity, adaption, self-regulation, flexibility and recoverability. Consequences of organizational resilience were separated into three themes: organization, employee and customer.

Conclusions: Organizational resilience delineates a coherent set of antecedents, attributes and consequences that can guide healthcare systems in calibrating their structures, processes and resources to context-specific demands. By internationalizing these qualities, organizations can systematically pursue resilience objectives, thereby sustaining adaptive capacity under conditions of stress and change. Our conceptual analysis of organizational resilience gives a complete comprehension of this phenomenon and a rationale for instrument development, future research and intervention.

Impact: This study defines the concept, antecedents, attributes and consequences of organizational resilience. By strengthening these elements, organizations can enhance their adaptability and long-term sustainability. The findings offer evidence-based guidance that healthcare organizations can apply to build resilience and effectively respond to future challenges.

Background: Recognizing the complexity of cross-sector collaboration, holistic and innovative approaches are required to achieve birth equity. This project applied systems thinking and the Remove, Repair, Remediate, Restructure, and Provide (R4P) framework to understand and address systemic barriers to birth equity. This paper describes the systems thinking activities used to identify system actors and critical actions they can take to advance birth equity.

Methods: We applied systems thinking tools through the R4P lens in a series of collaborative and iterative activities. We conducted an environmental scan and synthesis of reports with recommendations to improve birth equity. In addition, we engaged a diverse group of birth equity actors, including those from federal agencies, state and local health departments, community-based organizations, funders, academic institutions, health systems and national nonprofits, through systems mapping workshops to co-create a series of birth equity tools.

Results: Our collaborative efforts produced an innovative Birth Equity Ecosystem Map, Birth Equity Iceberg, and interactive Birth Equity Action Map. The Birth Equity Ecosystem Map is a comprehensive synthesis of recommendations defining an equitable ecosystem, while the Birth Equity Iceberg summarizes insights on systemic barriers to achieving birth equity most critical to address in the next 5 years. The Birth Equity Action Map is an interactive and strategic tool, synthesized from diverse system actors' experiences and perspectives, that describes needed actions and responsible actors for each systemic barrier identified. We probed for and organized actions by the five dimensions of the R4P framework to encourage comprehensive action to achieve equity. The Birth Equity Action Map and connected resources developed through this project help actors identify actions they can work on to overcome identified systemic barriers to birth equity in their community and key partners for each.

Conclusions: The tools we developed demonstrate how systems thinking and R4P can offer a more holistic and effective approach to tackling issues of birth equity and lead to more actionable insights, thereby contributing significantly to the public health goal of achieving equity. These tools can be used by birth equity advocates to assess and leverage their strengths, resources and unique context to identify priorities and collectively advance birth equity.

Background: Approaches from systems science are increasingly being trialed in public health because the drivers of poor health are complex, unpredictable and difficult to disentangle. While a broad range of methods is available to study systems science, one method alone is often insufficient for evaluation, as each offer only a limited perspective. Yet, few examples exist showing how several methods can be pragmatically integrated to generate new and meaningful insights, which is vital within systems changes. This paper describes, exemplifies and discusses the Integrated Methods for Public Health action Tracking (IMPAcT) process, which integrates group model building, Causal Loop Diagramming (CLD), the Action Scales Model (ASM), an Action Registry (AR) and Ripple Effects Mapping (REM), to better understand and address complexity within public health interventions.

Methods: We used common approaches for understanding system organization and interconnections (e.g. through CLD), identifying places to intervene in the system (e.g. ASM), tracking actions implemented within the system (e.g. REM) and understanding the impact at individual level of actions. We illustrate how the IMPAcT process can be applied via a case from a Danish project, the Healthy Active Children Study.

Results: We present a development process, that combines the above-mentioned approaches, to capture the behaviour, and allow tracking and evaluation of a system following several intervention efforts. Integrating complementary, participatory methods enabled a formative evaluation process that supported continuous learning, adaptation and improvement across complex systems. In the IMPAcT process, methods served both as evaluation tools and as means of stakeholder engagement and knowledge co-production. Embedding reflection and dialogue allowed stakeholders to examine practice and shape next steps. Visuals and narratives enhanced the clarity and impact of the evaluation.

Conclusions: The new process supports both those working at the front-line of systems change efforts, but also researchers, municipality staff and none the least, policymakers.