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The purpose of this paper is to examine the governing boards responsible for health care in Nova Scotia to determine the extent to which they facilitate and/or impede efforts to attend to the health needs of African Canadians.

A case study method was employed. Qualitative interview and documentary data were interpreted by means of a hybrid of methods including discourse analysis, thematic analysis, reflexive ethnography and ethnography.

Key findings from this study suggest that the complex mandate of DHAs, a lack of processes to assess need and limited data (including a lack of research) to support decision‐making contribute to a limited understanding of the health needs of African Canadians among DHA board members and executive management. Policy options include improving access to, and development of, culturally competent health services, conducting research and improving access to data to facilitate decision‐making, and educating board members and executive management about black culture. DHAs need to explore new and innovative ways to engage and include the black community in decision‐making.

Continued public and political emphasis on the maintenance of the acute care system, limited resources devoted to “population health” and internal and external constraints that serve to limit the capacity for health boards to make independent decisions pose significant challenges for DHAs as they seek to fulfill their legislated mandate to improve the health of their catchment population. Policy options are presented to address issues such as research and information management, education and awareness, representation and building meaningful opportunities for inclusion.

There is a dearth of literature examining the roles and responsibilities of governing boards in attending to the health needs of minority populations.

Purpose – Health system performance depends on production and use of quality health data and information. Routine health information systems (RHIS) are defined as systems that provide information at regular intervals of a year or less to meet predictable information needs. These include paper-based or electronic health records and facility- and district-level management information systems. RHIS are receiving increasing attention as an essential component of efficient, country-owned, integrated national systems. To guide investment decisions on RHIS, evidence is needed on which types of RHIS interventions work and which do not.

Design/methodology/approach – This chapter is a systematic review of the literature on the evaluation of RHIS interventions in low- and middle-income countries, starting from the premise that investments in RHIS could be better understood and so produce greater benefits than they currently do.

Findings – We describe the conceptual literature on the determinants of RHIS performance and its role in improving health systems functioning, discuss the evidence base on the effectiveness of strategies to improve RHIS performance, provide an overview of RHIS evaluation challenges, and make suggestions to improve the evidence base.

Originality/value – The goal is to help ensure that (a) RHIS interventions are appropriately designed and implemented to improve health systems functioning and (b) resulting RHIS information is used more effectively.

When introducing new health technologies, decision makers must integrate research evidence with local operational management information to guide decisions about whether and under what conditions the technology will be used. Multi‐criteria decision analysis can support the adoption or prioritization of health interventions by using criteria to explicitly articulate the health organization's needs, limitations, and values in addition to evaluating evidence for safety and effectiveness. This paper seeks to describe the development of a framework to create agreed‐upon criteria and decision tools to enhance a pre‐existing local health technology assessment (HTA) decision support program.

The authors compiled a list of published criteria from the literature, consulted with experts to refine the criteria list, and used a modified Delphi process with a group of key stakeholders to review, modify, and validate each criterion. In a workshop setting, the criteria were used to create decision tools.

A set of user‐validated criteria for new health technology evaluation and adoption was developed and integrated into the local HTA decision support program. Technology evaluation and decision guideline tools were created using these criteria to ensure that the decision process is systematic, consistent, and transparent.

This framework can be used by others to develop decision‐making criteria and tools to enhance similar technology adoption programs.

The development of clear, user‐validated criteria for evaluating new technologies adds a critical element to improve decision‐making on technology adoption, and the decision tools ensure consistency, transparency, and real‐world relevance.

The purpose of this paper is to describe how clinical registers were designed and used to serve multiple purposes in three health systems, in order to contribute practical experience for building learning healthcare systems.

Case description and comparison of the development and use of clinical registries, drawing on participants’ experience and published and unpublished research.

Clinical registers and new software systems enable fact-based decisions by patients, clinicians, and managers about better care, as well as new and more economical research. Designing systems to present the data for users’ daily work appears to be the key to effective use of the potential afforded by digital data.

The case descriptions draw on the experience of the authors who were involved in the development of the registers, as well as on published and unpublished research. There is limited data about outcomes for patients or cost-effectiveness.

The cases show the significant investments which are needed to make effective use of clinical register data. There are limited skills to design and apply the digital systems to make the best use of the systems and to reduce their disadvantages. More use can be made of digital data for quality improvement, patient empowerment and support, and for research.

Patients can use their data combined with other data to self-manage their chronic conditions. There are challenges in designing and using systems so that those with lower health and computer literacy and incomes also benefit from these systems, otherwise the digital revolution may increase health inequalities.

The paper shows three real examples of clinical registers which have been developed as part of their host health systems’ strategies to develop learning healthcare systems. The paper gives a simple non-technical introduction and overview for clinicians, managers, policy-advisors and improvers of what is possible and the challenges, and highlights the need to shape the design and implementation of digital infrastructures in healthcare services to serve users.

The United States devotes a larger share of its GDP to health care and spends more on health care per capita than any other country. The sheer size of the total spending on health care, at approximately $3.5 trillion in 2017, puts significant pressure on all payers and crowds out other forms of public and private spending.

In this brief commentary the authors suggest that, as part of the effort to deal with this pressure, the United States should look at borrowing a cost containment strategy from other countries: the use of hard caps on spending growth. The authors draw on our their experience of working with decision-makers over the last 20 years on the topic of priority setting to put forward some ideas on whether there is potential for application of trade-offs in the United States.

As hard caps force choices to be made, a necessary condition for successful implementation of this policy is the presence of an effective priority-setting framework to ensure that the right choices are made in operationalizing spending limitations. Work on this topic elsewhere can provide some insight into the use of a criteria-based framework for priority setting that purports transparency in decision-making to achieve value-based decisions.

Other countries still have much work to do, but there is a substantial track record of using formal priority-setting approaches that could potentially inform practice in the United States. We suggest that there are key segments of the US healthcare system where the adoption of formal priority-setting frameworks to guide trade-off decisions is feasible. Piloting such activity in these contexts is the next natural step in this line of inquiry.

One of the major issues faced by academic health science centers (AHSCs) is the need for mechanisms to foster the integration of research, clinical, and educational activities to achieve the vision of evidence-informed decision making (EIDM) and optimal client care. The paper aims to discuss this issue.

This paper synthesizes literature on organizational learning and collaboration, evidence-informed organizational decision making, and learning-based organizations to derive insights concerning the nature of effective workplace learning in AHSCs.

An evidence-informed model of collaborative workplace learning is proposed to aid the alignment of research, clinical, and educational functions in AHSCs. The model articulates relationships among AHSC academic functions and sub-functions, cross-functional activities, and collaborative learning processes, emphasizing the importance of cross-functional activities in enhancing collaborative learning processes and optimizing EIDM and client care. Cross-functional activities involving clinicians, researchers, and educators are hypothesized to be a primary vehicle for integration, supported by a learning-oriented workplace culture. These activities are distinct from interprofessional teams, which are clinical in nature. Four collaborative learning processes are specified that are enhanced in cross-functional activities or teamwork: co-constructing meaning, co-learning, co-producing knowledge, and co-using knowledge.

The model provides an aspirational vision and insight into the importance of cross-functional activities in enhancing workplace learning. The paper discusses the conceptual and empirical basis to the model, its contributions and limitations, and implications for AHSCs.

The model’s potential utility for health care is discussed, with implications for organizational culture and the promotion of cross-functional activities.

The purpose of this paper is to recognize the vital reasons for including public and patient voices in health policy decision-making, but illustrates the challenge it creates for decision-makers who must consider whether those voices represent patient interests or corporate interests.

This paper takes the form of a narrative review.

The history of flibanserin, a controversial new drug to treat a debatable condition, illustrates how a public relations campaign could circumvent the well-established process to weigh evidence of potential harm vs benefit by one of the most robust drug regulators in the world.

It is both vital to recognize a fundamental problem that exists when corporate interests deceptively assume the mantle of “the patient voice” and then act to reduce that influence while supporting and building capacity in genuinely independent, consumer-focused activities.

This paper suggests that organizations interested in consumer protection and the safe and cost-effective use of health resources create policies and procedures that can foster genuine consumer involvement while recognizing the danger to patient safety and consumer interests when consumer involvement is hijacked by vested interests.

The purpose of this paper is to better understand facilitators’ perceived role and influence on a policy dialogue’s (PD) process and impact. PDs enable interactions between policy makers, researchers and other stakeholders – one of the factors associated with promoting evidence-informed policy making.

This is an exploratory study based on semi-structured interviews with ten key informants from sub-Saharan Africa, the Middle East, North and South America. Participants were purposefully sampled based on their experience in facilitating or observing PDs organized by the WHO’s Evidence-informed Policy Network. Data were analyzed using a constant comparative method.

A successful PD relies on a structured process used to catalyze impact. Facilitators contribute to a successful PD through their facilitation skills, for example, helping to get to an informed judgment; knowledge, for example, about the health system; attitudes, for example, valuing the PD process over its outcomes; and personal attributes, for example, credibility. Facilitators’ involvement in preparatory and follow-up actions are equally paramount for a PD’s success. Challenges in implementing PDs can be prevented/attenuated, for example, through stakeholder analysis to identify suitable PD participants, and anticipate power constellations or potential conflicts.

Research should focus on the overall process of a PD – especially on preparation and follow-up activities and their influence on a PD’s success.

Informed by harnessing practical experiences, this paper outlines facilitators’ skills, attributes, attitudes, knowledge and how these can be used to influence a PD’s success.

The purpose of this paper is to examine how knowledge exchange between academics and clinicians in Collaborations for Leadership in Applied Health Research and Care (CLAHRCs) is influenced by their social position based on their symbolic and social capitals, that is, their personal professional status and connections to high-status professional peers, knowledge brokers, and unfamiliar professional peers.

Using an online survey, the author triangulates the cross-sectional measurement of the effects of academic and clinicians’ social position in the initial and later phases of CLAHRCs with the longitudinal measurement of these effects over a two-year period.

First, academics and clinicians with a higher personal professional status are more likely to develop joint networks and decision making both in the early and later phases of a CLAHRC. Second, academics and clinicians who are more connected to higher status occupational peers are more likely to develop joint networks in the early phase of a knowledge exchange partnership but are less likely to become engaged in joint networks over time. Third, involvement of knowledge brokers in the networks of academics and clinicians is likely to facilitate their inter-professional networking only in the later partnership phase.

Academics and clinicians’ capitals have a distinctive influence on knowledge exchange in the early and later phases of CLAHRCs and on a change in knowledge exchange over a two-year period.

Prior research on CLAHRCs has examined how knowledge exchange between academics and clinicians can be encouraged by the creation of shared governance mechanisms. The author advances this research by highlighting the role of their social position in facilitating knowledge exchange.