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The Models of Child Health Appraised (MOCHA) project identified the different models of primary care that exist for children, examined the particular attributes that might be different from those directed at adults and considered how these models might be appraised. The project took the multiple and interrelated dimensions of primary care and simplified them into a conceptual framework for appraisal. A general description of the models in existence in all 30 countries of the EU and EEA countries, focusing on lead practitioner, financial and regulatory and service provision classifications, was created. We then used the WHO ‘building blocks’ for high-performing health systems as a starting point for identifying a good system for children. The building blocks encompass safe and good quality services from an educated and empowered workforce, providing good data systems, access to all necessary medical products, prevention and treatments, and a service that is adequately financed and well led. An extensive search of the literature failed to identify a suitable appraisal framework for MOCHA, because none of the frameworks focused on child primary care in its own right. This led the research team to devise an alternative conceptualisation, at the heart of which is the core theme of child centricity and ecology, and the need to focus on delivery to the child through the life course. The MOCHA model also focuses on the primary care team and the societal and environmental context of the primary care system.

This paper offers an overview of the defining traits of the Spanish National Health Service (Sistema Nacional de Salud, in Spanish), as well as an account of its current trends in both spending and organisational changes. Beyond a thorough description of the Spanish public health-care system and its main quantitative indicators, we offer a critical review of the ongoing decentralisation process of health-care provision and its recent trends in pharmaceutical spending.

The text is organised in the following two parts. Part 1 provides an overview of the Spanish health-care system, structured in several sections. It starts by placing Spain within a classification of international health-care systems and is followed by an account of the importance of public provision in the Spanish case. A relation of the guiding principles of the Spanish public system concludes the first part. The second part focuses on two key developments that have shaped the evolution of the Spanish health-care system in the recent decades. The first is the process of decentralisation of health-care; the section explains the challenges arising with the transference of health-care provision responsibilities from the central to regional governments. The second section critically reviews the recent expansion of drug-related spending in the Spanish health-care system, and the policy responses to attempt to contain health-care costs.

Purpose – This chapter argues that the concept of agility is an effective robust framework for designing sustainable health care systems.

Design/methodology/approach – This case study of Alegent Health was based on 7 years of data collection. It includes observations of meetings, large-group interventions, and other activities; site visits to different hospitals in the system to observe changes in practice; interviews with Alegent Health executives, primary care physicians, hospital presidents, specialist physicians and physician groups, and health systems staff and nurses; and a variety of archival data including meeting minutes, video tapes, conference proceedings, and web site material.

Findings – The Alegent Health system has evolved over time according to the principles of agility. It built a series of new capabilities that contribute to improved clinical outcomes, sustained financial results, and more socially and ecologically responsible results. Designing health care systems based on agility is a more effective and sustainable approach than relying on legislative or other criteria.

Originality/value – The discussion of sustainability in health care has focused primarily on specific projects or how to respond to specific technological, regulatory, or clinical changes. Alegent Health's experience provides important lessons, opportunities, and challenges that can help advance our understanding of effective health care and use organizational agility to create more sustainable health care systems. This chapter provides health care system administrators an alternative design option.

Sociology promotes and describes public health, helping to explain macro-social dynamics of mental health care through studies of organizations, networks, and systems of care.

This chapter summarizes sociological research on mental health care organizations and systems, illustrating a macro-social perspective by examining the problem of transitions in care for young adults. Summary findings from a regional mental health services research project describe a system of care that includes 100 organizations. This system helps young adults with mental health needs.

The scope and management of care involves a focus on modes of treatment supported by research evidence and delivered effectively by people with cultural competencies. Care and continuity of care are delivered through coordinated systems of inter-organizational networks, linking organizations and providers. Active inter-organizational linkages are needed to support mental health for young adults during challenging and sometimes difficult transitions.

This research summarizes original and regional data on mental health care organizations within a regional system of care. Practical implications include support for the importance of coordination, transition planning, and cultural competence within and among organizations. Sociological and original research on organizations and systems should continue to elaborate the needs and values of mental health services for regional planning and public health.

The Institute of Medicine (IOM) views Health Information Technology (HIT) as an essential organizational prerequisite for the delivery of safe, reliable, and cost-effective health services. However, HIT presents the proverbial double-edged sword in generating solutions to improve system performance while facilitating the genesis of novel iatrogenic problems. Incongruent organizational processes give rise to technological iatrogenesis or the unintended consequences to system integrity and the resulting organizational outcomes potentiated by incongruent organizational–technological interfaces. HIT is a disruptive innovation for health services organizations but remains an overlooked organizational development (OD) concern.

Recognizing the technology–organizational misalignments that result from HIT adoption is important for leaders seeking to eliminate sources of system instability. The Health Information Technology Iatrogenesis Model (HITIM) provides leaders with a conceptual framework from which to consider HIT as an instrument for organizational development. Complexity and Diffusion of Innovation theories support the framework that suggests each HIT adoption functions as a technological change agent. As such, leaders need to provide operational oversight to managers undertaking system change via HIT implementation. Traditional risk management tools, such as Failure Mode Effect Analysis and Root Cause Analysis, provide proactive pre- and post-implementation appraisals to verify system stability and to enhance system reliability. Reconsidering the use of these tools within the context of a new framework offers leaders guidance when adopting HIT to achieve performance improvement and better outcomes.

The devastating 2014 Ebola outbreak caused human and economic loss, but it also resulted in remarkable improvement in healthcare leadership. The impact is most evident in the affected West African countries of Guinea, Liberia and Sierra Leone. In this chapter, the Ebola experience is used as a framework to explore the essential elements of healthcare leadership, with particular attention to healthcare crises in under-resourced communities. Overall, healthcare leadership presents unique challenges. In common with leaders of other industries, healthcare leaders must inspire others, create a sense of purpose, make difficult decisions and collaborate with a range of people. But, because their focus is on complex systems that aim to improve people's physical and mental well-being, expectations of healthcare leaders are especially high. Their work can be a matter of life or death. For the leader in an under-resourced area, the challenge and expectations are even higher, particularly in the face of new or emerging health threats. The key to effective healthcare leadership is systems thinking which involves looking at the entire system of care as an integrated whole, rather than discrete parts that operate in isolation. Healthcare leaders must understand that health means mobilizing multisectoral knowledge and resources and applying innovative and multiactor approaches to prevent, detect and address health problems. Since the 2014 Ebola crisis, healthcare leaders are increasingly using a systems approach by looking at the culture of health systems, the impact of diseases locally and globally, and the applicability of health interventions in different environments. In the post-Ebola era, steps to strengthen the healthcare system are described which includes the roles of healthcare leaders. These steps include deployment of field epidemiologists and community health agents, community education and fuller use of the One Health Platform, which allows actors from different sectors (human health, animal health and environmental health) to collaborate. Finally, suggestions for healthcare leadership training are offered.

Food system channels are proposed to be major components of the larger food system which influence health and illness.

Food system channels are defined, discussed in relationship to other food system components, considered in terms of historical food system changes, examined in relationship to wellbeing and disease, and proposed to have useful applications.

Food system channels are broad, organized, and integrated pathways through which foods and nutrients pass. Channels are larger in scale and scope than previously described food system structures like chains, stages, sectors, networks, and others. Four major types of contemporary Western food system channels differ in their underlying values and health impacts. (1) Industrialized food channels are based on profit as an economic value, which contributes to a diversity of inexpensive foods and chronic diseases. (2) Emergency food channels are based on altruism as a moral value, and try to overcome gaps in industrialized channels to prevent diseases of poverty. (3) Alternative food channels are based on justice and environmentalism as ethical values, and seek to promote wellness and sustainability. (4) Subsistence food channels are based on self-sufficiency as a traditional value, and seek self-reliance to avoid hunger and illness. Historical socioeconomic development of agricultural and industrial transitions led to shifts in food system channels that shaped dietary, nutritional, epidemiological, and mortality transitions.

Food system channels provide varying amounts of calories and types of nutrients that shape wellbeing and diseases. Sociologists and others may benefit from examining food system channels and considering their role in health and illness.

This chapter provides an assessment of the sustainability of Ireland's health care system. It starts by describing the historical development of the Irish system and identifying key features of the current system that raise potential challenges for sustainability. It then provides an analysis of recently compiled and up-to-date data on trends in health care expenditures. A number of specific demand and supply side challenges to sustainability are then described and discussed. This is followed by an examination of recent and current reforms to the health care system, focussing on their likely impact on sustainability, as well as a discussion of how health economics has and can inform policy, practice and debate. We also discuss the potential implications of the COVID-19 pandemic for the Irish system.

Over the last decades, the Czech health care system has undergone significant reforms. Regardless of its good performances in terms of health care spending and improved population's health, the sustainability and functionality of the Czech system still faces important challenges. It is particularly vulnerable to economic shocks and an ageing society; it suffers from inefficiencies in hospital management and experiences profound changes in the health workforce. To tackle these problems, policy makers have been working to reform the system, but these challenges have not yet been overcome. The present chapter provides an overview of selected reforms and their outcomes. First, we describe the main features of the health care system in the Czech Republic. Then, we discuss its main sustainability problems and the policy interventions that have been implemented to tackle these problems with a particular focus on evidence provided by the health economics literature on the actual effects of the reforms.