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The rising of chronic illness and the continuous aging of the global population requires a re-organization of health care systems based on relations and exchange of information to address patient needs in the community. The re-organization of health care systems involves interconnected changes and the development of integrated health care information systems and novel eHealth services. In Crete, the Foundation for Research and Technology-Hellas has developed HYGEIAnet, a Regional Health Information Network (RHIN) to contribute to the re-organization of health care systems and information sharing. We present HYGEIAnet, some of the most critical and novel eHealth services developed and deployed, discuss the impact of an RHIN on health care processes, and explore innovative models and services for health delivery and the coordination of care. We then critically discuss lessons learned regarding the effective management of change to overcome organizational and cultural issues in such large-scale initiatives. The paper concludes with policy and practice recommendations for managing change processes in health care organizations.

This chapter identifies the serious issue of the mental health and wellbeing of English paramedics working in the emergency ambulance service. It identifies the case of the extant top-down performance measurement regime and the absence of indicators of wellbeing in ambulance performance reporting. The impact of such measures on frontline staff and the implications for their motivation and commitment are also documented. More decentralised, open and discursive approaches to performance management in the public sector are advocated as key methods for re-imagining ambulance and wider public services in a global context.

Drawing on relevant literature, the chapter provides the context of the English ambulance service and the challenges it faces with reference to the New Public Management (NPM) and New Public Governance (NPG). Key issues concerning performance metrics and staff wellbeing and welfare are then identified and discussed. The notions of communicative rationality, deliberative democracy and agonistic pluralism are introduced as a framework for analysing the state of both wellbeing and resilience and the performance regime within the English ambulance service. The chapter relates these themes to the re-imagining of public services internationally, proposing a more participative and discursive approach.

It is desirable for the evaluation of public services to include the wellbeing of the healthcare provider, as well as the public service recipient. Additionally, there is a case for greater participative and dialogic engagement to address the intertwined relationship of ambulance staff wellbeing and the performance management regime of the service. The process should be revised, therefore, to take into account the wellbeing of ambulance staff as an integral and intrinsic part of the delivery of the service, and it is recommended that deliberative methods of participation are deployed in reimagining ambulance services and public services more generally.

The challenges facing ambulance services and, more generally, health services globally continue to proliferate and intensify. They are exacerbated by foreseeable contextual challenges such as the demographic profile of patients and service users and budgetary cuts. Traditional and more recent NPM approaches are proving inadequate for this challenge and appear unsustainable in practice. The lack of acknowledgement of welfare indicators in the performance metrics make them unfit for purpose. Our suggested discursive approach would help to re-imagine the service by improving its sustainability and resilience in parallel with the improved wellbeing and personal resilience of the people who provide the service.

The application of forecasting to health care is not new. A frequent issue in many Inpatient Rehabilitation Facilities (IRFs) is the fluctuating and unpredictable census. With scarce resources, particularly physical therapists and occupational therapists, this unpredictability makes appropriate scheduling of these resources challenging. This research addresses the issue of patient admissions in an inpatient rehabilitation facility attached to an 861 bed level-one trauma hospital. The goal is to develop a predictive model for the IRF's Census to assist in resource planning (e.g., labor, beds, and materials).

A key challenge for cost-effective Intelligent Tutoring Systems (ITSs) is the ability to create generalizable domain, learner, and pedagogical models so they can be re-used many times over. Investment in this technology will be needed to succeed in developing ITSs for team training. The purpose of this chapter is to propose an instructional framework for guiding team ITS researchers in their development of these models for reuse. We establish a foundation for the framework with three propositions. First, we propose that understanding how teams develop is needed to establish a science-based foundation for modeling. Toward this end, we conduct a detailed exploration of the Kozlowski, Watola, Jensen, Kim, and Botero (2009) theory of team development and leadership, and describe a use case example to demonstrate how team training was developed for a specific stage in their model. Next, we propose that understanding measures of learning and performance will inform learner modeling requirements for each stage of team development. We describe measures developed for the use case and how they were used to understand teamwork skill development. We then discuss effective team training strategies and explain how they were implemented in the use case to understand their implications for pedagogical modeling. From this exploration, we describe a generic instructional framework recommending effective training strategies for each stage of team development. To inform the development of reusable models, we recommend selecting different team task domains and varying team size to begin researching commonalities and differences in the instructional framework.

Building a culture of safety in transportation is not dissimilar from building a culture of safety in health. Public health is widely known for protecting the public from diseases through milk pasteurization and chlorination of drinking water, and from injuries by implementing environmental and occupational safeguards and fostering behavioral change. Lifestyle and environmental changes that have contributed to the reductions in smoking and heart disease can also help change driving, walking and cycling behaviors, and environments. Stimulating a culture of safety on the road means providing safe and accessible transportation for all. The vision for a culture of traffic safety is to change the public’s attitude about the unacceptable toll from traffic injuries and to implement a systems approach to traffic injury prevention as a means for improving public health and public safety. Framing the motor vehicle injury problem in this way provides an opportunity for partnerships between highway safety and public health to improve the culture of safety.

Objective – The aim of the paper is to bring evidence and lessons from two low- and middle-income countries (LMIs) of the former USSR into the global debate on health financing in poor countries. In particular, we analyze the introduction of social health insurance (SHI) in Kyrgyzstan and Moldova. To some extent, the intent of SHI introduction in these countries was similar to that in LMIs elsewhere: increase prepaid revenues for health and incorporate the entire population into the new system. But the approach taken to universality was different. In particular, the SHI fund in each country was used as the key instrument in a comprehensive reform of the health financing system, with the new revenues from payroll taxation used in an explicitly complementary manner to general budget revenues. From a functional perspective, the reforms in these countries involved not only the introduction of a new source of funds, but also the centralization of pooling, a shift from input- to output-based provider payment methods, specification of a benefit package, and greater autonomy for public sector health care providers. Hence, their reforms were not simply the introduction of an SHI scheme, but rather the use of an SHI fund as an instrument to transform the entire system of health financing.

Methodology/approach – The study uses administrative and household data to demonstrate the impact of the reforms on regional inequality and household financial burden.

Findings – The approach used in these two countries led to improved equity in the geographic distribution of government health spending, improved financial protection, and reduced informal payments.

Implications for policy – The comprehensive approach taken to reform in these two countries, and particularly the redirection of general budget revenues to the new SHI funds, explain much of the success that was achieved. This experience offers potentially useful lessons for LMIs elsewhere in the world, and for shifting the global debate away from what we see as a false dichotomy between SHI and general revenue-funded systems. By demonstrating that sources are not systems, these cases illustrate how, in particular by careful design of pooling and coverage arrangements, the introduction of SHI in an LMI context can avoid the fragmentation problem often associated with this reform instrument.

Failure to rescue events, or events involving preventable deaths from complications, are a significant contributor to inpatient mortality. While many interventions have been designed and implemented over several decades, this patient safety issue remains at the forefront of concern for most hospitals. In the first part of this study, the development and implementation of one type of highly studied and widely adopted rescue intervention, algorithm-based patient assessment tools, is examined. The analysis summarizes how a lack of systems-oriented approaches in the design and implementation of these tools has resulted in suboptimal understanding of patient risk of mortality and complications and the early recognition of patient deterioration. The gaps identified impact several critical aspects of excellent patient care, including information-sharing across care settings, support for the development of shared mental models within care teams, and access to timely and accurate patient information.

This chapter describes the use of several system-oriented design and implementation activities to establish design objectives, model clinical processes and workflows, and create an extensible information system model to maximize the benefits of patient state and risk assessment tools in the inpatient setting. A prototype based on the product of the design activities is discussed along with system-level considerations for implementation. This study also demonstrates the effectiveness and impact of applying systems design principles and practices to real-world clinical applications.