31 st August 2007 Domains and Dimensions of Health Systems Research Health Systems Research: Purpose and Scope Stiofan de Burca Health Systems Research Centre, UL

31 st August 2007 Domains and Dimensions of Health Systems Research 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?

31 st August 2007 Domains and Dimensions of Health Systems Research IDRC

31 st August 2007 Domains and Dimensions of Health Systems Research IDRC

31 st August 2007 Domains and Dimensions of Health Systems Research 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

31 st August 2007 Domains and Dimensions of Health Systems Research 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

31 st August 2007 Domains and Dimensions of Health Systems Research 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?

31 st August 2007 Domains and Dimensions of Health Systems Research 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

31 st August 2007 Domains and Dimensions of Health Systems Research Health Systems Research Centre DoHC / HSE support Policy Advisory Group External Academic Advisory Group Management Committee Stakeholder Groups

31 st August 2007 Domains and Dimensions of Health Systems Research Current projects 1.Experience of ageing in the community 2.Community mental health teams: determinants of effectiveness 3.Customised QI Frameworks for Clinical Directorates (Pilot)

31 st August 2007 Domains and Dimensions of Health Systems Research 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

31 st August 2007 Domains and Dimensions of Health Systems Research 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)

31 st August 2007 Domains and Dimensions of Health Systems Research 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

31 st August 2007 Domains and Dimensions of Health Systems Research 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

31 st August 2007 Domains and Dimensions of Health Systems Research 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

31 st August 2007 Domains and Dimensions of Health Systems Research 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