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Professor Andrew LongSchool of HealthcareUniversity of [email protected]
June 19th 2006
Health Systems Research: What is it? And, does it matter?
Overview of Presentation
To elaborate on the range of meanings attached to ‘health’ ‘systems’ ‘research’
To identify essential commitments of HSyR As a philosophy of practice As a commitment to problem definition
To explore the HSyR features of three case studies: Evaluation of older people partnership Population health and measles prevention Fostering an outcomes culture in routine practice
Health Systems Research: playing with words? Health
Healthy vs. dis-eased; well vs. ill; working vs. incapacitated And connotations within ‘health’ services
Managing disease Promoting health and healing Population, community or individual health
Systems Complex whole; inter-connected parts Organised, structured group of things
Research Systematic enquiry – acquire knowledge Enhance evidence base Inform and empower (service and research) users –> influence
policy and practice
Joining the words together! Health systems
‘Whole’ systems to support or improve health and well-being ‘Whole’ systems of health care Systems within systems – e.g. intermediate care; TCM
acupuncture within complementary and alternative medicine
Health research Research applied to health and ill-health … epidemiology … Research studying health … sociology … economics …
Health systems research Whole systems research (exploring complex health care
interventions) Melting point for different disciplines Philosophy about a way of doing research Multiple perspectives
Some Definitions Health research
Study of health – individual, community, population
Health services research (HSR) study/evaluation of provision, effectiveness, efficiency and use
of health services
Health systems research (HSyR) study/evaluation of … health sector to enhance or contribute to
health of the community
Whole systems research (WSyR) study/evaluation of systems that honours the philosophy,
integrity and complexity of that system, that is, its explanatory model
HSyR – Essential Commitments Field of Research:
Complexity of programmes and policies in health (and other) policy sectors
Beginning and end of health care, vs. social care, vs. community care
Crossing the R&D Divide - Research into Practice: Involve key stakeholders (decision makers, services users,
carers) in research process – design to implementation Timely, relevant research and utility for practice
Evaluation and Research as Learning: Not just means to see ‘what works, for whom, in what
circumstance and from whose perspective’ But to identify and celebrate learning (for all stakeholders), and Enable ongoing evaluation in practice – sustainable change
Mode of Working: Complexity requires working with and across disciplines Melting pot where disciplines can meet, listen, learn and share
to explore the totality of the research problem
Desirable Process and Outcome
‘The involvement of users throughout the research process helps to create a cadre of sophisticated research users who are not only able to make effective use of research, but can more clearly specify what their needs are …. ‘ (National Audit Office, 2003)
Case Study One: Evaluation of Interventions for Prevention for Older People What is the Problem
Evaluating Partnerships for Older People Programme aimed at promoting independence of older people and preventing long term institutional care
Policy led, research to influence longer term commitment by Treasury
System Complexity Prevention = ? Success criteria = ? (whose perspective to adopt?) Outcome realisation – the more upstream the longer the time scale Understanding of ‘what works for whom …’ vs. ‘does it work?’
Team Composition Older people (‘City X’ Older People’s Forum) in form of Greek chorus Change agent team ... Project lead network Multiple disciplines – older people researchers, social and health
systems, health economist, statistician, gerontology, sociology/social research methodology
Case Study Two: Population Health and Measles Prevention (Jackson et al)
What is the Problem How to increase the take-up of MMR (vs. single disease vaccination
approach) Research project to explore feasibility, acceptability and effectiveness of
parent forum (plus usual care)
System Complexity Conceptual model: cognitive-deficit model vs. engagement model Multiple outcomes: parents, child, vaccination, disease incidence
Team Composition Parent – co-leader of Parent Forum Health Protection Agency, PCT immunisation co-ordinators Multiple disciplines – nursing/primary care/public health researchers,
psychology, public health physician, decision analyst, health economist, statistician
Case Study Three: Fostering an Outcomes Culture in Routine Practice
What is the Problem Sustainability – ongoing monitoring of achieved outcomes / evaluation of
practice (vs. one-off external evaluation)
System Complexity What outcome – different perspectives What outcome measures/measurement tools – quality and feasibility Outcomes of ‘our’ intervention or ‘others’ or of the ‘whole’ Timescale to realise desired outcomes Commitment and time availability of practitioners
Team Composition Local practitioners External facilitators – health systems research, outcome measurement,
health economist External resource/service managers
HSyR: Some Benefits and Caveats
Research only that which the government or other policy makers wants, timely issues, emphasis on utility and transferability of findings, that are relevant to practice Value to NHS, practice and decision making Maximising benefit to society/citizens
Questions over, inter alia: Research, must be generalisable beyond the local
setting (not just this particular setting) Research as enlightenment, shaping policy
agenda, challenging existing assumptions and encouraging debate
Public good vs. policy/political wish
Concluding Comments
HSyR: At a minimum, systems approach leads to broadening
of problem definition At an optimum, enabling breadth of understanding of
the ‘whole’, co-working, trans-disciplinary opportunities, enhancing population health and well-being
HSyR: As a means to enhance take-up of research findings
into practice Engage with service users and carers Ultimate test – is practice changed?
