Search results

The purpose of this paper is to present a case study of the World Health Organization’s Global Healthcare Workforce Alliance (GHWA). Based on a commissioned evaluation of GHWA, it applies network theory and key concepts from systems thinking to explore network emergence, effectiveness, and evolution to over a ten-year period. The research was designed to provide high-level strategic guidance for further evolution of global governance in human resources for health (HRH).

Methods included a review of published literature on HRH governance and current practice in the field and an in-depth case study whose main data sources were relevant GHWA background documents and key informant interviews with GHWA leaders, staff, and stakeholders. Sampling was purposive and at a senior level, focusing on board members, executive directors, funders, and academics. Data were analyzed thematically with reference to systems theory and Shiffman’s theory of network development.

Five key lessons emerged: effective management and leadership are critical; networks need to balance “tight” and “loose” approaches to their structure and processes; an active communication strategy is key to create and maintain support; the goals, priorities, and membership must be carefully focused; and the network needs to support shared measurement of progress on agreed-upon goals. Shiffman’s middle-range network theory is a useful tool when guided by the principles of complex systems that illuminate dynamic situations and shifting interests as global alliances evolve.

This study was implemented at the end of the ten-year funding cycle. A more continuous evaluation throughout the term would have provided richer understanding of issues. Experience and perspectives at the country level were not assessed.

Design and management of large, complex networks requires ongoing attention to key issues like leadership, and flexible structures and processes to accommodate the dynamic reality of these networks.

This case study builds on growing interest in the role of networks to foster large-scale change. The particular value rests on the longitudinal perspective on the evolution of a large, complex global network, and the use of theory to guide understanding.

In Canada, community engagement and accountability are a political imperative, resulting in an omnipresent program with varied opportunities for public participation. The purpose of this paper is to promote leadership and commitment for health system transformation that truly benefits communities.

This paper is based on the author’s experience with many engagement and accountability activities, applied in varied settings, for purposes such as evaluation, planning, policy making and system transformation. The specific context is generalized with international experiences and references.

The “lessons learned” are based on practical considerations with relevance for both novice and experienced practitioners: clarifying principles, processes and purposes at the outset; using effective leadership to achieve the desired impact; using a variety of methods to engage communities; clarifying engagement and accountability roles precisely; measuring things that are meaningful; and consulting with internal as well as external communities. Also, community leaders should recognize effort as well as results.

Commitment to engagement and accountability is commendable – but is it enough? The paper concludes by looking beyond health system impacts to propose a broader systems perspective. If clinical governors want to use engagement and accountability to achieve “total value” for their communities, they will need to demonstrate as leaders that they are committed to long-term thinking and broad social goals.

Too much focus on the process of care may mask accountability for reporting outcomes or systemic impact. The sustainable development goals highlight the need for systems thinking and public expectations include corporate social responsibility. As shown in the examples cited, a deeper commitment to engagement and accountability requires looking beyond care delivery to social determinants and to systemic impacts of the health care industry itself.

This viewpoint introduces a “Readiness Self-Assessment Guide” that can be used as a diagnostic tool to help health service governors and managers, particularly in Low-Middle Income Countries, or those in the early stages of developing their governance program.

The approach uses the conceptual framework for governance developed by Barbazza and Tello (2014).

The Guide is based on five foundational elements or components of governance that frame the actual governance activities. The self-assessment process uses a sequence of real-world examples to help users of the Guide assess their organization’s “readiness” or current capacity to strengthen quality. A simple scoring process allows users to rate their organization’s progress through potential evolutionary steps. The resulting analysis is intended to be the starting point of a structured discussion among team members about priorities, enabling factors and constraints.

Assessment of the institutional context is a fundamental step that will enable quality teams to select the appropriate tools for their priority concerns. This Readiness Self-Assessment Guide can be used as part of that diagnostic assessment.

This paper is empirically derived from the author’s experience as a consultant helping health service organizations and governing authorities to develop health governance programs in several countries.

The purpose of this paper is to introduce the “Johari Window” as a tool to illustrate how providers and patients differ in their understanding of healthcare quality.

The four quadrants of the Johari Window depict information known by both parties, by providers only, by patients only and by neither party.

By understanding these differing perceptions, clinicians and planners can improve the patient’s experience of service delivery.

There has been no formal evaluation of this tool’s performance. It is presented as a heuristic teaching model to stimulate inquiry and discussion.

The author has used the Johari Window in various cultural contexts, where its clarity and simplicity help introduce a potentially sensitive subject. Because it has face validity as an easy-to-understand tool, it can be used with students and junior care providers as well as non-clinician governors.

The purpose of this paper is to present a detailed case study of the evaluation strategies of a complex, multi-faceted response to a public health emergency: drug-related overdose deaths. It sets out the challenges of evaluating such a complex response and how they were overcome. It provides a pragmatic example of the rationale and issues faced to address the what, the why and particularly the how of the evaluation.

The case study overviews British Columbia’s Provincial Response to the Overdose Public Health Emergency, and the aims and scope of its evaluation. It then outlines the conceptual approach taken to the evaluation, setting out key methodological challenges in evaluating large-scale, multi-level, multisectoral change.

The evaluation is developmental and summative, utilization focused and system informed. Defining the scope of the evaluation required a strong level of engagement with government leads, grantees and other evaluation stakeholders. Mixed method evaluation will be used to capture the complex pattern of relationships that have informed the overdose response. Working alongside people with drug use experience to both plan and inform the evaluation is critical to its success.

This case study builds on a growing literature on evaluating large-scale and complex service transformation, providing a practical example of this.

The British Columbia Ministry of Health’s Clinical Care Management initiative was used as a case study to better understand large-scale change (LSC) within BC’s health system. Using a complex system framework, the purpose of this paper is to examine mechanisms that enable and constrain the implementation of clinical guidelines across various clinical settings.

Researchers applied a general model of complex adaptive systems plus two specific conceptual frameworks (realist evaluation and system dynamics mapping) to define and study enablers and constraints. Focus group sessions and interviews with clinicians, executives, managers and board members were validated through an online survey.

The functional themes for managing large-scale clinical change included: creating a context to prepare clinicians for health system transformation initiatives; promoting shared clinical leadership; strengthening knowledge management, strategic communications and opportunities for networking; and clearing pathways through the complexity of a multilevel, dynamic system.

The action research methodology was designed to guide continuing improvement of implementation. A sample of initiatives was selected; it was not intended to compare and contrast facilitators and barriers across all initiatives and regions. Similarly, evaluating the results or process of guideline implementation was outside the scope; the methods were designed to enable conversations at multiple levels – policy, management and practice – about how to improve implementation. The study is best seen as a case study of LSC, offering a possible model for replication by others and a tool to shape further dialogue.

Recommended action-oriented strategies included engaging local champions; supporting local adaptation for implementation of clinical guidelines; strengthening local teams to guide implementation; reducing change fatigue; ensuring adequate resources; providing consistent communication especially for front-line care providers; and supporting local teams to demonstrate the clinical value of the guidelines to their colleagues.

Bringing a complex systems perspective to clinical guideline implementation resulted in a clear understanding of the challenges involved in LSC.