Selected Topics - Health Services Management

• Centre for Health Assets Australasia
  Hosted by the Faculty of the Built Environment at UNSW, the vision of the Centre for Health Assets Australasia is..." to be the Australasian focal point for research and knowledge creation in health facility asset management and to contribute to the delivery of healthcare of the highest quality in Australia and New Zealand through research outcomes which enhance the design, procurement and management of health facilities."

Events

• School of Public Health and Community Medicine, UNSW - Upcoming Events

Global policies and related documents

• WHO Essential Drugs and Medicines Policy (EDM)
  This site provides access to WHO documents on essential medicines policy. It includes a definition of essential medicines, a library of essential medicines, guides to selection and use and links to a wide array of policy documents.
• WHO Managers taking Action based on Knowledge and Effective use of resources to achieve Results (MAKER)
  The MAKER website provides information on improving health services delivery through effective management of resources and services. Topic areas include general management, working with partners, sub-national and district health management, programme management, and managing facilities, community health services, resources and support systems, and quality of service delivery.

Reports, guidelines and projects

• A flow demand model to predict hospital utilisation
  This 2002 study by Monica Olivieira of The London School of Economics and Political Science finds that models to predict hospital demand have been particularly weak in three respects; in capturing the process of demand for hospital care, in modelling the interaction between hospital utilisation and the supply of alternative hospitals, and in dealing with geographic variations. She proposes a more accurate alternative which predicts hospital demand and utilisation of hospital care at a small area level.
• Access to Essential Drugs
  A global campaign launched by Doctors Without Borders (Medicins Sans Frontieres) to guarantee access to essential medicines for all.
• Capacity planning in health care: a review of the international experience: New policy brief on capacity planning
  "…This policy brief [by Stefanie Ettelt, Ellen Nolte, Sarah Thomson, Nicholas Mays, and the International Healthcare Comparisons Network] reviews approaches to capacity planning, a crucial component of health care governance. By concentrating on a selection of countries as diverse as Canada, Denmark, England, Finland, France, Germany, Italy, the Netherlands and New Zealand, it aims to show a range of approaches to health care financing and organization, since both of these factors have an impact on approaches to capacity planning." Also available in Russian.
• Framework for assessing, improving and enhancing health service planning
  "Healthcare planning is widely seen as a core component of health system governance. It forms a key instrument for decision makers to influence and direct health service provision, a function which is likely to become ever more important as health systems in Europe are facing increasingly complex challenges that demand innovative solutions. How this is achieved best and in what circumstances remains however uncertain, given the variety of approaches adopted in different settings, often reflecting the wider institutional, legislative and political framework of a country’s health system. However, there is considerable potential for policy learning across countries from the diversity of healthcare planning approaches in Europe and elsewhere. This report aims to contribute to this process through developing and validating a framework for assessing, improving and enhancing healthcare planning and so providing a tool for analysts and decision makers seeking to understand whether the approach of planning taken in a given setting supports its goals and how the approach can be improved in future. We identified a set of criteria guided by an understanding of healthcare planning as an explicit process of defining objectives and goals and to devise strategies of how these objectives can be met… We tested our criteria empirically through an in-depth analysis of four countries, using a case study approach. Countries were selected to provide a range of types of government and healthcare system: Germany, Austria, Canada (Ontario) and New Zealand. The analysis provides important insights into how different systems approach healthcare planning, identifying common challenges, but also differences highlighting the very contextual nature within which healthcare planning as an instrument to directing health service provision sits… The framework developed here presents a first step towards developing a tool for assessing healthcare planning in high income countries. Further validation through applying it to a wider range of countries is desirable." [Rand Corporation and the Bertelsmann Foundation, 2010]
• Gobernanza en Sistemas de Salud: conceptos, aportes y evidencias para el avance de estrategias de Protección Social en la Salud de los Migrantes
  "En el actual proceso de globalización y crisis económica, donde las fronteras geográficas parecen borrarse y las identidades se desdibujan, cuando se habla de la economía del mundo, del sistema económico global o de salud global, el fenómeno migratorio cobra nuevas dimensiones y significados entre las naciones. Porque no obstante este supuesto que funciona como sustento ideológico de la homogeneización del mundo y negación de la diversidad cultural e histórica de los pueblos, algunos países fortalecen sus fronteras geográficas y endurecen su política migratoria. La migración si bien es un problema social que siempre ha existido, se ha agudizado en las últimas décadas y plantea una multiplicidad de escenarios y problemas históricos que con el transcurrir del tiempo lejos de ofrecer soluciones se ha tornado cada vez más complejo y por lo tanto más difícil de explicar y abordar. Esto hace necesaria la convergencia de diferentes perspectivas analíticas y metodológicas que permitan un acercamiento más reflexivo que contribuya a la comprensión de todos los elementos y espacios de interacción que operan entre los diferentes actores. Desde lo local a lo global, de lo micro a lo macro donde el presente se muestra como parte de la historia pero también como posibilidad del futuro. Tal es el caso de la relación México-Estados Unidos caracterizada por la asimetría tanto en lo económico como en lo social. Dos naciones tan cercanas geográficamente pero tan lejanas en los otros ámbitos de la vida social como el económico, el social y el cultural. Tal disparidad se torna más complicada cuando se hace referencia a los principales protagonistas del flujo migratorio que se da entre ambos países, ya que hablar de migración internacional entre nuestro país y su vecino del norte, es hablar de los miembros de uno de los grupos sociales más desprotegidos y vulnerables de la sociedad mexicana: los trabajadores agrícolas migratorios. Aunque no son los únicos, si representan el mayor contingente que migra hacia ese país donde al igual que en su país de origen se encuentran al margen de cualquier forma de protección en salud y seguridad social. Es en este contexto que el tema de la desprotección en seguridad social y salud, cobra gran relevancia ya que más de la mitad de los migrantes mexicanos de 18 a 64 años carecen de todo derecho y seguridad social incluyendo el derecho universal a la salud tanto en México como en Estados Unidos." [Instituto Nacional de Salud Pública, Mexico, 2010]
• Governance and Corruption in Public Health Care Systems
  This Working Paper by Maureen Lewis from the Center for Global Development examines the factors that influence health care delivery in the developing world. It emphasises the role that good governance can have on stemming problems such as absenteeism, corruption and mismanagement and the important role this can have on health care delivery.
• Governance for health in the 21st century: a study conducted for the WHO Regional Office for Europe
  "Mind-sets on how we view and address health and its determinants have shifted. Two challenges go hand in hand: (1) the governance of the health system and health systems strengthening, which are what we refer to as ‘health governance’; and (2) the joint action of health and non-health sectors, of the public and private sectors and of citizens for a common interest in what we call 'governance for health'. The latter is the subject of this study. Living in a 'knowledge society' means that power and authority are no longer concentrated in government. Informed citizens, conscientious businesses, independent agencies and expert bodies increasingly have a role to play. Nevertheless, governments and health ministries continue to be important in managing governance for health, setting norms, providing evidence and 'making the healthier choice the easier choice'. We define governance for health and well-being as 'the attempts of governments and other actors to steer communities, whole countries or even groups of countries in the pursuit of health as integral to well-being through both whole-of-government and whole-of-society approaches'. The entire society must be understood as being responsible for its health." (Zsuzsanna Jakab, WHO Regional Director for Europe) [World Health Organization Regional Office for Europe, August 2011]
• Healthy Urban Planning: Recommendations from the NSW HIA project, 2006
  This 2007 report by P. Harris, E. Harris, B. Harris-Roxas and L. Kemp examines several focus areas concerned with health planning and service provision in urban NSW, Australia, and provides recommendations and rationales for each.
• How health systems can address inequities in priority public health conditions: the example of tuberculosis
  "The literature and case study synthesis undertaken by the Network showed that social determinants shape the spread of TB at multiple levels. These determinants are differentially distributed, with the poor and socially excluded disproportionately exposed. Government policies, global economic trends and other structural factors shape poverty and the strength of health care systems. These in turn contribute to downstream factors, such as the prevalence of TB in the wider community, living conditions, tobacco use and prevalence of diseases of the poor that increase TB vulnerability. Downstream factors interact with biology to shape the likelihood of exposure to TB droplets and, when exposed and infected, the likelihood of developing active disease… Analysis of these social determinants has policy implications. Current strategies need to be reinvigorated and combined with new strategies to directly tackle known social determinants. This requires: (i) strengthening and improving the coverage of existing TB programmes to reduce TB morbidity and mortality; (ii) taking a social determinants of health approach to better prevent and address the consequences of TB, including risk factors that lie outside of the health system; and (iii) strengthening health systems, particularly through a primary health care approach. Operationalization of these three principles might include improving universal social protection systems, using targeting only for those who fall through the cracks of universal services, and enhanced availability, accessibility, acceptability and quality of primary health care, TB and other services. Intersectoral action for health would also be required, entailing health impact assessments, providing examples of good practice to other sectors, supporting civil society groups to advocate for enhanced action by all on the social determinants of health and providing evidence regarding the relationship between health outcomes and social determinants." [WHO Regional Office for Europe, 2010]
• Improving Health Service Delivery in Developing Countries: From Evidence to Action
  "Improving health services is a crucial part of achieving the Millennium Development Goals in low- and middle-income countries (LMICs). Despite the abundance of evidence on the efficacy of interventions that can save lives at low cost, the pathways to delivering health services effectively in LMICs are not well known. Decision makers around the world need better information about which strategies to improve health services work best, or how to make current strategies more effective. By collecting and synthesizing what is known about implementation of health strategies, this book fills an important void in our knowledge about how to improve health services in LMICs. A major contribution of the book is to synthesize a deep and difficult literature on health services in LMICs. The first chapters of the book are comprehensive and systematic reviews of the literature that examine important sets of strategies for improving health services through health services strengthening strategies and approaches to implementation (chapter 1); strengthening health services organizations (chapter 2); improving performance of individual health care providers (chapter 3); and empowerment of communities (chapter 4). The book also pulls together years of international data and applies novel analytical approaches to examine how changes in the coverage of different health services affect each other on a national level (chapter 5). The analysis challenges the practice behind setting international targets for health services and offers an alternative based on each country’s experience. This book helps us think beyond what can be learned from the simpler, reproducible, and controlled interventions that are commonly described in research but are less applicable in practice. It demonstrates how a better understanding of implementation processes — the “how to” — is a crucial complement to the evidence addressing which health intervention should be selected. By better recognizing how context matters — how enabling and inhibiting factors influence even the most standardized or well-intentioned health strategy — the book points a way for managers and decision makers to deal with the complexities they regularly face. Chapter 6 outlines a way of thinking of the institutional factors that influence the delivery of health services, which should be helpful for analysts, managers, and policy makers. In chapter 8, the book describes how strategies were developed and implemented in the context of seven country case studies." [The International Bank for Reconstruction and Development / The World Bank 2009]
• Improving social and health care services
  This report by Rebecca Fauth and Michelle Mahdon contends that, “…The field of social care has made great strides in identifying its values and vision for the future and what needs to change to achieve improvements across a range of services. What is missing, however, are the specific actions needed to make these improvements a reality. Implementing change and improvement is both a multifaceted and dynamic process that takes time to come about, and specific change programmes are generally unique to individual organisations. Organisations embark on change and improvement programmes for different reasons and how close they are to the desired end state also varies. The Social Care Institute for Excellence SCIE commissioned this knowledge review to describe the processes and actions that have proven most effective in bringing about and sustaining improvement in social care services…”.
• Integrated Care: A Guide for Policymakers
  "Based on the presentations and outcomes of research and discussions held on the occasion of a dedicated workshop at the European Social Network Conference (Edinburgh, 2005), this publication explores in clear and concise terms the rationale for introducing integrated care and its benefits for different users. It discusses the different levels at which integration must occur as well as the different types of integration. Further, it briefly analyses the various outcomes of integration on different users and providers. Finally, it describes specific challenges that policymakers face when they implement integrated care approaches as well as specific steps to be taken to overcome these challenges".
• Mass Gatherings and Public Health: The Experience of the Athens 2004 Olympic Games
  This 402-page PDF document tells us that “….Large-scale mass gatherings, such as the Olympic Games, represent significant challenges for the entire health sector of host countries. Emerging global public health threats of natural or deliberate nature increase considerably the health and safety vulnerability of mass gatherings. Major areas of public health responsibility include health care capacity and mass-casualty preparedness; disease surveillance and outbreak response; environmental health and food safety; public information and health promotion; public health preparedness and response to incidents potentially involving the deliberate use of explosives, biological and chemical agents or radio nuclear material; and leadership, operations and unified command. This book comprehensively and systematically presents the experience of and lessons learned from the public health aspects of the preparations and conduct of the Athens 2004 Olympic Games. Documenting this experience can be a source of valuable information and knowledge for governments at all levels and communities in building their capacity for not only large-scale events but also preparing to deal with the avian influenza pandemic threat or other emergencies such as flooding and phenomena often associated with climate change…”.
• Measuring Health Care Quality: Obstacles and Opportunities, (PDF) 57pg
  This May 2004 report addresses the issue of measuring the many factors, unrelated to health care such as age, gender, environment, genetics and behaviour that influence health care outcomes. It analyses the affect that completeness, accuracy and specificity of diagnosis, procedure and medication codes on which risk adjustment methods are based have on the measuring and reporting of health outcomes.
• Performance measurement for health system improvement: experiences, challenges and prospects (Summary) "Performance measurement offers policy-makers a major opportunity to secure health system improvement and accountability. Its role is to improve the quality of decisions made by all actors within the health system, including patients, practitioners, managers, governments at all levels, insurers and other payers, politicians, and citizens as financial supporters. Recent major advances in information technology and increasing demands for health system accountability and patient choice have driven rapid advances in health system performance measurement. Health systems, however, are still in the relatively early stages of performance measurement, and major improvements are still needed in data collection, analytical methodologies, and policy development and implementation. Health system performance has a number of aspects – including population health, health outcomes from treatment, clinical quality and the appropriateness of care, responsiveness, equity and productivity – and progress is varied in the development of performance measures and data collection techniques for these different aspects. Securing improved performance measurement is an important stewardship task of government, as many of the benefits of performance measurement cannot be realized without the active leadership of government, whether through law, regulation, coordination or persuasion... Stewardship responsibilities associated with performance measurement can be summarized under the following headings: 1. development of a clear conceptual framework and a clear vision of the purpose of the performance measurement system; 2. design of data collection mechanisms; 3. information governance; 4. development of analytical devices and capacity to help understand the data; 5. development of appropriate data aggregation and presentational methods; 6. design of incentives to act on performance measures; 7. proper evaluation of performance-measurement instruments; and 8. managing the political process."
• Primary Care at a Crossroads
  The result of a meeting on the current and future challenges to primary care this supplement to the Annals of Internal Medicine from 2003 presents an overview of the current crisis in primary care, the implications of patient's views of primary care, the Chronic Illness Model as one possible solution and a prediction of a tiering in the way primary care is delivered in the future.
• Primary care in the driver's seat: organisational reform in European primary health care
  Published by the European Observatory on Health Systems and Policy,"... this book is a study of the reforms of primary care in Europe as well as their impacts on the broader coordination mechanisms within European health care systems. It also provides suggestions for effective strategies for future improvement in health care system reform…..”
• Psychological and psychopathological reactions in Honduras following Hurricane Mitch: implications for service planning
  Background: Posttraumatic stress disorder (PTSD) and other psychopathological outcomes have not been sufficiently studied in community-based samples in Latin America. This study explored various psychopathological reactions and their respective risk factors two months after Hurricane Mitch struck Honduras in October 1998. Methods: In the Honduran capital of Tegucigalpa, 800 respondents age 15 and older were selected from residential areas of high, middle, or low socioeconomic status that had suffered either high or low impact from the devastating effects of the hurricane. The Composite International Diagnostic Interview was used to diagnose PTSD. Depression, alcohol misuse, and grief reaction were examined using screening instruments, and the Self–Reporting Questionnaire was used to measure demoralization. The Impact of Event Scale was administered to ascertain the severity of the posttraumatic reaction. Results: PTSD was present in 10.6% of the sample. Respondents from the high-impact residential areas were more distressed, had higher scores on the grief inventory, and showed greater severity in PTSD symptoms. The respondents from the high-impact residential areas also had higher prevalence rates of major depression, alcoholism, and prior emotional problems. The best explanatory model for the risk of developing PTSD included the degree of exposure based on reported traumatic events, and associated increased demoralization. Among the persons with PTSD, its severity was predicted by being female and by the degree of exposure to hurricane-related traumatic events. Conclusions: Out of a total population of 3.3 million adults (age 15 and older) in Honduras, it is estimated that over 492 000 of them may have developed PTSD due to Hurricane Mitch. Adequate health disaster preparedness and response requires full acknowledgement of the multiple psychological effects that victims experience. [author abstract] [Rev Panam Salud Publica. 2005; 18(4/5): 287–295]
• Public-private partnerships for hospitals
  While some forms of public–private partnerships are a feature of hospital construction and operation in all countries with mixed economies, there is increasing interest in a model in which a public authority contracts with a private company to design, build and operate an entire hospital. Drawing on the experience of countries such as Australia, Spain, and the United Kingdom, this paper reviews the experience with variants of this model. (published in - Bulletin of the World Health Organisation 2006;84:890-896)
• Synthesizing Evidence for Management and Policy Making
  This special issue of the Journal of Health Services Research and Policy [10(3), Supplement 1] considers the most effective means of encouraging public policy and management to be better informed by the results of relevant and reliable research evidence.
• When do vertical (stand-alone) programmes have a place in health systems?
  "The terms vertical and integrated are widely used in health service delivery, but each describes a range of phenomena. In practice, the dichotomy between them is not rigid, and the extent of verticality or integration varies between programmes – including: (1) a vertically funded, managed, delivered and monitored programme; (2) one with integrated funding, organization and management but separate delivery; and (3) a fully integrated approach comprising comprehensive primary health care services. Most health services combine vertical and integrated elements, but the balance between programmes in these elements varies considerably. Hence, when vertical and horizontal and programme design are being discussed, clarity is needed on the programme element being referred to: (1) governance arrangements, (2) organization, (3) funding and (4) service delivery."
• World Alliance for Patient Safety: Forward Programme (PDF) 33pg
  World Health Organization, October 2004 - This report provides an overview of patient safety in the pressurised and fast-moving clinical environments of modern health care.

Educational resources

• Drugs and Devices Information Line
  This service is provided by the Pharmacoepidemiology program at Harvard University, School of Public Health
• HospitalWeb
  This site provides a list of hospitals on the web. The aim of the site is to provide a simple and globally accessible way for patients, medical researchers, and physicians to obtain information about hospitals throughout the world.
• HSRProj (Health Services Research Projects in Progress)
  A free, online database of current HSR projects. the HSRProj (Health Services Research Projects in Progress) database contains descriptions on more than 6,000 ongoing health services research projects funded by government and state agencies, foundations, and private organisations. Records include both grants and contracts awarded by major public and private funding agencies and foundations. Individuals can retrieve names of organisations that are either conducting or sponsoring research, principal investigator contact information, beginning and end dates of a project, and information about study design and methodology.
• PharmWeb
  PharmWeb is a portal to an extensive range of pharmaceutical and health care related internet resources. It includes links to conferences and meetings, worldwide pharmacy colleges, departments and schools, discussion forums and chat sessions, job vacancies, statistics and government bodies.
• Virtual Hospital
  Virtual Hospital is a digital health sciences library created in 1992 at the University of Iowa to help meet the information needs of health care providers and patients. The goal of the Virtual Hospital digital library is to make the Internet a useful medical reference and health promotion tool for health care providers and patients. The Virtual Hospital digital library contains thousands of textbooks and booklets for health care providers and patients.

Organisations and Networks

UN and multinational

Government

• Quality Use of Medicines (Australia)
  The aim Australia's Quality Medicines Policy is to improve the way medicines are prescribed and used to ensure better health outcomes for all Australians. The policy focuses on an evidence based approach, with an emphasis on appropriate, safe and efficacious use.

Non Government

• Australian Healthcare and Hospitals Association
  The Australian Healthcare Association is the national industry body for publicly funded hospitals and healthcare organisations, including aged and extended care and primary and community health in Australia.
• Canadian Health Services Research Foundation
  The Canadian Health Services Research Foundation supports the evidence-based management of Canada's healthcare system by facilitating knowledge transfer and exchange - bridging the gap between research and healthcare management and policy.
• EssentialDrugs.org
  An electronic conference to allow health professionals, particularly in developing countries where access to telephone and facsimile may be prohibitively expensive and postal services can be unreliable to share information in the field of essential drugs.
• Health Action International
  HAI is an non-profit, global network of health, development, consumer and other public interest groups throughout Europe working for a more rational use of medicinal drugs. It represents the interests of consumers in drug policy and believes that all drugs marketed should be safe, effective, affordable and meet real medical needs.
• Institute for Safe Medication Practices (USA)
  A non-profit organisation that works closely with healthcare practitioners and institutions, regulatory agencies, professional organisations and the pharmaceutical industry to provide education about adverse drug events and their prevention. The Institute provides an independent review of medication errors that have been voluntarily submitted by practitioners to a national medical errors reporting program operated by the United States Pharmacopeia.
• International Society for Pharmacoepidemiology
  "A non-profit international professional membership organization dedicated to promoting pharmacoepidemiology, the science which applies epidemiologic approaches to studying the use, effectiveness, value and safety of pharmaceuticals"
• Social Care Institute for Excellence (SCIE)
  SCIE's role is to develop and promote knowledge about good practice in social care. SCIE works with people and organisations throughout the social care sector to identify useful information, research and examples of good practice. Using this information, it produces resources which evaluate practice in a particular area of social care, and identifies areas where more research is needed to inform good practice.

Academic Institutions with particular focus in this area

• Hospital Management Research Unit
  This unit, at the University of Toronto Canada carries out several projects that assist the Ontario Ministry of Health & Long Term Care in the planning and performance assessment of health services, while also fulfilling research program priorities of the University's Department of Health Policy, Management and Evaluation.

Key Conferences, conference and workshop reports

Coming conferences

Conference reports

• Health Services Restructuring: New Evidence and New Directions
  Health Services Restructuring: New Evidence and New Directions was organised by the John Deutsch Institute and the Institute for Research on Public Policy, Canada and held 17-18 November 2005 at Kingston, Ontario. This site provides links to papers presented at the conference.

Journals, Newsletters, Forums

Bibliographies, Libraries

Public health bookshops

• Public Health bookshop