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Health Systems and Services

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601).

Deadline for manuscript submissions: closed (31 May 2018) | Viewed by 66445

Special Issue Editors

School of Nursing Midwifery and Health Systems, University College Dublin, Belfield Dublin 4, Ireland
Interests: health systems research, implementation science, collective leadership, quality and safety
University College Dublin Centre for Interdisciplinary Research, Teaching and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery & Health Systems, Health Sciences Centre, University College Dublin, Dublin 4, Ireland
Interests: applied health; organisational psychology; medical decision-making; nursing
Special Issues, Collections and Topics in MDPI journals
Social Science Applied to Healthcare Improvement Research (SAPPHIRE) Group, Health Sciences, Centre for Medicine, University of Leicester, University Road, Leicester, LE1 7RH, UK

Special Issue Information

Dear Colleagues,

Health Systems Research: New and Innovative Methods for Exploration and Implementation

Health systems research is a growing area of interdisciplinary endeavour aimed at better understanding the complexity of healthcare and utilising that understanding to improve the health of the population. Ever changing population demographics, shifts in patterns of disease burden and exciting advances in medicines and treatment regimes create new and diverse demands on health systems. Health systems researchers work to develop a robust evidence base to support new and innovative models that address all aspects of maintaining health and well-being.

Health systems research brings particular challenges and opportunities: interdisciplinary working; collaborating with clinical and other healthcare staff; simultaneously working at different levels of a system or organisation; designing/co-designing interventions; constructing studies that can rigorously test such interventions; and working closely with the potential beneficiaries and end users of research throughout the process, be they patients, carers, clinicians or managers. As researchers we are being pushed to step outside of our comfort zones and find new methods to explore and understand the complexity of health systems and new designs to implement and test interventions in this dynamic environment. 

This special issue has a focus on new methodologies in research and implementation of health systems interventions. Papers that describe research and evidence-based interventions in the hospital or at the hospital-community care interface and utilise novel or complex methods are invited. Papers focusing on research that is co-designed by researchers, healthcare staff and patients would be particularly welcome.

Prof. Dr. Eilish McAuliffe
Dr. Aoife DeBrun
Prof. Dr. Graham Martin                                                 
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Health systems

  • Complexity

  • Co-design

  • Hospital interventions

  • Integrated care

Published Papers (8 papers)

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Research

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16 pages, 3308 KiB  
Article
Accounting for Fairness in a Two-Stage Stochastic Programming Model for Kidney Exchange Programs
by Hyunwoo Lee, Seokhyun Chung, Taesu Cheong and Sang Hwa Song
Int. J. Environ. Res. Public Health 2018, 15(7), 1491; https://doi.org/10.3390/ijerph15071491 - 14 Jul 2018
Cited by 3 | Viewed by 3364
Abstract
Kidney exchange programs, which allow a potential living donor whose kidney is incompatible with his or her intended recipient to donate a kidney to another patient in return for a kidney that is compatible for their intended recipient, usually aims to maximize the [...] Read more.
Kidney exchange programs, which allow a potential living donor whose kidney is incompatible with his or her intended recipient to donate a kidney to another patient in return for a kidney that is compatible for their intended recipient, usually aims to maximize the number of possible kidney exchanges or the total utility of the program. However, the fairness of these exchanges is an issue that has often been ignored. In this paper, as a way to overcome the problems arising in previous studies, we take fairness to be the degree to which individual patient-donor pairs feel satisfied, rather than the extent to which the exchange increases social benefits. A kidney exchange has to occur on the basis of the value of the kidneys themselves because the process is similar to bartering. If the matched kidneys are not of the level expected by the patient-donor pairs involved, the match may break and the kidney exchange transplantation may fail. This study attempts to classify possible scenarios for such failures and incorporate these into a stochastic programming framework. We apply a two-stage stochastic programming method using total utility in the first stage and the sum of the penalties for failure in the second stage when an exceptional event occurs. Computational results are provided to demonstrate the improvement of the proposed model compared to that of previous deterministic models. Full article
(This article belongs to the Special Issue Health Systems and Services)
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17 pages, 550 KiB  
Article
Using Co-Design to Develop a Collective Leadership Intervention for Healthcare Teams to Improve Safety Culture
by Marie E. Ward, Aoife De Brún, Deirdre Beirne, Clare Conway, Una Cunningham, Alan English, John Fitzsimons, Eileen Furlong, Yvonne Kane, Alan Kelly, Sinéad McDonnell, Sinead McGinley, Brenda Monaghan, Ann Myler, Emer Nolan, Róisín O’Donovan, Marie O’Shea, Arwa Shuhaiber and Eilish McAuliffe
Int. J. Environ. Res. Public Health 2018, 15(6), 1182; https://doi.org/10.3390/ijerph15061182 - 05 Jun 2018
Cited by 90 | Viewed by 15598
Abstract
While co-design methods are becoming more popular in healthcare; there is a gap within the peer-reviewed literature on how to do co-design in practice. This paper addresses this gap by delineating the approach taken in the co-design of a collective leadership intervention to [...] Read more.
While co-design methods are becoming more popular in healthcare; there is a gap within the peer-reviewed literature on how to do co-design in practice. This paper addresses this gap by delineating the approach taken in the co-design of a collective leadership intervention to improve healthcare team performance and patient safety culture. Over the course of six workshops healthcare staff, patient representatives and advocates, and health systems researchers collaboratively co-designed the intervention. The inputs to the process, exercises and activities that took place during the workshops and the outputs of the workshops are described. The co-design method, while challenging at times, had many benefits including grounding the intervention in the real-world experiences of healthcare teams. Implications of the method for health systems research are discussed. Full article
(This article belongs to the Special Issue Health Systems and Services)
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17 pages, 20293 KiB  
Article
A Socio-Technical Exploration for Reducing & Mitigating the Risk of Retained Foreign Objects
by Siobhán Corrigan, Alison Kay, Katie O’Byrne, Dubhfeasa Slattery, Sharon Sheehan, Nick McDonald, David Smyth, Ken Mealy and Sam Cromie
Int. J. Environ. Res. Public Health 2018, 15(4), 714; https://doi.org/10.3390/ijerph15040714 - 10 Apr 2018
Cited by 12 | Viewed by 7297
Abstract
A Retained Foreign Object (RFO) is a fairly infrequent but serious adverse event. An accurate rate of RFOs is difficult to establish due to underreporting but it has been estimated that incidences range between 1/1000 and 1/19,000 procedures. The cost of a RFO [...] Read more.
A Retained Foreign Object (RFO) is a fairly infrequent but serious adverse event. An accurate rate of RFOs is difficult to establish due to underreporting but it has been estimated that incidences range between 1/1000 and 1/19,000 procedures. The cost of a RFO incident may be substantial and three-fold: (i) the cost to the patient of physical and/or psychological harm; (ii) the reputational cost to an institution and/or healthcare provider; and (iii) the financial cost to the taxpayer in the event of a legal claim. This Health Research Board-funded project aims to analyse and understand the problem of RFOs in surgical and maternity settings in Ireland and develop hospital-specific foreign object management processes and implementation roadmaps. This project will deploy an integrated evidence-based assessment methodology for social-technical modelling (Supply, Context, Organising, Process & Effects/ SCOPE Analysis Cube) and bow tie methodologies that focuses on managing the risks in effectively implementing and sustaining change. It comprises a multi-phase research approach that involves active and ongoing collaboration with clinical and other healthcare staff through each phase of the research. The specific objective of this paper is to present the methodological approach and outline the potential to produce generalisable results which could be applied to other health-related issues. Full article
(This article belongs to the Special Issue Health Systems and Services)
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13 pages, 4545 KiB  
Article
Exploring Geographic Variation of Mental Health Risk and Service Utilization of Doctors and Hospitals in Toronto: A Shared Component Spatial Modeling Approach
by Jane Law and Christopher Perlman
Int. J. Environ. Res. Public Health 2018, 15(4), 593; https://doi.org/10.3390/ijerph15040593 - 26 Mar 2018
Cited by 14 | Viewed by 4943
Abstract
Mental Health has been known to vary geographically. Different rates of utilization of mental health services in local areas reflect geographic variation of mental health and complexity of health care. Variations and inequalities in how the health care system addresses risks are two [...] Read more.
Mental Health has been known to vary geographically. Different rates of utilization of mental health services in local areas reflect geographic variation of mental health and complexity of health care. Variations and inequalities in how the health care system addresses risks are two critical issues for addressing population mental health. This study examines these issues by analyzing the utilization of mental health services in Toronto at the neighbourhood level. We adopted a shared component spatial modeling approach that allows simultaneous analysis of two main health service utilizations: doctor visits and hospitalizations related to mental health conditions. Our results reflect a geographic variation of both types of mental health service utilization across neighbourhoods in Toronto. We identified hot and cold spots of mental health risks that are common to both or specific to only one type of health service utilization. Based on the evidence found, we discuss intervention strategies, focusing on the hotspots and provision of health services about doctors and hospitals, to improve mental health for the neighbourhoods. Limitations of the study and further research directions are also discussed. Full article
(This article belongs to the Special Issue Health Systems and Services)
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11 pages, 1636 KiB  
Article
Social Network Analysis as a Methodological Approach to Explore Health Systems: A Case Study Exploring Support among Senior Managers/Executives in a Hospital Network
by Aoife De Brún and Eilish McAuliffe
Int. J. Environ. Res. Public Health 2018, 15(3), 511; https://doi.org/10.3390/ijerph15030511 - 13 Mar 2018
Cited by 46 | Viewed by 8058
Abstract
Health systems research recognizes the complexity of healthcare, and the interacting and interdependent nature of components of a health system. To better understand such systems, innovative methods are required to depict and analyze their structures. This paper describes social network analysis as a [...] Read more.
Health systems research recognizes the complexity of healthcare, and the interacting and interdependent nature of components of a health system. To better understand such systems, innovative methods are required to depict and analyze their structures. This paper describes social network analysis as a methodology to depict, diagnose, and evaluate health systems and networks therein. Social network analysis is a set of techniques to map, measure, and analyze social relationships between people, teams, and organizations. Through use of a case study exploring support relationships among senior managers in a newly established hospital group, this paper illustrates some of the commonly used network- and node-level metrics in social network analysis, and demonstrates the value of these maps and metrics to understand systems. Network analysis offers a valuable approach to health systems and services researchers as it offers a means to depict activity relevant to network questions of interest, to identify opinion leaders, influencers, clusters in the network, and those individuals serving as bridgers across clusters. The strengths and limitations inherent in the method are discussed, and the applications of social network analysis in health services research are explored. Full article
(This article belongs to the Special Issue Health Systems and Services)
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2624 KiB  
Article
Combining Theory-Driven Evaluation and Causal Loop Diagramming for Opening the ‘Black Box’ of an Intervention in the Health Sector: A Case of Performance-Based Financing in Western Uganda
by Dimitri Renmans, Nathalie Holvoet and Bart Criel
Int. J. Environ. Res. Public Health 2017, 14(9), 1007; https://doi.org/10.3390/ijerph14091007 - 03 Sep 2017
Cited by 28 | Viewed by 10051
Abstract
Increased attention on “complexity” in health systems evaluation has resulted in many different methodological responses. Theory-driven evaluations and systems thinking are two such responses that aim for better understanding of the mechanisms underlying given outcomes. Here, we studied the implementation of a performance-based [...] Read more.
Increased attention on “complexity” in health systems evaluation has resulted in many different methodological responses. Theory-driven evaluations and systems thinking are two such responses that aim for better understanding of the mechanisms underlying given outcomes. Here, we studied the implementation of a performance-based financing intervention by the Belgian Technical Cooperation in Western Uganda to illustrate a methodological strategy of combining these two approaches. We utilized a systems dynamics tool called causal loop diagramming (CLD) to generate hypotheses feeding into a theory-driven evaluation. Semi-structured interviews were conducted with 30 health workers from two districts (Kasese and Kyenjojo) and with 16 key informants. After CLD, we identified three relevant hypotheses: “success to the successful”, “growth and underinvestment”, and “supervision conundrum”. The first hypothesis leads to increasing improvements in performance, as better performance leads to more incentives, which in turn leads to better performance. The latter two hypotheses point to potential bottlenecks. Thus, the proposed methodological strategy was a useful tool for identifying hypotheses that can inform a theory-driven evaluation. The hypotheses are represented in a comprehensible way while highlighting the underlying assumptions, and are more easily falsifiable than hypotheses identified without using CLD. Full article
(This article belongs to the Special Issue Health Systems and Services)
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Review

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24 pages, 858 KiB  
Review
A Systematic Underpinning and Framing of the Servicescape: Reflections on Future Challenges in Healthcare Services
by Jieun Han, Hyo-Jin Kang and Gyu Hyun Kwon
Int. J. Environ. Res. Public Health 2018, 15(3), 509; https://doi.org/10.3390/ijerph15030509 - 13 Mar 2018
Cited by 20 | Viewed by 7434
Abstract
Ever since Bitner defined the term “servicescape” as the physical environment in which the service is assembled, several scholars have attempted to better understand the impact of the built environment in the context of different service settings. While servicescape is a topic of [...] Read more.
Ever since Bitner defined the term “servicescape” as the physical environment in which the service is assembled, several scholars have attempted to better understand the impact of the built environment in the context of different service settings. While servicescape is a topic of increasing academic interest among scholars and practitioners, most studies in the area are dedicated to understanding the built environment of hedonic service. More studies are needed to examine utilitarian servicescape and in this paper, we have focused on the healthcare environment. This study aims to identify the gap in servicescape and healthscape studies by providing a theoretical structure of the current servicescape literature and comprehend the academic differences between hedonic servicescape and utilitarian healthscape studies. After reviewing 44 selected papers based on rigorous criteria, we: (1) framed the servicescape factors; (2) analyzed the servicescape literature from the perspectives of terminologies, research fields, methodologies, and frameworks; and (3) identified the current paths of healthscape research. Through this work, we highlight the significance of adopting different dimensions and factors to evaluate the distinguished service environment by the servicescape type and propose several research agendas for future studies on healthscapes. The research findings can contribute to a deep understanding of healthscapes and can introduce a new viewpoint for interpreting the servicescape in diversified service settings. Full article
(This article belongs to the Special Issue Health Systems and Services)
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11 pages, 1292 KiB  
Review
Undertaking a Collaborative Rapid Realist Review to Investigate What Works in the Successful Implementation of a Frail Older Person’s Pathway
by Éidín Ní Shé, Fiona Keogan, Eilish McAuliffe, Diarmuid O’Shea, Mary McCarthy, Rosa McNamara and Marie Therese Cooney
Int. J. Environ. Res. Public Health 2018, 15(2), 199; https://doi.org/10.3390/ijerph15020199 - 25 Jan 2018
Cited by 20 | Viewed by 8694
Abstract
We addressed the research question “what factors enable the successful development and implementation of a frail older person’s pathway within the acute setting”. A rapid realist review (RRR) was conducted by adopting the RAMESES standards. We began with a sample of 232 articles [...] Read more.
We addressed the research question “what factors enable the successful development and implementation of a frail older person’s pathway within the acute setting”. A rapid realist review (RRR) was conducted by adopting the RAMESES standards. We began with a sample of 232 articles via database searches supplemented with 94 additional records including inputs from a twitter chat and a hospital site visit. Our final sample consisted of 18 documents. Following review and consensus by an expert panel we identified a conceptual model of context-mechanism-(resources)-outcomes. There was overall agreement frailty should be identified at the front door of the acute hospital. Significant challenges identified related to organisational boundaries both within the acute setting and externally, the need to shift outcomes to patient orientated ones, to support staff to sustain the pathway by providing ongoing education and by providing role clarity. RRRs can support research such as the systematic approach to improving care for frail older adults (SAFE) study by producing accounts of what works based on a wide range of sources and innovative engagement with stakeholders. It is evident from our provisional model that numerous factors need to combine and interact to enable and sustain a successful frail older person’s pathway. Full article
(This article belongs to the Special Issue Health Systems and Services)
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