FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W2344464657> ?p ?o ?g. }

• W2344464657 endingPage "16" @default.
• W2344464657 startingPage "14" @default.
• W2344464657 abstract "The key theme in this editorial series is that healthcare remains resistant to innovation and reform. This editorial will explore issues related to health system design that contribute to this resistance and propose possible solutions. At the outset, it is useful to consider key characteristics of innovative systems. Broadly, innovative systems comprise interrelated and interdependent elements. These elements continually influence each other in order to achieve the purpose of the system.1 Highly innovative organisations or systems such as Apple and Google are orientated to and focussed on delivering their goal or purpose. These systems also have effective feedback loops and are highly flexible. These characteristics will be revisited later in this editorial. A fundamental challenge is that, in general, health systems have evolved rather than been purposefully designed. This evolution has been driven in part by the need to respond to new health challenges and growing population demand. Arguably, more significant factors are the political and intrinsic professional drivers that continue to influence health system evolution.2-4 The result is systems with boundaries based on professional preferences, frameworks applied retrospectively to fit system constraints, and processes developed to meet the requirements of providers. To apply design thinking and design principles to a health system, a clear understanding of the purpose of that system is critical. We must identify and clearly communicate the purpose so that we can deliberately and relentlessly design our systems to deliver against the stated purpose. Adopting a deliberate design approach will also assist in orientating our systems toward patient or consumer needs. A clear focus on purpose links to another principle for design: first, consider what is desirable and then explore how to make it feasible.5, 6 This ordering is distinct from that commonly applied in health and other sectors. This approach also demands that we invest in understanding and articulating what we want and the problem(s) that we are trying to solve. The question of what is desirable must be approached from the perspective of the patients and population served by a health system. This approach will aid alignment between the purpose of a health system and population need. There is also a requirement to involve patients directly in the design process. One pragmatic reason for this requirement is that systems where a co-design paradigm is used can outperform systems that apply more traditional models.6, 7 The differences in conceptual frameworks for a user-centred design approach and the more traditional evolutionary approach to health system development are summarised in Figures 1 and 2 (adapted from Gray et al.).8 An evolutionary approach to health system development is further exacerbated by a disproportionate focus on the structural components of health systems. In this context, structure refers to the organisation of different components of a health system, for example, department of health, health boards, funders, providers, primary care and secondary care. In health systems that have evolved rather than been purposefully designed, innovation often takes the form of, and is limited to, structural re-organisation. Structure influences function, but it is only one factor that contributes to overall performance. In certain cases, structural reform shifts accountability and/or responsibility to different actors or organisations; however, this reform does not address other fundamental system deficiencies. A recent example is the shift of responsibility for funding of healthcare services to primary care (Clinical Commissioning Groups (CCG)) in the National Health Service in England. This reform came into being in early 2013 and moved responsibility for commissioning from Strategic Health Authorities and Primary Care Trusts to CCG. This reform did not purposely address other issues such as evaluation frameworks, value-based measurement or service integration. To date, the impact of this reform on clinical and patient reported outcomes is yet to be quantified.9 There is little to suggest that potential future improvements in these two areas could be attributed to this structural reform alone. Structural reform is highly visible. Non-structural reform and innovation is often less visible and requires longer timeframes to demonstrate an impact. This bias toward structural reform is driven by an overemphasis on activity rather than impact. Because of increasing complexity and the highly adaptive nature of healthcare, it is no longer sufficient to consider structural reform in isolation. Innovative systems pay attention to the processes, interactions and feedback mechanisms between system components in addition to structure. An exhaustive review of these components is beyond the scope of this editorial. However, there are two key components that warrant further exploration: funding and accountability frameworks. Funding and accountability frameworks should be linked in well-designed systems. Currently, the extent to which they are linked within different health systems varies significantly.10 Funding is typically linked to forecasted activity, which is informed by population size. This is true across public and private systems where different models are deployed, but all of these models incentivise activity rather than outcomes. This mechanism ultimately either drives consumption (for example fee for service, bundled payments) or drives enrolment processes, coupled with initiatives to minimise service delivery (e.g. capitation). Where attempts have been made to improve quality of care, the focus is still on encouraging process measure capture rather than meaningful clinical and/or patient reported outcomes. Clearly, this is not an easy problem to fix. A shift to a focus on incentives or disincentives based on outcomes is emerging in certain jurisdictions.11 This approach requires alignment between multiple stakeholders and risk sharing across different providers. This could ultimately facilitate a long-term investment approach to funding in healthcare. Accountability frameworks that link and govern various stakeholders in health systems are often not fit for purpose. Recent reforms in New Zealand and Australia have seen the introduction of process targets, such as waiting times, in an attempt to increase provider accountability and system performance. Analysis of the impact of such frameworks has revealed that the impact on outcomes is questionable, while many organisations develop ‘target work-arounds’.11-13 Also, in many cases providers retain autonomy irrespective of their performance against the targets.12-14 There are mechanisms to remove autonomy; however, this occurs as a last resort in instances where total system failure is demonstrated.14 The need for provider autonomy is not in doubt. However, the design and implementation of accountability frameworks should encourage a greater focus on delivering meaningful outcomes and should promote transparency in performance. This transparency should then be coupled with increased accountability within an appropriate regulatory framework. Furthermore, the regulatory framework must have the principles of patient safety and patient value at its core. The use of a decentralised or devolved health system model is one mechanism through which provider autonomy can be promoted while operating within a robust accountability framework. A decentralised model is one where central agencies devolve responsibility for care delivery and/or funding to local or regional organisations. This model is appropriate within a design-centred paradigm given the need for agility to ensure that local population needs inform local service delivery. The role of central agencies in a decentralised model remains critical. There are two important functions that central agencies such as a Ministry of Health must deliver: policy or strategy development and strategy execution. In current systems, these functions are often combined. Close alignment between these two functions is critical; however, to achieve good performance these functions should be separated. This approach at a central agency level has been shown to be effective in other sectors.15 This is also consistent with design thinking where individual components of a system are responsible for specific functions. A potential benefit of this separation is that it could facilitate greater collaboration between appropriate organisations in policy and strategy. For example, central agencies should work closely with academic institutions and, where appropriate, industry to inform policy and strategy development. With respect to execution, central agencies must focus on implementing an optimal operating model. Critically, this operating model must support robust accountability frameworks and effective funding as previously highlighted. Funding of services at a central level may form part of an optimal operating model if population needs support this approach. This may address key system deficiencies such as a lack of appropriate scale in funders or a lack of adequate funding capability in a decentralised model. Health systems must be designed to deliver their purpose. There is no doubt that patient and population requirements will continue to change. Applying design principles and adopting a broader, more deliberate approach to system design will help to ensure that our health systems are adaptable and sustainable." @default.
• W2344464657 created "2016-06-24" @default.
• W2344464657 creator A5016779137 @default.
• W2344464657 creator A5036402373 @default.
• W2344464657 date "2016-01-01" @default.
• W2344464657 modified "2023-09-26" @default.
• W2344464657 title "Intrinsically flawed health systems by design" @default.
• W2344464657 cites W1966094122 @default.
• W2344464657 cites W2010776757 @default.
• W2344464657 cites W2059702009 @default.
• W2344464657 cites W2068217839 @default.
• W2344464657 cites W2112002413 @default.
• W2344464657 cites W2147641120 @default.
• W2344464657 doi "https://doi.org/10.1111/imj.12953" @default.
• W2344464657 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/26813897" @default.
• W2344464657 hasPublicationYear "2016" @default.
• W2344464657 type Work @default.
• W2344464657 sameAs 2344464657 @default.
• W2344464657 citedByCount "1" @default.
• W2344464657 countsByYear W23444646572016 @default.
• W2344464657 crossrefType "journal-article" @default.
• W2344464657 hasAuthorship W2344464657A5016779137 @default.
• W2344464657 hasAuthorship W2344464657A5036402373 @default.
• W2344464657 hasBestOaLocation W23444646571 @default.
• W2344464657 hasConcept C112930515 @default.
• W2344464657 hasConcept C127413603 @default.
• W2344464657 hasConcept C17744445 @default.
• W2344464657 hasConcept C177713679 @default.
• W2344464657 hasConcept C199539241 @default.
• W2344464657 hasConcept C2779473830 @default.
• W2344464657 hasConcept C55587333 @default.
• W2344464657 hasConcept C71924100 @default.
• W2344464657 hasConceptScore W2344464657C112930515 @default.
• W2344464657 hasConceptScore W2344464657C127413603 @default.
• W2344464657 hasConceptScore W2344464657C17744445 @default.
• W2344464657 hasConceptScore W2344464657C177713679 @default.
• W2344464657 hasConceptScore W2344464657C199539241 @default.
• W2344464657 hasConceptScore W2344464657C2779473830 @default.
• W2344464657 hasConceptScore W2344464657C55587333 @default.
• W2344464657 hasConceptScore W2344464657C71924100 @default.
• W2344464657 hasIssue "1" @default.
• W2344464657 hasLocation W23444646571 @default.
• W2344464657 hasLocation W23444646572 @default.
• W2344464657 hasOpenAccess W2344464657 @default.
• W2344464657 hasPrimaryLocation W23444646571 @default.
• W2344464657 hasRelatedWork W1798870981 @default.
• W2344464657 hasRelatedWork W1970371692 @default.
• W2344464657 hasRelatedWork W2086802883 @default.
• W2344464657 hasRelatedWork W2170981806 @default.
• W2344464657 hasRelatedWork W2289435061 @default.
• W2344464657 hasRelatedWork W2464577366 @default.
• W2344464657 hasRelatedWork W2737571454 @default.
• W2344464657 hasRelatedWork W3190644262 @default.
• W2344464657 hasRelatedWork W4252371801 @default.
• W2344464657 hasRelatedWork W4281915604 @default.
• W2344464657 hasVolume "46" @default.
• W2344464657 isParatext "false" @default.
• W2344464657 isRetracted "false" @default.
• W2344464657 magId "2344464657" @default.
• W2344464657 workType "article" @default.