Global Surgery – Informing National Strategies for Scaling Up Surgery in Sub-Saharan Africa
Jakub
Gajewski
Royal College of Surgeons in Ireland, Dublin 2, Ireland
author
Leon
Bijlmakers
Radboud University
Medical Centre, Nijmegen, The Netherlands
author
Ruairí
Brugha
Royal College of Surgeons in Ireland, Dublin 2, Ireland
author
text
article
2018
eng
Surgery has the potential to address one of the largest, neglected burdens of disease in low- and middle-income countries (LMICs), especially in sub-Saharan Africa (SSA). The Lancet Commission on Global Surgery (LCoGS) has provided a blueprint for a systems approach to making safe emergency and elective surgery accessible and affordable and has started to enable African governments to develop national surgical plans. This editorial outlines an important gap, which is the need for surgical systems research, especially at district hospitals which are the first point of surgical care for rural communities, to inform the implementation of country plans. Using the Lancet Commission as a starting point and illustrated by two European Union (EU) funded research projects, we point to the need for implementation research to develop and evaluate contextualised strategies. As illustrated by the case study of Zambia, coordination by global and external stakeholders can enable governments to lead national scale-up of essential surgery, supported by national partners including surgical specialist associations.
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
7
v.
6
no.
2018
481
484
https://www.ijhpm.com/article_3485_b0d03a63699c77df49098703f33ab11c.pdf
dx.doi.org/10.15171/ijhpm.2018.27
Fostering the Catalyst Role of Government in Advancing Healthy Food Environments
Raphael
Lencucha
School of Physical & Occupational Therapy, McGill University, Montréal, QC,
Canada
author
Laurette
Dubé
McGill Centre for the Convergence for Health and Economics, McGill
University, Montréal, QC, Canada
author
Chantal
Blouin
Institut national de sante publique, Québec,
QC, Canada
author
Anselm
Hennis
Department of Noncommunicable Diseases and Mental Health,
Pan American Health Organization, Washington, DC, USA
author
Mauricio
Pardon
Pan American
Health Organisation, Washington, DC, USA
author
Nick
Drager
McGill University, Montréal, QC,
Canada
author
text
article
2018
eng
Effective approaches to non-communicable disease (NCD) prevention require intersectoral action targeting health and engaging government, industry, and society. There is an ongoing vigorous exploration of the most effective and appropriate role of government in intersectoral partnerships. This debate is particularly pronounced with regards to the role of government in controlling unhealthy foods and promoting healthy food environments. Given that food environments are a key determinant of health, and the commercial sector is a key player in shaping such environments (eg, restaurants, grocery stores), the relationship between government and the commercial sector is of primary relevance. The principal controversy at the heart of this relationship pertains to the potential influence of commercial enterprises on public institutions. We propose that a clear distinction between the regulatory and catalyst roles of government is necessary when considering the nature of the relationship between government and the commercial food sector. We introduce a typology of three catalyst roles for government to foster healthy food environments with the commercial sector and suggest that a richer understanding of the contrasting roles of government is needed when considering approaches NCD prevention via healthy food environments.
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
7
v.
6
no.
2018
485
490
https://www.ijhpm.com/article_3462_4bc2b3647d3b10eaa6f9c057587a5b1f.pdf
dx.doi.org/10.15171/ijhpm.2018.10
What Is Resilience and How Can It Be Nurtured? A Systematic Review of Empirical Literature on Organizational Resilience
Edwine
Barasa
Health Economics Research Unit, KEMRI Wellcome Trust Research
Programme, Nairobi, Kenya
author
Rahab
Mbau
Health Economics Research Unit, KEMRI Wellcome Trust Research
Programme, Nairobi, Kenya
author
Lucy
Gilson
School of Public Health and Family Medicine, University
of Cape Town, Cape Town, South Africa
author
text
article
2018
eng
Background Recent health system shocks such as the Ebola outbreak of 2014–2016 and the global financial crisis of 2008 have generated global health interest in the concept of resilience. The concept is however not new, and has been applied to other sectors for a longer period of time. We conducted a review of empirical literature from both the health and other sectors to synthesize evidence on organizational resilience. Methods We systematically searched for literature in PubMed, Econlit, EBSCOHOST databases, google, and Google Scholar and manually searched the reference lists of selected papers. We identified 34 papers that met our inclusion criteria. We analysed data from the selected papers by thematic review. Results Resilience was generally taken to mean a system’s ability to continue to meet its objectives in the face of challenges. The concepts of resilience that were used in the selected papers emphasized not just a system’s capacity to withstand shocks, but also to adapt and transform. The resilience of organizations was influenced by the following factors: Material resources, preparedness and planning, information management, collateral pathways and redundancy, governance processes, leadership practices, organizational culture, human capital, social networks and collaboration. Conclusions A common theme across the selected papers is the recognition of resilience as an emergent property of complex adaptive systems. Resilience is both a function of planning for and preparing for future crisis (planned resilience), and adapting to chronic stresses and acute shocks (adaptive resilience). Beyond resilience to acute shocks, the resilience of health systems to routine and chronic stress (everyday resilience) is also key. Health system software is as, if not more important, as its hardware in nurturing health system resilience
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
7
v.
6
no.
2018
491
503
https://www.ijhpm.com/article_3460_c345c9e12775645b1d1f07d2d4dacdd8.pdf
dx.doi.org/10.15171/ijhpm.2018.06
Sunshine Policies and Murky Shadows in Europe: Disclosure of Pharmaceutical Industry Payments to Health Professionals in Nine European Countries
Alice
Fabbri
Charles Perkins Centre and Faculty of Pharmacy, The University of Sydney,
Camperdown, NSW, Australia
author
Ancel.la
Santos
Health Action International, Amsterdam, The
Netherlands
author
Signe
Mezinska
Faculty of Medicine and Institute of Clinical and Preventive
Medicine, University of Latvia, Riga, Latvia
author
Shai
Mulinari
Department of Sociology, Faculty
of Social Sciences, Lund University, Lund, Sweden
author
Barbara
Mintzes
Charles Perkins Centre and Faculty of Pharmacy, The University of Sydney,
Camperdown, NSW, Australia
author
text
article
2018
eng
Relationships between health professionals and pharmaceutical manufacturers can unduly influence clinical practice. These relationships are the focus of global transparency efforts, including in Europe. We conducted a descriptive content analysis of the transparency provisions implemented by February 2017 in nine European Union (EU) countries concerning payments to health professionals, with duplicate independent coding of all data. Using an author-generated, semi-structured questionnaire, we collected information from each disclosure policy/code on: target industries, categories of healthcare professionals covered, scope of payments included, location and searchability of the disclosed data. Our analysis shows that although important improvements have been put in place in the past few years, significant gaps remain in disclosure requirements and their implementation. The situation differs substantially from country to country and the most striking differences are between governmental and self-regulatory approaches, especially with regard to the comprehensiveness of the disclosed data. In many cases, individuals can still opt out and reporting is incomplete, with common influential gifts such as food and drink excluded. Finally, in several countries data are only available as separate PDFs from companies, thus making the payment reports difficult to access and analyse. In order to overcome these gaps, minimum standards for disclosures should be implemented across Europe. All payments to healthcare professionals and organizations should be included, all health-related industries should be required to submit reports, and usability of disclosed data should be guaranteed.
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
7
v.
6
no.
2018
504
509
https://www.ijhpm.com/article_3478_01506afd7a87a4afdd601c98746920d5.pdf
dx.doi.org/10.15171/ijhpm.2018.20
Developing a Framework for a Program Theory-Based Approach to Evaluating Policy Processes and Outcomes: Health in All Policies in South Australia
Angela
Lawless
College of Nursing and Health Sciences, Flinders University, Adelaide, SA,
Australia
author
Fran
Baum
Southgate Institute for Health Society and Equity, Flinders University,
Adelaide, SA, Australia
author
Toni
Delany-Crowe
Southgate Institute for Health Society and Equity, Flinders University,
Adelaide, SA, Australia
author
Colin
MacDougall
College of Medicine and Public Health, Flinders
University, Adelaide, SA, Australia
author
Carmel
Williams
Department of Health and Ageing, Adelaide,
SA, Australia
author
Dennis
McDermott
The Poche Centre for Indigenous Health and Well-being, Flinders
University, Adelaide, SA, Australia
author
Helen
van Eyk
Southgate Institute for Health Society and Equity, Flinders University,
Adelaide, SA, Australia
author
text
article
2018
eng
Background The importance of evaluating policy processes to achieve health equity is well recognised but such evaluation encounters methodological, theoretical and political challenges. This paper describes how a program theorybased evaluation framework can be developed and tested, using the example of an evaluation of the South Australian Health in All Policies (HiAP) initiative. Methods A framework of the theorised components and relationships of the HiAP initiative was produced to guide evaluation. The framework was the product of a collaborative, iterative process underpinned by a policy-research partnership and drew on social and political science theory and relevant policy literature. Results The process engaged key stakeholders to capture both HiAP specific and broader bureaucratic knowledge and was informed by a number of social and political science theories. The framework provides a basis for exploring the interactions between framework components and how they shape policy-making and public policy. It also enables an assessment of HiAP’s success in integrating health and equity considerations in policies, thereby laying a foundation for predicting the impacts of resulting policies. Conclusion The use of a program theory-based evaluation framework developed through a consultative process and informed by social and political science theory has accommodated the complexity of public policy-making. The framework allows for examination of HiAP processes and impacts, and for the tracking of contribution towards distal outcomes through the explicit articulation of the underpinning program theory.
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
7
v.
6
no.
2018
510
521
https://www.ijhpm.com/article_3429_08e3e1d940657729be4c8cbc2a98110b.pdf
dx.doi.org/10.15171/ijhpm.2017.121
Promoting Researchers and Policy-Makers Collaboration in Evidence-Informed Policy-Making in Nigeria: Outcome of a Two-Way Secondment Model between University and Health Ministry
Chigozie
Jesse Uneke
African Institute for Health Policy & Health Systems, Ebonyi State University,
Abakaliki, Nigeria
author
Abel
Ebeh Ezeoha
African Institute for Health Policy & Health Systems, Ebonyi State University,
Abakaliki, Nigeria
author
Henry
Chukwuemeka Uro-Chukwu
National Obstetrics Fistula Centre,
Abakaliki, Nigeria
author
Chinonyelum
Thecla Ezeonu
Department of Paediatrics, Faculty of Medicine, Ebonyi
State University, Abakaliki, Nigeria
author
Jonathan
Igboji
Ebonyi State Ministry of Health, Abakaliki,
Nigeria
author
text
article
2018
eng
Background There is need to strengthen institutions and mechanisms that can more systematically promote interactions between researchers, policy-makers and other stakeholders who can influence the uptake of research findings. In this article, we report the outcome of a two-way secondment model between Ebonyi State University (EBSU) and Ebonyi State Ministry of Health (ESMoH) in Nigeria as an innovative collaborative strategy to promote capacity enhancement for evidence-to-policy-to-action. Methods This study was an exploratory design with a quantitative cross-sectional survey technique. A secondment memorandum of understanding (MOU) was signed between heads of EBSU and ESMoH. The secondment program lasted six months with ten researchers and ten policy-makers spending up to two days per week in each other’s organization. The secondee researchers got engaged in policy-making and implementation activities in ESMoH, while the policy-maker secondees got involved in research activities in EBSU. Secondees evidence-to-policy capacity enhancement meetings were held and questionnaires designed in 5-point Likert scale were used to assess their impact. Results The secondee policy-makers and researchers admitted having considerable knowledge of secondment with mean ratings (MNRs) of 3.40 and 3.74 respectively on the 5 points scale. Secondment appeared to be more common in the policy-makers’ organization (MNRs: 2.80-3.07) than in the researchers’ institution (MNRs: 2.58-2.84). The secondee policy-makers participated in some academic and research activities including serving in research ethics committee in EBSU and provided policy-making perspective to the activities. The secondee researchers supported the policymaking process in ESMoH through policy advisory roles, and provided capacity enhancement for staff of the ministry on the use of research evidence in policy-making. There was a noteworthy increase on knowledge of policy analysis and contextualization among the secondees ranging from 20.7% to 50.4% and 31.3% to 42.8% respectively following a training session. A Society for Health Policy Research and Knowledge Translation was established by mutual agreement of secondees as a platform to permanently institutionalize the collaboration. Conclusion The outcome of this study clearly suggests that secondment has great potential in promoting evidence informed policy-making and merits further consideration.
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
7
v.
6
no.
2018
522
531
https://www.ijhpm.com/article_3430_58ba939f63d71b0971180addf715114d.pdf
dx.doi.org/10.15171/ijhpm.2017.123
Prioritising, Ranking and Resource Implementation - A Normative Analysis
Lars
Sandman
National Center for Priority Setting in Health-Care, Department of Medicine and Health, Linköping University, Linköping, Sweden
author
text
article
2018
eng
Background Priority setting in publicly financed healthcare systems should be guided by ethical norms and other considerations viewed as socially valuable, and we find several different approaches for how such norms and considerations guide priorities in healthcare decision-making. Common to many of these approaches is that interventions are ranked in relation to each other, following the application of these norms and considerations, and that this ranking list is then translated into a coverage scheme. In the literature we find at least two different views on how a ranking list should be translated into coverage schemes: (1) rationing from the bottom where everything below a certain ranking order is rationed; or (2) a relative degree of coverage, where higher ranked interventions are given a relatively larger share of resources than lower ranked interventions according to some “curve of coverage.” Methods The aim of this article is to provide a normative analysis of how the background set of ethical norms and other considerations support these two views. Results The result of the analysis shows that rationing from the bottom generally gets stronger support if taking background ethical norms seriously, and with regard to the extent the ranking succeeds in realising these norms. However, in non-ideal rankings and to handle variations at individual patient level, there is support for relative coverage at the borderline of what could be covered. A more general relative coverage curve could also be supported if there is a need to generate resources for the healthcare system, by getting patients back into production and getting acceptance for priority setting decisions. Conclusion Hence, different types of reasons support different deviations from rationing from the bottom. And it should be noted that the two latter reasons will imply a cost in terms of not living up to the background set of ethical norms.
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
7
v.
6
no.
2018
532
541
https://www.ijhpm.com/article_3432_62c71755a6ba0ec18b70f6b6c2ac9744.pdf
dx.doi.org/10.15171/ijhpm.2017.125
Misuse of Artemisinin Combination Therapies by Clients of Medicine Retailers Suspected to Have Malaria Without Prior Parasitological Confirmation in Nigeria
Earnest
Nwokolo
Society for Family Health, Abuja, Nigeria
author
Chinazo
Ujuju
Society for Family Health, Abuja, Nigeria
author
Jennifer
Anyanti
Society for Family Health, Abuja, Nigeria
author
Chinwoke
Isiguzo
Society for Family Health, Abuja, Nigeria
author
Ifeanyi
Udoye
Society for Family Health, Abuja, Nigeria
author
Elamei
Bongos-Ikwue
Society for Family Health, Abuja, Nigeria
author
Onoriode
Ezire
Society for Family Health, Abuja, Nigeria
author
Mopelola
Raji
Society for Family Health, Abuja, Nigeria
author
Wellington A.
Oyibo
ANDI Centre of Excellence for
Malaria Diagnosis, College of Medicine, University of Lagos, Lagos, Nigeria
author
text
article
2018
eng
Background Prompt and effective case detection and treatment are vital components of the malaria case management strategy as malaria-endemic countries implement the testing, treating and tracking policy. The implementation of this policy in public and formal private sectors continue to receive great attention while the informal private retail sector (mostly the patent and propriety medicine vendors [PPMVs]) where about 60% of patients with fever in Nigeria seek treatment is yet to be fully integrated. The PPMVs sell artemisinin combination therapies (ACTs) without prior testing and are highly patronized. Without prior testing, malaria is likely to be over-treated. The need to expand access to diagnosis in the huge informal private health sector among PPMVs is currently being explored to ensure that clients that patronize retail drug stores are tested before sales of ACTs. Methods A cross-sectional multistage study was conducted among 1279 adult clients, 20 years and above, who purchased malaria medicines from 119 selected PPMVs in five administrative areas (States) of Nigeria, namely: Adamawa, Cross River, Enugu, Lagos and Kaduna, as well as the Federal Capital Territory, Abuja. Exit interviews using a standard case report questionnaire was conducted after the purchase of the antimalarial medicine and thick/thin blood smears from the clients’ finger-prick were prepared to confirm malaria by expert microscopy. Results Of the 1279 clients who purchased malaria medicines from the PPMV outlets, 107 (8.4%) were confirmed to have malaria parasites. The malaria prevalence in the various study areas ranged from 3.5% to 16%. A high proportion of clients in the various study sites who had no need for malaria medicines (84%-96.5%) purchased and used antimalarial medicines from the PPMVs. This indicated a high level of over-treatment and misuse of antimalarials. Common symptoms that are widely used as indicators for malaria such as, fever, headache, and tiredness were not significantly associated with malaria. Nausea/vomiting, poor appetite, chills, bitter taste in the mouth and dark urine were symptoms that were significantly associated with malaria among the adult clients (P < .05) but not fever (P = .06). Conclusion Misuse of ACTs following overtreatment of malaria based on clinical diagnosis occurs when suspected cases of malaria are not prior confirmed with a test. Non-testing before sales of malaria medicines by PPMVs will perpetuate ACT misuse with the patients not benefiting due to poor treatment outcomes, waste of medicines and financial loss from out-of-pocket payment for unneeded medicines.
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
7
v.
6
no.
2018
542
548
https://www.ijhpm.com/article_3434_327540839a42482eefba872bd3a42365.pdf
dx.doi.org/10.15171/ijhpm.2017.122
Knowledge, Attitude, and Practices Regarding HIV and TB Among Homeless People in Tehran, Iran
Fahimeh
Bagheri Amiri
Urology and Nephrology Research Center, Shahid Beheshti University of
Medical Sciences, Tehran, Iran
author
Amin
Doosti-Irani
Department of Epidemiology, School of
Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
author
Abbas
Sedaghat
Blood Transfusion Research Center, High Institute for Research and Education
in Transfusion Medicine, Tehran, Iran
author
Noushin
Fahimfar
Department
of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
author
Ehsan
Mostafavi
Department of Epidemiology and Biostatistics, Research Centre for Emerging
and Reemerging Infectious Diseases, Pasteur Institute of Iran, Tehran, Iran
author
text
article
2018
eng
Background Homeless people are at high risk of HIV and tuberculosis (TB) infection due to living in poor sanitary conditions and practicing high-risk behavior. The aim of this study is to assess the knowledge, attitude, and practice (KAP) of homeless people in Tehran regarding TB and HIV. Methods Using a convenience sampling, we performed a cross-sectional study on homeless people in Tehran from June to August 2012. Participants aged 18-60 years having at least 10 days of homelessness in the preceding month to the study period were included. All required data were collected through face-to-face interviews conducted using a researcherdesigned questionnaire. Each score in KAP of TB and HIV was separately divided by the maximum score and multiplied by 100 to attain percentage scores. The mean scores were compared using analysis of variance (ANOVA) and student’s t test. A Tukey test was used for post hoc analysis and two-by-two comparisons. Results In this study, 593 participants consisting of 513 men and 80 women were included. The mean age of the participants was 41.74 ± 0.45 years. Moreover, the total mean score of KAP toward HIV was 79.24 (95% CI: 77.36, 81.12), 57.13 (95% CI: 55.12, 59.14), and 21.14 (95% CI: 18.35, 23.93), respectively. The total mean score of knowledge and practice regarding TB was 62.04 (95% CI: 59.94, 64.14) and 42.57 (95% CI: 40.36, 44.78), respectively. Conclusion Although a relatively acceptable knowledge was detected in this high-risk population, practices regarding TB and HIV showed some weaknesses. Developing special programs to improve the healthy behavior of this population is highly recommended.
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
7
v.
6
no.
2018
549
555
https://www.ijhpm.com/article_3435_fa993d2da014f0618fc43b17f5df90c2.pdf
dx.doi.org/10.15171/ijhpm.2017.129
Connections, Communication and Collaboration in Healthcare’s Complex Adaptive Systems; Comment on “Using Complexity and Network Concepts to Inform Healthcare Knowledge Translation”
Tracey
Bucknall
School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong,
VIC, Australia
author
Danielle
Hitch
Occupational Therapy,
School of Health and Social Development, Deakin University, Geelong, VIC,
Australia
author
text
article
2018
eng
A more sophisticated understanding of the unpredictable, disorderly and unstable aspects of healthcare organisations is developing in the knowledge translation (KT) literature. In an article published in this journal, Kitson et al introduced a new model for KT in healthcare based on complexity theory. The Knowledge Translation Complexity Network Model (KTCNM) provides a fresh perspective by making the complexity inherent in complex systems overt. The model encourages a whole system view and focuses on the interdependent relationships between actions, interactions and actors. Taking a systems approach assists our understanding of the connections, communication and collaboration necessary to promote knowledge mobilisation and facilitate the adoption of change. With further development, this could enable the targeting of more effective strategies across the various stakeholders and levels of service, fostering redesign and innovation.
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
7
v.
6
no.
2018
556
559
https://www.ijhpm.com/article_3443_4666c4396e2c7e955e4c34364c4c77b5.pdf
dx.doi.org/10.15171/ijhpm.2017.138
Applying KT Network Complexity to a Highly-Partnered Knowledge Transfer Effort; Comment on “Using Complexity and Network Concepts to Inform Healthcare Knowledge Translation”
JoAnn E.
Kirchner
QUERI for Team-Based Behavioral Healthcare, Central Arkansas Veterans
Healthcare System, Little Rock, AR, USA
author
Sara J.
Landes
VISN 16 South Central Mental
Illness Research Education and Clinical Center (MIRECC), Central Arkansas
VA Health Care System, Little Rock, AR, USA
author
Aaron E.
Eagan
Office of Mental Health and
Suicide Prevention, Department of Veterans Affairs, Gainesville, FL, USA
author
text
article
2018
eng
The re-conceptualization of knowledge translation (KT) in Kitson and colleagues’ manuscript “Using Complexity and Network Concepts to Inform Healthcare Knowledge Translation” is an advancement in how one can incorporate implementation into the KT process. Kitson notes that “the challenge is to explain how it might help in the healthcare policy, practice, and research communities.” We propose that these concepts are well presented when considering highly-partnered research that includes all sectors. In this manuscript we provide an example of highly-partnered KT effort framed within the KT Complexity Network Theory. This effort is described by identifying the activities and sectors involved.
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
7
v.
6
no.
2018
560
562
https://www.ijhpm.com/article_3444_d68e0b54c935cbb9061cdad1483fd3df.pdf
dx.doi.org/10.15171/ijhpm.2017.141
Using Complexity to Simplify Knowledge Translation; Comment on “Using Complexity and Network Concepts to Inform Healthcare Knowledge Translation”
Anita
Kothari
School of Health Studies, Faculty of Health Sciences, Western University, London, ON, Canada
author
Shannon
Sibbald
School of Health Studies, Faculty of Health Sciences, Western University, London, ON, Canada
author
text
article
2018
eng
Putting health theories, research and knowledge into practice is a challenge referred to as the knowledge-toaction gap. Knowledge translation (KT), and its related concepts of knowledge mobilization, implementation science and research impact, emerged to mitigate this gap. While the social interaction view of KT has gained currency, scholars have not easily made a link between KT and the concept of complexity. Kitson and colleagues suggest we ought to examine the role of complexity in KT processes using defined theories and concepts borrowed from network and complex adaptive systems theory. They further argue that better KT outcomes might be achieved using this new lens. There remain, however, several critical considerations for this sort of theory application to work in the real-world. Complexity and network theory offer explanatory power about the KT problem, but these theories are less helpful for understanding solutions.
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
7
v.
6
no.
2018
563
565
https://www.ijhpm.com/article_3447_fcf7743f3f86fcf05b46b614e9ec044b.pdf
dx.doi.org/10.15171/ijhpm.2017.139
From Linear to Complicated to Complex; Comment on “Using Complexity and Network Concepts to Inform Healthcare Knowledge Translation”
Jo
Rycroft-Malone
School of Healthcare Sciences, Bangor University, Bangor, UK
author
text
article
2018
eng
Attention to collaborative approaches to encouraging evidence use in healthcare practice are gaining traction. The inherent complexities in collaborative and networked approaches to knowledge translation (KT) have been embraced by Kitson and colleagues in their complexity network model. In this commentary, the potential of complexity as presented by Kitson et al within their model is considered. The utility of such a model will be contingent upon how easy users find it to understand and apply to their challenge, and doing so in a way that is useful to not only help with explanation, but also with prediction.
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
7
v.
6
no.
2018
566
568
https://www.ijhpm.com/article_3453_2b4fe539db485d73a1786d3f8cc8283b.pdf
dx.doi.org/10.15171/ijhpm.2018.02
The Paradox of Intervening in Complex Adaptive Systems; Comment on “Using Complexity and Network Concepts to Inform Healthcare Knowledge Translation”
Jacqueline
Chandler
Cochrane, London, UK
author
text
article
2018
eng
This commentary addresses two points raised by Kitson and colleagues’ article. First, increasing interest in applying the Complexity Theory lens in healthcare needs further systematic work to create some commonality between concepts used. Second, our need to adopt a better understanding of how these systems organise so we can change the systems overall behaviour, creates a paradox. We seek to manipulate systems that self-organise and follow their own internal rules. Although, our actions may impact and indeed meet some of our objectives, system behaviour will always emerge with unpredictable consequences. Likewise, outcomes at the aggregated level of the system never reaches an optimal point as defined by the ‘external controller.’ Kitson and colleagues’ theoretical model may struggle to resolve the paradox of gaining control over the multiple knowledge translation (KT) systems covered by the model, because theoretically these systems retain control under the principle of self-organisation. That is not to suggest that individual agents cannot influence system dynamics just that the desired outcome cannot be guaranteed. Indeed, for systems to change they will need strong incentives.
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
7
v.
6
no.
2018
569
571
https://www.ijhpm.com/article_3456_5ca311b0b5a9175d0dbfeed2e8022ede.pdf
dx.doi.org/10.15171/ijhpm.2018.05
Researching the Co-Existence and Continuity of Standardization and Customization in Healthcare: A Response to Recent Commentaries
Russell
Mannion
Health Services Management Centre, University of Birmingham, Birmingham, UK
author
Mark
Exworthy
Health Services Management Centre, University of Birmingham, Birmingham, UK
author
text
article
2018
eng
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
7
v.
6
no.
2018
572
573
https://www.ijhpm.com/article_3457_76deb3a5f1d3278aab4c62eeeff21f1e.pdf
dx.doi.org/10.15171/ijhpm.2018.07