Professor Andrew Long

1
Health Systems Research What is it? And, does it
matter?

• Professor Andrew Long
• School of Healthcare
• University of Leeds
• a.f.long_at_leeds.ac.uk
• June 19th 2006

2
Overview of Presentation

• To elaborate on the range of meanings attached to
  health systems research
• To identify essential commitments of HSyR
• As a philosophy of practice
• As a commitment to problem definition
• To explore the HSyR features of three case
  studies
• Evaluation of older people partnership
• Population health and measles prevention
• Fostering an outcomes culture in routine practice

3
Health Systems Research playing with words?

• Health
• Healthy vs. dis-eased well vs. ill working vs.
  incapacitated
• And connotations within health services
• Managing disease
• Promoting health and healing
• Population, community or individual health
• Systems
• Complex whole inter-connected parts
• Organised, structured group of things
• Research
• Systematic enquiry acquire knowledge
• Enhance evidence base
• Inform and empower (service and research) users
  gt influence policy and practice

4
Joining the words together!

• Health systems
• Whole systems to support or improve health and
  well-being
• Whole systems of health care
• Systems within systems e.g. intermediate care
  TCM acupuncture within complementary and
  alternative medicine
• Health research
• Research applied to health and ill-health
  epidemiology
• Research studying health sociology economics
  
• Health systems research
• Whole systems research (exploring complex health
  care interventions)
• Melting point for different disciplines
• Philosophy about a way of doing research
• Multiple perspectives

5
Some Definitions

• Health research
• Study of health individual, community,
  population
• Health services research (HSR)
• study/evaluation of provision, effectiveness,
  efficiency and use of health services
• Health systems research (HSyR)
• study/evaluation of health sector to enhance
  or contribute to health of the community
• Whole systems research (WSyR)
• study/evaluation of systems that honours the
  philosophy, integrity and complexity of that
  system, that is, its explanatory model

6
HSyR Essential Commitments

• Field of Research
• Complexity of programmes and policies in health
  (and other) policy sectors
• Beginning and end of health care, vs. social
  care, vs. community care
• Crossing the RD Divide - Research into Practice
• Involve key stakeholders (decision makers,
  services users, carers) in research process
  design to implementation
• Timely, relevant research and utility for
  practice
• Evaluation and Research as Learning
• Not just means to see what works, for whom, in
  what circumstance and from whose perspective
• But to identify and celebrate learning (for all
  stakeholders), and
• Enable ongoing evaluation in practice
  sustainable change
• Mode of Working
• Complexity requires working with and across
  disciplines
• Melting pot where disciplines can meet, listen,
  learn and share to explore the totality of the
  research problem

7
Desirable Process and Outcome

• The involvement of users throughout the
  research process helps to create a cadre of
  sophisticated research users who are not only
  able to make effective use of research, but can
  more clearly specify what their needs are .
  (National Audit Office, 2003)

8
Case Study One Evaluation of Interventions for
Prevention for Older People

• What is the Problem
• Evaluating Partnerships for Older People
  Programme aimed at promoting independence of
  older people and preventing long term
  institutional care
• Policy led, research to influence longer term
  commitment by Treasury
• System Complexity
• Prevention ?
• Success criteria ? (whose perspective to
  adopt?)
• Outcome realisation the more upstream the
  longer the time scale
• Understanding of what works for whom vs.
  does it work?
• Team Composition
• Older people (City X Older Peoples Forum) in
  form of Greek chorus
• Change agent team ... Project lead network
• Multiple disciplines older people researchers,
  social and health systems, health economist,
  statistician, gerontology, sociology/social
  research methodology

9
Case Study Two Population Health and Measles
Prevention (Jackson et al)

• What is the Problem
• How to increase the take-up of MMR (vs. single
  disease vaccination approach)
• Research project to explore feasibility,
  acceptability and effectiveness of parent forum
  (plus usual care)
• System Complexity
• Conceptual model cognitive-deficit model vs.
  engagement model
• Multiple outcomes parents, child, vaccination,
  disease incidence
• Team Composition
• Parent co-leader of Parent Forum
• Health Protection Agency, PCT immunisation
  co-ordinators
• Multiple disciplines nursing/primary
  care/public health researchers, psychology,
  public health physician, decision analyst, health
  economist, statistician

10
Case Study Three Fostering an Outcomes Culture
in Routine Practice

• What is the Problem
• Sustainability ongoing monitoring of achieved
  outcomes / evaluation of practice (vs. one-off
  external evaluation)
• System Complexity
• What outcome different perspectives
• What outcome measures/measurement tools quality
  and feasibility
• Outcomes of our intervention or others or of
  the whole
• Timescale to realise desired outcomes
• Commitment and time availability of practitioners
• Team Composition
• Local practitioners
• External facilitators health systems research,
  outcome measurement, health economist
• External resource/service managers

11
HSyR Some Benefits and Caveats

• Research only that which the government or other
  policy makers wants, timely issues, emphasis on
  utility and transferability of findings, that are
  relevant to practice
• Value to NHS, practice and decision making
• Maximising benefit to society/citizens
• Questions over, inter alia
• Research, must be generalisable beyond the local
  setting (not just this particular setting)
• Research as enlightenment, shaping policy agenda,
  challenging existing assumptions and encouraging
  debate
• Public good vs. policy/political wish

12
Concluding Comments

• HSyR
• At a minimum, systems approach leads to
  broadening of problem definition
• At an optimum, enabling breadth of understanding
  of the whole, co-working, trans-disciplinary
  opportunities, enhancing population health and
  well-being
• HSyR
• As a means to enhance take-up of research
  findings into practice
• Engage with service users and carers
• Ultimate test is practice changed?