Research Article: Health systems thinking: A new generation of research to improve healthcare quality

Date Published: October 30, 2018

Publisher: Public Library of Science

Author(s): Hannah H. Leslie, Lisa R. Hirschhorn, Tanya Marchant, Svetlana V. Doubova, Oye Gureje, Margaret E. Kruk

Abstract: Hannah Leslie and colleagues of the High-Quality Health Commission discuss in an Editorial the findings from their report that detail the improvements needed to prevent declines in individuals’ health as the scope and quality of health systems increase. Patient-centered care at the population level, improved utility of research products, and innovative reporting tools to help guide the development of new methods are key to improved global healthcare.

Partial Text: Conducting meaningful research depends upon a common language and valid measures to benchmark progress and inform action. A peril of the current global attention to health system quality is the elasticity of central concepts concerning quality care and people-centered health systems. Without shared understanding and standards among researchers and policy makers, momentum is in danger of dissipating into inconsistent assessments and mutually incomparable investments, leaving researchers without insight and policy makers without direction.

The dominance of global rather than national funders for health system research and the privileging of short-term, program-specific effects over breadth and sustainability has resulted in fragmented assessments that are poorly suited to sound policy making [1,16]. Country-level action is needed to guide the next generation of research towards system-wide improvement. Strengthening quality measurement and implementing large-scale improvements demands a capacity for synthesizing complex data that goes beyond current mechanisms for collection and analysis. Countries must strengthen capacity to extract meaningful insight about system quality from diverse data sources—demographics, health information systems, finance, and patient sources, among others—to inform decisions across health system levels.

In measurement, innovation is needed in tools and methods to collect data on patient experience and outcomes, to extract insight on quality from health facilities and systems, and particularly to synthesize information for practical application. In improvement, tools are needed for broad-scale evaluation that balances feasibility against rigorous assessment of causality and transferability. Pooling insight and tools across traditional disciplinary divides and looking beyond health science to education and organizational management can accelerate progress. Solutions must consider representativeness as well as vulnerable subpopulations to ensure this progress is equitable.



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