Most countries are transforming their health systems to meet the challenges posed by the shifting burden of disease, demographic changes, workforce pressures, the arrival of digital health, and artificial intelligence. To overcome these challenges, health systems across countries are looking to similar solutions - improving population health, patient-centeredness, strengthening integrated care, and overcoming fragmentation. However, while ‘whys’ and ‘whats’ for transformation are clear, less attention is being devoted to the trickier matter of how to make it happen. This seminar will focus on those ‘hows’, with special emphasis on policy-level changes and lessons learnt from health system transformation across Europe.
Transforming health systems is a complex challenge with no quick straightforward solutions. Most observers agree that even when policies are well designed their implementation can frequently result in failure. To better understand why policy failures occur, Prof David Hunter and Dr Rafael Bengoa launched a project under the auspices of the Division of Health Systems and Public Health, WHO European Region. The project’s principal aim is to provide practical guidance and tools to policy-makers and practitioners that are based on first-hand experience in implementing health system changes across European countries. From these experiences of health system transformations, they have identified sets of enablers, facilitators, and barriers to large-scale changes in selected countries (Sweden, England, Spain, and Portugal). Sharing all lessons learnt from across European experiences will help health systems across Europe and beyond to make faster progress and make more efficient use of resources in the endeavour of carrying out all necessary transformations. This project draws on research undertaken by Andrew Pettigrew and colleagues at the University of Warwick at the time of the NHS internal market reforms in the early 1990s. They devised a receptive context for change framework, including the five factors we have used for our project. Some 27 years later, this remains relevant. Taken together, the factors can guide and shape transformational change efforts.
In an effort to tackle the ‘know-do’ gap, this programme of work is co-led by Prof. David Hunter and Dr Rafael Bengoa. Prof. Hunter´s academic career spans over 40 years researching complex health systems, with a particular interest in how policy is formed and implemented, public health, and healFth systems transformation. Between 1999 and July 2017, David was Director of the Centre for Public Policy and Health at Durham University. The Centre was designated a WHO Collaborating Centre in Complex Health Systems Research, Knowledge and Action in 2014. David moved to the Institute of Health & Society, Newcastle University in August 2017. Since August 2018 he is an Emeritus Professor at Newcastle University. Dr Rafael Bengoa is Co-Director of the Institute for Health and Strategy (Si-Health), Bilbao, Spain. He was Director for Health System Policies in the World Health Organization and former Minister for Health and Consumer Affairs in the Basque Regional Government. Previously, he was Vice Chairman of the Advisory Group of Horizon 20/20. He is a Senior Fellow of Harvard University School of Public Health and an International Policy Advisor in Health and Social Sector. He recently led the Committee for the Health Reform in Northern Ireland (Systems, not Structures).
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