The Rural Research Capacity
Building Program 2
The contribution of primary health care research and researchers to health reform consultation
2
2010 Primary Health Care Research Conference 3 Patient safety in primary
health care 3
RESEARCH ROUNDup 4
Divisions Network matters 4-5 Passion and commitment:
Getting it out here 6 Tri-State Program hosts US
Professor 6
Thanks for the evidence 7 PHCRED Strategy: Research Capacity Building Initiative 7-12 WebsiteWatch: The future of health research: Web 2.0 12
BookWatch: 13 Laying foundations for
innovative and sustainable policy
14
Claiming the space: Shaping the future of primary health care
14
Health services research:
Reforming, responding, rewarding
15
ReportWatch: Systems thinking for health systems strengthening
15
Upcoming events 16
Editorial: Where next for primary care?
Philip Davies, Professor of Health Systems & Policy, School of Population Health, University of Queensland
In 1962 Decca Records in England famously declined to sign the Beatles on the grounds that “guitar groups are on the way out”. Despite the obvious hazards of crystal ball gazing it is important that researchers consider what might lie ahead for primary care.
Traditional, open-ended, fee-for-service payments are no longer fit for purpose as the sole (or even principal)
basis for funding primary care.
We need to embrace multi- disciplinary care but if fee- for-service rebates, in their present form, were to be made widely available to non-medical practitioners, Medicare spending could spiral out of control.
Telephone and internet- based consultations are set to grow in importance but cannot easily be
accommodated within the existing funding paradigm.
‘Pure’ fee-for-service doesn’t adequately reward
preventative services; it can inhibit effective management of chronic conditions; and it has failed to bring sufficient services to rural and remote communities.
New approaches to primary care funding are likely to blend fee-for-service, capitation and pay-for- performance. But changes to how the money flows will drive broader developments in the sector.
Capitation and pay-for- performance both require a
formal link between service providers and service users, so patient ‘enrolment’ or affiliation with practices seems inevitable. Practices will also need to interface with electronic health record systems and employ a more diverse range of professional and support staff.
In order to meet such
challenges, practices will need to strengthen their
management capacity and invest in new technologies.
Novel forms of organisation can be expected to emerge as primary care becomes more complex and capital- intensive.
As far as the primary care research agenda is
concerned, we can expect to see the focus shift from the processes of care to the business and institutional context in which services are delivered.
“Nothing’s gonna change my world”, sang the Beatles some eight years after their
rejection by Decca. It’s doubtful whether the primary care community could make that same claim today.
PHC RIS Assist 1800 025 882 www.phcris.org.au
Volume 14, Issue 3 February 2010 ISSN 1832 620X
PHC RIS infonet
Call for abstracts closing 19 March
Visit www.phcris.org.au/conference/2010 Newsletter of the Primary Health Care
Research & Information Service
Page 2 Volume 14, Issue 3
authors of discussion and
commissioned papers, 17% had a current PHC university appointment.
PHC research organisations made 40 submissions to the three initiatives.
Using a definition of primary health care research used by the Primary Health Care Research, Evaluation and Development (PHCRED) program, we identified approximately 12% of more than 8 000 references cited in
submissions and commissioned papers as PHC research publications. Thirty four citations were for research carried out under the PHCRED program by the Australian Primary Health Care Research Institute (APHCRI) and PHC RIS.
The National Primary Health Care Strategy final report accompanying the draft Strategy cited 26% of the submissions received. It cited 50% of submissions from consumer groups
and 45% of submissions from research organisations, most of which (eight out of 10) were from PHC research organisations.
PHC researchers and research make a considerable contribution to the three reform initiatives and the study highlights the capacity of Australian PHC research to contribute to such policy initiatives. This could be enhanced by researchers
understanding the relevance of their research to policy and reform
questions, developing the skills to write a good submission, and using
opportunities to contribute to
submissions by credible organisations within their networks.
The Final Report is now available on the PHC RIS website:
<www.phcris.org.au/activities/>
Eleanor Jackson Bowers and Libby Kalucy, PHC RIS
During 2009, with three major reform strategies occurring and all their consultation documents, submissions and reports being publicly available, PHC RIS took the opportunity to establish what contribution primary health care (PHC) research and researchers have made to the Australian health reform effort. Using publicly available information on the websites of the three reform initiatives, we were able to show that of the 30 people nominated by the Minister of Health to take part in working groups, one third had published papers in the field of primary health care. Of the 70
The contribution of primary health care research and researchers to health reform consultation
The Rural Research Capacity Building Program: developing research skills in rural health workers
program requirements. Six have submitted their final reports for review and 38 candidates are active in the program. Nineteen candidates have withdrawn.
During initial training, self assessment on a five point scale of experience with ten research skills was determined using a ‘research spider’.2 This measure is repeated at month 18 and again at completion of the program. A two-tailed paired test was used to compare results. Combined results from the 2006 and 2007 cohorts yielded significant results for all ten measures for month one and month 18 (n=33), and month one and
completion (n=15). This supports findings from ‘graduation interviews’
conducted with candidates, where many described the satisfaction of extending themselves, learning and applying new knowledge and finishing the research and final report.
While the overall program is
coordinated by NSW IRCST, its delivery relies on partnerships with other organisations such as the NSW PHC Collaboration, the Australian Rural Health Research Collaboration and the
support of the rural Area Health Services.
More information on the RRCBP including evaluation and completed research reports can be found on our website <www.ircst.health.nsw.gov.au/
initiatives/
building_rural_research_capacity>
References
1 NSW Health Department. (2001). A Framework for Building Capacity to Improve Health. Sydney: Better Health Centre.
2 Smith H, Wright D, Morgan S, Dunleavey J, Moore M. (2002). The 'Research Spider': a simple method of assessing research experience. Primary Health Care Research and Development, 3, 139-140.
Emma Webster, Rural Research Support Officer, NSW Institute of Rural Clinical Services and Teaching
The Rural Research Capacity Building Program (RRCBP) commenced in 2006 and is an initiative of the NSW Institute of Rural Clinical Services and Teaching (NSW IRCST). It aims to develop research skills in rural health workers through participation in a structured program based on principles of capacity building.1 Intakes close annually in June, and following a formal selection process, candidates accepted into the program are provided with face to face and telephone based teaching, project development support, mentoring and 97 paid backfill days over two years.
Candidates are expected to submit their proposal for ethical review, undertake the research and publish a report in that timeframe.
Since 2006, NSW IRCST has accepted 84 people into the RRCBP over four intakes. Twenty one have completed all
PHC RIS infonet Page 3
2010 Primary Health Care Research Conference
to share ideas, form collaborations and networks with speakers and other delegates.
Our theme this year is Primary health care research and reform: Improving care. Given that primary health care and prevention are at the forefront of the reform agenda, research in these areas is vital to ensure changes will improve care. The research presented at this conference will contribute to this these changes.
As we have come to expect, this conference will be an ideal opportunity to present and discuss relevant research.
Building on from previous conferences and taking into account the increase in primary health care research, the
PHC RESEARCH AND HEALTH REFORM: IMPROVING CARE
Ellen McIntyre, Conference Convenor &
Fiona Thomas, Conference Coordinator, PHC RIS
Call for abstracts now open The annual Primary Health Care Research Conference (formerly the GP
& PHC Research Conference) is one of the premier primary health care networking events in Australia. It is a must for anyone with an interest in primary health care research, evaluation and development. The conference provides essential
opportunities for researchers, decision makers, practitioners and consumers
and Quality in Health Care, which was established in 2005 to lead and coordinate improvements in safety and quality nationally.
The Commission’s remit is across the continuum of health care, including primary and acute care, in both the public and private sectors. Many of the Commission’s existing programs are relevant to primary health care, and the Commission is now keen to build on this by focusing specifically on patient safety issues in this sector.
The Commission will shortly be releasing a discussion paper about patient safety in primary care in Australia. Patient safety relates to the reduction of unnecessary harm, and is distinct from the broader definitions of quality.3 Although the evidence base and research methods in this field are still developing, it is clear that there are significant patient safety risks in primary health care, and that patients may experience considerable harm from the errors and incidents that occur in these settings.4 The
Commission wants to raise awareness of these issues, stimulate discussion, and support coordinated national action on patient safety in primary care. In the context of current health reforms, there are opportunities to build on the systems and programs
that already exist to further improve the safety and quality of primary health care in Australia.
References
1 Wilson RM, Runciman WB, Gibberd RW, Harrison BT, Newby L, Hamilton JD.
(1995). The Quality in Australian Health Care Study. Medical Journal of Australia.
163:458-71.
2 Faunce TA, Bolsin SNC. (2004). Three Australian whistleblowing sagas: Lessons for internal and external regulation.
Medical Journal of Australia. 181(1):
44-7.
3 Runciman W, Hibbert P, Thomson R, Van Der Schaaf T, Sherman H, Lewalle P.
(2009). Towards an International Classification for Patient Safety: Key concepts and terms. International Journal for Quality in Health Care. 21 (1):18-26.
4 Pearson A, Aromataris E. (2009). Patient Safety in Primary Healthcare: A Review of the Literature. Adelaide: Joanna Briggs Institute.
<www.safetyandquality.gov.au/internet/
safety/publishing.nsf/Content/com- pubs_PrimaryCare-con/$File/26889- Literature-Review.PDF>
Nicola Dunbar, Program Manager, Australian Commission on Safety and Quality in Health Care
<www.safetyandquality.gov.au/ >
The field of patient safety emerged following research showing that a large number of harmful, but potentially preventable, incidents occur in hospitals,1 and following a number of high profile inquiries into incidents at specific hospitals.2 These origins mean that the focus of much of the early patient safety work was limited to issues that were particularly relevant for acute care settings; there was little examination of the patient safety risks that exist in primary health care.
In Australia, however, most health care is provided in primary care settings.
Given the size and importance of this sector, it is essential that attention is paid to ensuring that the care provided in this sector is safe, and that risks of unnecessary harm associated with the delivery of health care are minimised.
There are a large number of organisations that have a role in quality and safety in primary health care in Australia, and many initiatives are in place to improve care in this sector. One of these organisations is the Australian Commission on Safety
Patient safety in primary health care: Time for national action
program is an exciting blend of keynote speakers, panel sessions, workshops, symposia, and poster and paper presentations.
We invite you to submit abstracts for papers, posters, symposia and workshops covering all forms of primary health care research including general practice, allied and community health, nursing, multidisciplinary teams and models of care.
The call for abstracts closes Friday, 19 March.
Visit <www.phcris.org.au/
conference/2010> for more details.
Page 4 Volume 14, Issue 3
input from a palliative specialist from Adelaide.
The initial audit held in July 2009, reviewed three cases provided by local GPs and palliative care nurses. All presented challenging aspects including less than optimal symptom control or an issue with communication or Advance Directives (legal documents that allow you to convey your decisions about end-of-life care ahead of time).
Discussion included a brief preview of the case from the health professional/s involved and an outline of best practice and care standards provided by a palliative specialist from the Southern Adelaide Palliative Service. Together with identifying two to three key learning points, the group also identified actions or systemic changes that might improve palliative care in the region.
The benefits of this approach include the opportunity for health professionals to share their knowledge and to ask the palliative specialist questions both about the cases being reviewed and the care of current patients.
Evaluations show that participants value the opportunity to build a
professional relationship with the palliative specialist from Adelaide and are changing their practice as a result of what they have learned at the audit sessions. A summary of each audit is also distributed to interested
stakeholders across the region.
Subsequent audits in October 2009 and February 2010 have attracted a growing and diverse range of health professionals including GPs, palliative care and community health nurses, pharmacists, medical students and local health service managers. Staff from local residential aged care facilities have also expressed interest in attending.
For further information Helene can be contacted on P: 08 8552 7981 or E: [email protected]
A TEAM APPROACH TO PALLIATIVE CARE CLINICAL AUDITS
Helene Hipp,
Rural Palliative Care Coordinator, General Practice Network South Inc
Palliative care clinical audits held in the Southern Fleurieu Region, including Kangaroo Island (South Australia), use a multidisciplinary approach to review difficult cases.
The quarterly audits have been introduced as part of the federally- funded General Practice Network South (GPNS) Rural Palliative Care Project, in conjunction with local health
professionals.
Initial consultation recognised that existing local multidisciplinary team meetings lacked a specific focus on palliative patients, did not always include the treating GP or have regular
Divisions Network matters
RESEARCH ROUNDup: Australia’s primary health care research workforce
The Australian government has recognised the importance of strengthening PHC research by establishing the Primary Health Care Research, Evaluation and Development (PHCRED) Strategy which seeks to improve Australia’s ability to produce high quality primary health care research. The strategy, which has been funded since 2000, has increased participation in this field of research by building and supporting researchers in the field and closing the gap between research and policy.
By analysing data from two current sources of information about the PHC research workforce (the 2009 GP &
PHC Research Conference presenters and data from the PHCRED Researcher Development Program national survey), we found that PHC researchers come from diverse backgrounds and disciplines. Medical,
nursing or allied health backgrounds are balanced by other research disciplines and skills. This diverse research workforce is in a sound position to continue generating research evidence relevant to multidisciplinary primary health care, to inform policy and practice.
This issue of RESEARCH ROUNDup can be viewed on-line at
<www.phcris.org.au/publications/
researchroundup>
Ellen McIntyre, PHC RIS
The latest RESEARCH ROUNDup focuses on the primary health care research workforce in Australia in the context of a significant health reform.
While much is yet to be decided, two clear themes can be identified from the reform reports. The first is the
importance of multidisciplinary team work in the primary health care (PHC) setting. The second is the importance of further developing and
strengthening Australia’s PHC research sector which is critical to inform its health policy and practice.
These themes of a stronger
multidisciplinary focus and a stronger PHC research sector reinforce each other, as clinical, health system and health services research increasingly needs to be undertaken by researchers from multiple disciplines and
backgrounds.
Page 4 Volume 14, Issue 3
PHC RIS infonet Page 5
Divisions Network matters
from the survey plus whole sections relating to prevention, chronic disease management and quality support. At the same time, some new questions were introduced addressing Aboriginal and Torres Strait Islander (ATSI) access to major health services and IM/IT in Divisions.
In 2007-08, all 115 Divisions completed the ASD. Findings showed that the nation-wide number of practices continued to decrease (n=7 361 to 7 261), although increased numbers were reported for GPs (n=22 868 to 22 965) and practice nurses (n=7 493 to 8 575). Division membership (particularly non-GP members) declined (n=25 523 to 23 289), as did the number of Division board members (n=957 to 919).
Support for practice nurses was a continued priority, with 100% of Divisions conducting at least one related activity.
Ninety-five percent of Divisions conducted at least one activity to improve access to ATSI major health services, with the majority focusing on promoting Indigenous health issues (see Figure 1). Fifty-six Divisions (49%) reported currently using the Information Management Maturity Framework (IMMF), with 90%
intending to use this resource either annually or on an ad hoc basis in the future.
The 2007-08 Summary Data Report is available as a PDF for download on the PHC RIS website <www.phcris.org.au/
products/asd/>. Any related enquires should be directed to Cecilia Moretti [email protected] or Rachel Katterl
[email protected], or contact PHC RIS Assist on 1800 025 882 (free call within Australia).
RELEASE OF THE SUMMARY DATA REPORT OF THE 2007-08 ANNUAL SURVEY OF DIVISIONS OF GENERAL PRACTICE
Cecilia Moretti, PHC RIS
The Primary Health Care Research and Information Service (PHC RIS) has collected and reported data from the Annual Survey of Divisions (ASD) since 1993-94. This has traditionally been in the format of a comprehensive national-level report, identifying trends and patterns in Division activities and infrastructure in the context of broader health and political developments. In 2007-08, significant changes resulted in a much abbreviated Summary Data Report identifying longitudinal trends with limited explanatory text.
Approximately two-thirds of
established questions were removed
Figure 1: Proportion of Divisions (n=115) conducting programs to improve access to ATSI major health services, 2007-08
PHC RIS infonet Page 5
14 22
29 33
37 39 39 42
46 49
50 57
58 71
0 20 40 60 80 100
Other Recruitment & retention of Indigenous staff Recruitment & retention of staff for Indigenous services Supporting ATSI Health Services in PIP accreditation-related activities Assist in grant applications & project proposals Cultural sensitivity training Introduce Indigenous services to existing clinic/practice Professional development for Indigenous staff Supporting ATSI Health Services in immunisation-related activities Assit ATSI Health Services in catchment to make optimal use of MBS Support development of Indigenous clinics Participation in Indigenous organisations Participation in community projects Promoting Indigenous health issues
Type of activity
Proportion of Divisions (%)
Page 6 Volume 14, Issue 3
Passion and commitment: Getting it out there
Evaluation was very prominent not just in what was found but also in how this could best be achieved and the training required to do this. Evaluation was considered in arts and health, group parenting programs, and a smoke free work site.
Data collection using different approaches featured in several presentations: qualitative comparative analysis for reporting medication error, a community development approach in mapping primary care services in a rural area, and using anecdotes and evidence to support Aboriginal Community efforts to respond to alcohol, tobacco and other drug use issues.
GPs were also a focus of attention:
from screening for physical activity using Lifescripts, to rural GPs and resilience, and the support GPs give to cardiac patients about smoking cessation.
Populations of interest spanned:
children with sensory defectiveness, self determination of people living with a disability, identifying adolescents who self-harm (the prize winning presentation), mapping the experience of refugee women, decision making capacity by people with chronic kidney diseases, training and the roles of nurse practitioners, and assisting rural cancer patients via the journey navigator.
PHCRED is alive and very well in Tasmania!
Further information about the presentations is available at
<www.phcred.utas.edu.au/
symposiums.htm>
6
THANNUAL PHCRED STATEWIDE SYMPOSIUM
19 Nov 2009, Hobart
Attended by Ellen McIntyre, PHC RIS and
Candice Lai (pictured), Tas PHCRED Statewide Coordinator
The passion to do research and the commitment to see this through were very evident at the 6th Annual Tasmanian PHCRED Symposium held recently in Hobart. Diversity in what was presented made for a very interesting day and yet there was a cohesiveness in the rigour with which the work presented had been done.
Allowing plenty of time for discussion with each presentation provided the delegates with a great opportunity to explore ideas.
Primary Health Care (PHC) Researchers were also able to meet with Professor Weiss individually to discuss papers they were preparing for publication.
This was a rare opportunity for researchers to meet with the editor of a national journal and receive feedback and advice on an individual level.
Professor Weiss also met with the Adelaide to Outback Medical Education Team, the Discipline of General Practice at Flinders University and the
University Department of Rural Health, Greater Green Triangle in
Warrnambool.
This initiative indicates the benefit to be gained from the PHCRED programs working in partnership and combining resources. The PHCRED Tri-State Program provides the structure and facilitation for this type of activity to occur. Conferences, forums, workshops and other means of building networks and capacity amongst PHC Researchers will continue to be provided during 2010.
For more information see the Tri-State website <www.phcredtristate.org.au>
or contact Elena DiBez, Tri-State Administrator based at Flinders University on 08 7221 8535
Elena DiBez, Administrator, PHCRED Tri-State Program
During October and November 2009 the PHCRED Tri-State Program hosted a visit from Barry Weiss, Professor of Medicine at the University of Arizona College of Medicine. Professor Weiss is also editor of Family Medicine, the national journal of the Society of Teachers of Family Medicine.
During his visit Professor Weiss conducted workshops in writing for publication with PHCRED programs in:
Adelaide, Alice Springs, Whyalla and Warrnambool. The workshops were well attended and provided insight into how to plan, target and promote articles for publication.
Tri-State Program hosts US Professor
Professor Weiss with Ruth Sladek at the
Writing for publication workshop
Page 7 PHC RIS infonet
Thanks for the evidence
manager Cheryl Bush presented a framework for self management capacity and Type 2 diabetes, while mental health counsellor Carole Meade reported on GP interviews regarding depression and Type 2 diabetes.
It was appropriate that practice manager Maureen Goss finished the day outlining her research on the need for general practices to embrace research if primary health care research is to be sustainable. The closing statement from Department of Health and Ageing representative Edward Cocks “Thanks for the
evidence” was a fitting end to the day.
Disability, health, and international development
A few years ago I spent some time in a remote southern province of Laos to evaluate a disability and development project. In the course of this work, I met people with disabilities and their family members who told me of the reality of their struggles, the
discrimination they faced, their health, social and support needs, and what the project had achieved. I encountered disabled children who despite enormous obstacles managed to engage in school, as well as villagers with disabilities whose lives had been transformed through participation in income-generation projects that gave them new skills, an income and a key role in the community.
Kuipers P. (2009). Disability, health, and international development. The Lancet. 374 (9704), 1813.
Community-based rehabilitation:
opportunity and challenge
Community-based rehabilitation (CBR) is the main way in which disabled people in most of the world have any chance of accessing rehabilitation services. CBR was first promoted by WHO in the mid-1970s to address the shortage of rehabilitation assistance by providing services in the community with use of local resources. The strategy drew on the principles of primary health care, accepted
international rehabilitation practices of the time, and also existing local practices.
Hartley S, Finkenflugel H, Kuipers P, Thomas M.
(2009). Community-based rehabilitation:
opportunity and challenge. The Lancet. 374 (9704), 1803-1804.
CENTRE FOR REMOTE HEALTH
FLINDERS UNIVERSITY
Pim Kuipers
Senior Research Fellow P: 08 8951 4702 E: pim.kuipers@
flinders.edu.au
Pim Kuipers holds a PHCRED Mid- Career Fellowship. His research includes an examination of the model of Community Based Rehabilitation (CBR). As a result of his work in this area he was recently invited to contribute towards The Lancet special issue on disability and rehabilitation.
He wrote a ‘perspectives’ piece and contributed to a ‘commentary’ article.
Parker, a district nurse, spoke passionately about assessing the efficacy of low level laser therapy in the healing of leg ulcers. General Practitioners (GP) Jason Ong, Adeline Ooi, Richard Teague, and Amanda Fraser covered contraceptive choices among women, pap smears, sexual health of injecting drug users, and Medicare independence for young people. Youth health nurse Shelley Walker explored ‘sexting’ among young people.
Specific populations included refugees and asylum seekers and their
experiences of general practitioner services (presented by Dr I-Hao Cheng), the four year-old Healthy Kids Check (Dr Karyn Alexander),
community-dwelling older people and physical activity interventions (Nicole Hale, project officer), resident mobility and the No Lift policy (Jan Taylor, physiotherapist), junior doctors and medical identity (Dr Rachel Lee) and clinician attitudes regarding seclusion in mental health (nurse Dannii Taylor).
Acute stroke and Type 2 diabetes was the focus for three researchers.
Paramedic Brian Steer focused on GPs role in the initial assessment and referral of acute stroke. Practice
3RD ANNUAL VICPHCRED CONFERENCE
9 Nov 2009, Melbourne,
Attended by Ellen McIntyre, PHC RIS and Anna Chapman, VicPHCRED Statewide Coordinator
This 3rd Annual VicPHCRED Conference showcased 18 new and emerging researchers in primary health care. As well as providing a great opportunity for networking and collaboration between researchers, practitioners and policy makers, those present were inspired, stimulated and challenged by Bond University Professor of General Practice Mieke van Driel’s presentation of her research journey that spanned Europe, UK, and Asia and Africa where she worked with Medecins Sans Frontieres. Australian primary health care research is the better for her presence here.
The presentations were diverse in the topics covered, the target populations, the methodologies used, as well as the background of the researchers. For example, Drs Belinda Hall and Angela Todd, both chiropractors presented on
chiropractic and infants while Kerry
Mieke van Driel, Ellen McIntyre,
Anna Chapman and Shane Thomas
PHCRED Strategy: Research Capacity Building Initiative
Page 8 Volume 14, Issue 3
PHCRED Strategy: Research Capacity Building Initiative
Nine short research presentations on a variety of topics were held and included current NRGP research and participation in other research in our region and the Sydney region. Briefly, research included: Occupational Violence in GP; Procedural skills for GP registrars; Waiting Room Ambience Project (WRAP); Community Stroke Study; Physical Activity Coaching;
Palliative Care needs assessment project; Warfarin and AF study; Thirst and Salt intake; and UNSW Research Centre opportunities for funded research.
Importantly, the Forum offered the opportunity to informally workshop two research ideas, Strokes in the
community and Thirst and the use of salt.
The 2009 NRGP Forum was once again a successful day, focusing on sharing research information and discussing research ideas in a friendly
environment. We look forward to continuing to provide support to staff of NRGP member practices to facilitate the conduct of practice-based primary care research during 2010.
DISCIPLINE OF GENERAL PRACTICE
UNIVERSITY OF NEWCASTLE
Georgina Cotter NRGP Project Officer P: 02 4968 6735
E: [email protected] The Network of Research General Practices (NRGP) for the Hunter, New England and Central Coast is
committed to fostering a culture of inquiry and building research capacity among GPs and staff.
2009 saw another year of growth for the NRGP with 17 member practices and an increasing interest in research projects. Our 3rd NRGP Forum was held at The Oak Resort, Sunsets at the Bay, Salamander Bay on 28November 2009, where 26 people attended in a friendly collegiate atmosphere.
Inspiring guest speakers are hallmarks of our Forums, and this year we were privileged to have Dr Geoff Mitchell, Professor of General Practice and Palliative Care, University of Queensland and Dr Dan Lasserson, Clinical Lecturer, University of Oxford, who shared the difficulties and successes of their most interesting research journeys. Their research commenced with the desire to share and explore their observations in
medical practice.
NRGP members at the 3rd annual NRGP Forum held on 28 November 2009
improvements including quality initiatives in team-care and improving care in the emergency room setting.
Presentations highlighted an enormous amount of work that had been
conducted by the Fellows over and above their busy professional roles. All the presenters spoke with enthusiasm and commitment about their research, despite many facing unexpected challenges along the way.
The two-day event also provided the Fellows with an opportunity to attend two workshops, one on grant-writing and the other on publishing findings from their work.
PHCRED Queensland organisers were delighted with the results of the day, having a full presentation attendance from the 2009 Fellows. PHCRED Queensland Coordinator Denise Schultz
said the program had worked very hard over the year to ensure that the Fellows were well supported.
The turnout and the quality of the work presented was unrivalled by previous events. The day culminated in a Fellows Dinner providing opportunities for networking and continued
discussions from the day.
2010 is already gearing up to be a bigger and better year in Queensland
(Continued on page 9)
PHCRED QUEENSLAND
Lily Cheung P: 0466 113 688 E: [email protected]
Fantastic Fellows from Queensland An annual highlight of the PHCRED Queensland program is the Fellows Day which provides our emergent primary health care researchers with an opportunity to showcase the work they have been doing over the past year.
In 2009 the program was jam-packed with 16 Fellows presenting their work to their peers. Topics ranged from child and maternal health to palliative care, with a strong focus on health service
Page 9 PHC RIS infonet
PHCRED Strategy: Research Capacity Building Initiative
as the PHCRED program turns its attention to a Research and Policy Showcase in March, and recruits team- based research projects to continue on the success achieved by the program to date.
Fantastic Fellows from Queensland
(Continued from page 8)
She gives the example of constructing survey tools: “Really thinking deeply about the [information and] questions so I don’t miss a thing, scrutinising where that question can lead or not lead that will be of more benefit to the research”.
Her expectations of the RDP have been grounded by the learning process. “I was expecting to be a whiz in research when I joined but that has not
happened yet but overall, I am happy about what I have gained so far”, she says.
John Widdup is a Podiatrist working in private practice in SSW. Also having worked as an Aboriginal foot educator in urban and remote communities, he continues to be interested in diabetes and the high risk foot.
His project looks at the utilisation rates of early childhood services by
Aboriginal infants within an urban population, with a particular focus on determining if there is any discrepancy with utilisation rates between
Aboriginal and non-Aboriginal infants.
John is being supervised by Dr
Elizabeth Comino and assisted by Vana Webster.
John was met with some indifference when showing results to some project stakeholders: “Trying to explain the
findings of my investigations, particularly when the results didn’t favour the particular stakeholder you are addressing, was a challenging and a little hostile ordeal. Being able to interpret any findings in the
appropriate context I have found to be very important”.
He feels that he has had the opportunity to develop not only new research skills but also his abilities in project management: “I have had the opportunity to experience developing a project from start to finish, so I feel I have learnt new skills at every step. In particular, I have developed skills in managing stakeholders involved with the project, the process of applying for ethics approval and data analysis including understanding and interpreting results”.
His RDP experience has exceeded his expectations: “I have, to a large degree, been able to design and perform my own project when I was expecting that I would be working on a project assisting someone else”.
Both RDP's hope to continue as researchers and are keen to pursue PhDs in the future.
CENTRE FOR PRIMARY HEALTH CARE AND EQUITY
UNIVERSITY OF NEW SOUTH WALES
Suzan Mehmet Research Network Administrator/Coordinator P: 02 9616 8520
E: s.mehmet@
unsw.edu.au
The UNSW Research Capacity Building Initiative currently has enthusiastic trainees Della Maneze and John Widdup continuing with the Research Development Program in 2010.
Della Maneze is well known to the UNSW team. She was involved with research published in the Australian and New Zealand Journal of Public Health (ANZJPH) looking at Kava use amongst Tongan males in South Western Sydney (SSW). Della is an overseas trained doctor, working as a Multicultural Health Worker.
Currently, she is working on a project focusing on enhancing integrated care for chronic disease, spearheaded by Professor Siaw-Teng Liaw. Her project focuses on the integration of care in the management of diabetes for patients hospitalised at Fairfield Hospital.
Della calls herself a newbie in research and says “What little knowledge I gain is beneficial. Sometimes when you are deeply immersed into it, you don’t realise what you have learnt. But on reflection and applying it to a different study, you realise you have learnt quite a lot”.
Working on her project in this way has meant that she has deepened her understanding of the research process.
Della Maneze
John Widdup
Page 10 Volume 14, Issue 3
One of the recommendations from the first course delivered in 2007 was that participants would like a course workbook. In consultation with the Aboriginal Health Council of South Australia an agreement was made for the NRUDRH to purchase copies of workbooks they had developed for modification and use by the NRUDRH.
In 2009, after consulting with local Aboriginal health services, the NRUDRH decided to change the target audience.
An expression of interest was sent out through our Aboriginal health research networks to identify interest in the training for community-based Aboriginal research assistants. We were aware that many projects employ local Aboriginal people who have good community connections and content knowledge; however they have not had formal research training.
The response was very positive with many project leaders indicating they had been looking for this type of training which had previously not been available. In September 2009 Shawn Wilson and Janelle Stirling delivered the course to 13 participants on
campus at The University of Sydney.
The feedback from the course was very positive with many students reporting comments like:
“I felt very comfortable after meeting everyone and finding out that I was not alone in learning about research”.
ABORIGINAL HEALTH STREAM
NORTHERN RIVERS UNIVERSITY DEPARTMENT OF RURAL HEALTH
Janelle Stirling Associate Professor Aboriginal Health P: 02 6620 7697 E: Janelle.Stirling@
ncahs.health.nsw.gov.au
The Northern Rivers University Department of Rural Health (NRUDRH) PHCRED program has been working for a number of years on the development and implementation of program called Walking through Research. The program includes mentoring and introductory training in Aboriginal health research in a culturally safe learning environment. The original program was aimed at Aboriginal Health Workers working in the local area. While this program had some successes, limitations were identified in that workers found it difficult to implement their learnings in the workplace due to other demands and a lack of support structures for research.
PHCRED Strategy: Research Capacity Building Initiative
atmosphere creates an added interest in the research process. The
opportunity also ensures that they feel part of a wider primary health care research community consisting of GPs, allied health professionals, consumer representatives and primary health care researchers.
In 2008, a third year student, Michaelia Verbeek, not only presented at the conference but also won best poster at the faculty medical student research evening at UWA with her topic, Parental attitudes to childhood obesity in a regional town in WA. This year, 2009, two students who completed their project as a team and in conjunction with the Wheatbelt GP Network, won best student
presentation at the statewide PHCRED conference. Their presentation was entitled, Efficacy of Wheatbelt GP Network’s Discovering Solutions for Family Abuse Men’s Domestic Violence Program: A quality control study.
The unit coordinator, Caroline Bulsara, believes that including students in research activities during their medical studies engenders an interest in
research early on. The experience also demonstrates the broad and varied scope of primary health care research.
By having students present in a supportive atmosphere whereby delegates can discuss their work with them and provide positive feedback is extremely valuable.
GENERAL PRACTICE
THE UNIVERSITY OF WESTERN AUSTRALIA
Dr Caroline Bulsara PHCRED Coordinator P: 08 9449 5166 E: caroline.bulsara@
uwa.edu.au
Engaging undergraduate students in the primary health care research Medical students at the University of WA (UWA) have been an important part of the PHCRED strategy in recent years. Towards to end of their third year research project they are encouraged to present their work at the PHCRED statewide conference held in November of each year. For
students, having the opportunity to present their work in a supportive
Shawn Wilson, NRUDRH, Walking Through Research participants Eddy Harris and Monica Whyman, and Janelle Stirling, NRUDRH, at
the University of Sydney
Sean and Bridget Copson 3rd year medical students presenting their work at the
2009 PHCREDWA Conference
Page 11 PHC RIS infonet
PHCRED Strategy: Research Capacity Building Initiative
what is known and what should be known about the role of the GP, and in particular, whether that role is clinically significant.
Support through PHCRED via the Research Development Program has made it possible to conduct a literature review so that a contribution might be made through publication.
There is evidence that whilst the individual GP may report little contact with patients suffering acute stroke, as a population the role of GPs is
underestimated. It has been established that for many patients calling general practice is a crucial cause of delay to acute therapies such as thrombolysis. Preliminary results indicate that whilst most GPs believe stroke is a medical emergency, their assessments and referral may not align with best practice. In particular, there
is an apparent lack of awareness of the window for thrombolysis and the need to refer immediately to a suitable hospital by calling for an ambulance.
Because the literature available is from many countries with quite different health care systems, investigation into the Australian context is required. It is important to make a distinction between issues to do with general practice, such as whether callers are triaged, and issues to do with the knowledge and management choices of individual GPs, such as the decision to visit patients, rather than call 000.
Appropriate investigations, followed by targeted interventions, may save many Australians from death or disability.
DEPARTMENT OF GENERAL PRACTICE
MONASH UNIVERSITY AND AMBULANCE VICTORIA
Brian Steer RDP Fellow P: 03 9877 9116 E: Brian.Steer@
med.monash.edu.au
As a leading cause of death and disability, no stone is to be left unturned in the calling to prevent, manage or support those who do or would suffer from stroke. According to the National Stroke Foundation, the role of the GP in acute stroke is unclear. It is timely that a review of the literature be conducted to discover
Indigenous. The course can be completed part-time over two years, which attracted Val to enrol.
“The end result of the Graduate Certificate enabled me to get a deeper understanding of primary health care and evaluation processes. It’s an area becoming more relevant and a priority area for Indigenous health outcomes,”
said Ms Alberts.
On-line discussions and
teleconferencing was used to connect students. Ms Alberts said she found the flexibility of the course delivery a plus.
“It means that people in full time work can do one subject per semester.
Students need to be aware that the course is self-directed and self- motivation is necessary!”
Primary health care research is an area which is growing in significance, particularly in Indigenous communities.
Completing the Graduate Certificate at James Cook University will allow health practitioners to embark on research projects with confidence that they have a solid knowledge base and the practical skills required to work in Indigenous health.
Students interested in furthering their knowledge as an Aboriginal Health Worker can also take advantage of a qualification in Indigenous Research Capacity Building delivered at
Certificate IV or Diploma level. The course, developed by JCU, began in August 2008 through the Aboriginal Health Council of South Australia (AHCSA). From 2010 onwards it will be delivered through JCU and the AHCSA in northern Queensland. For further information about both courses contact [email protected]
SCHOOL OF MEDICINE AND DENTISTRY
JAMES COOK UNIVERSITY
Sharon Barnwell
Communications and PA to Head of School
P: 07 4781 5025
E: [email protected] The first graduate of James Cook University’s (JCU) Graduate Certificate of Primary Health Care Research, Valerie Alberts, said she is pleased with the focus of the course and will
recommend it to others.
“As an Indigenous person, I found the content accurately reflected the cultural background and complexity of Indigenous health issues. I will be encouraging Indigenous postgraduates to consider the course,” Ms Alberts said.
Administered through the School of Medicine and Dentistry, the certificate is designed for postgraduates and health professionals to broaden their foundation for primary health care research and evaluation.
Robyn Preston, PHCRED Coordinator at JCU, said numbers in the course are expected to double over the next two years. Currently there are 21 students enrolled, eight of whom are
Valerie Alberts
Page 12 Volume 14, Issue 3
PHCRED Strategy: Research Capacity Building Initiative
measures for treating eating disorder patients in rural areas. The literature has revealed that a good outcome for an eating disorder patient is a weight within 10-15% of ideal body weight for height, and the return of menses in females with anorexia nervosa. It was also noted from the literature that patients treated in a multidisciplinary team have better outcomes.
The aim of Sally’s research was to determine the health outcomes of eating disorder patients (such as those with anorexia nervosa, bulimia nervosa, or Eating disorder not otherwise specified (EDNOS)) who have received dietetic treatment at Tamworth Rural Referral Hospital. Her research involved a retrospective review of medical records over the preceding five years to determine health outcomes compared to the best practice goals, as identified in the literature. Data collected included: age of patients, length of treatment, referral source, weight, height, menstruation status, compensatory behaviours, presentations to hospital
and consultations with other health professionals.
Preliminary results from the raw data show that of the 39% of patients treated by the dietetic department at Tamworth Rural Referral hospital for an eating disorder who begin treatment under their ideal body weight, 36%
achieved a weight within 10-15% of their ideal body weight for height at the end of treatment. A limitation of this study is that there was limited other outcome data available from the medical records.
UNIVERSITY DEPARTMENT OF RURAL HEALTH NORTHERN NSW
UNIVERSITY OF NEWCASTLE
Sally Moy
Dietician, RDP Fellow P: 02 6767 8443 E: Sally.Moy@
hnehealth.nsw.gov.au
Sally Moy is an experienced dietitian who has worked in a number of rural settings. During the past two years Sally has been based at Tamworth Rural Referral Hospital and has developed a keen interest in the treatment of patients with eating disorders. Sally is currently involved in the Researcher Development Program (RDP) fellowship program with the University Department of Rural Health Northern NSW in Tamworth.
As a part of her research this year, Sally has undertaken a literature review to determine if there are any best practice guidelines and outcome
personal accounts and experiences.
Blogs about health and healthcare may be found via a conventional web search. An example is Mental Health Blog at <www.mentalhealthblog.com>.
Alternatively blogs can also be found by searching within popular blog websites, for example
<www.blog.com> and
<www.blogger.com>.
Wikis
Wikis (wiki is pronounced ‘wicky’) are web pages which can be edited and updated by the public. They are useful as an information repository, and may take the form of an encyclopedia on the discussed topic. A popular wiki is Wikipedia, which is a free web-based encyclopedia, and contains a vast knowledge-base of information on a vast array of topics. However like blogs, there are also more specific and personalised wikis dedicated to health and healthcare.
Like blogs, wikis will often contain up- to-the-minute information about healthcare topics. However, whereas a blog may be well-suited to a simpler journal-like system of entries, a wiki is more community-oriented, and includes features to make it useful as a centrally-managed on-line information repository amongst a small to large community.
Example wikis include Mental Health Wiki at <www.mentalhealthwiki.org>
or WikiPH (a public health wiki) at
<www.wikiph.org> and many others can be found on the net.
Of course, as always when searching for information on-line, one should be mindful of its accuracy and credibility, and steps to verify details with credible sources etc should be taken.
David Branford, PHC RIS
For the health researcher it pays to be a little ‘internet aware’, because there are now more web-based research options than ever before. Web 2.0 applications like Twitter and Facebook are now receiving a lot of media exposure, and there are a great many web 2.0 applications available to the health researcher. Two such applications are blogs and wikis.
Blogs
The name ‘Blog’ is an abbreviation of
‘web log’. It is something akin to an on-line diary or journal, and ‘blogging’
refers to adding to this diary or journal.
The individual who is blogging may be another researcher, a patient, clinician, doctor, nurse, etc. Blogs are useful not only for the facts they may contain, but also for up-to-the-minute opinions and
WebsiteWatch: The future of health research - Web 2.0
Sally Moy
PHC RIS infonet Page 13
BookWatch: Knowledge Translation in Health Care: Moving from evidence to practice
environments along with the need for new human resource skills in bridging the significant cultural gaps between the two communities.
This introductory guide to the rapidly developing field of knowledge
translation in health care outlines strategies for successful knowledge translation in practice and policy making. The knowledge translation interventions are diverse, ranging from educational, linkage and exchange, audit and feedback, informatics, patient-mediated, and organisational.
While the selection of intervention remains an art, it is supported by structured methods based on objectives, barriers and enablers.
It is an essential read for health policy makers, researchers, managers, clinicians and trainees.
The book is available from <http://
au.wiley.com/WileyCDA/WileyTitle/
productCd-1405181060.html>
Reference
Straus S, Tetroe J, Graham I. (Eds) (2009).
Knowledge Translation in Health Care:
Moving from evidence to practice. Oxford:
Wiley-Blackwell Publishing.
Ellen McIntyre, PHC RIS
Given the increasing focus on
knowledge exchange to move evidence into practice, this text, Knowledge Translation in Health Care, is very timely.
Written in an easy to read format by a who’s who of experts in this field, key topics include knowledge creation, the knowledge-to-action cycle, theories and models of knowledge to action, knowledge exchange and evaluation of knowledge to action.
As mentioned in the foreword, to improve the uptake of health research into practice requires a willingness to consider new ways of doing business.
This book identifies them as a cultural change toward more relevant, good quality research and greater attention to the application of findings; new structures, activities and processes to provide better communication between researchers and decision makers; and better understanding of each other’s
white family [the media] says ‘they’re looking for food’. You see a black family it says ‘they’re looting’”.
Wilkinson and Pickett demonstrate that the inequalities exemplified by such reasoning are powerfully related to Louisiana’s poor performance in all manner of social and well-being measures, and that analogous results can be found in most societies with severe inequities.
Although many studies are referred to, this book is intended for a general audience and the technicalities of the research are often glossed over.
However, for those who are interested in the methodological basis of studies there are full references for all data sources and journal articles. Many readers of PHC RIS infonet will be familiar with issues relating to inequality and poor health outcomes (covered in some detail in this book), but The Spirit Level provides a methodologically sound and well- written introduction to the wider implications of inequity.
The book is available from
<www.penguin.com.au/lookinside/
spotlight.cfm?SBN=9780141032368>
Reference
Wilkinson RG, Pickett K. (2009). The Spirit Level: Why more equal societies almost always do better. London: Allen Lane.
Nova Reinfeld-Kirkman, PHC RIS
The Spirit Level: Why more equal societies almost always do better presents a powerful argument that it is the relative inequality within a society (rather than, for example, low average incomes) that foster detrimental outcomes across the society. Using a surprisingly large range of indices, from obesity to homicide rates, Wilkinson and Pickett show that inequality harms not only those who are most disadvantaged, but whole populations.
Although most of the empirical evidence is drawn from large scale population surveys, Wilkinson and Pickett nicely use stories to flesh out the meaning and importance of their findings. For example: when discussing the social implications of the high rates of distrust that emerge in unequal societies, they quote the Louisiana Governor on troop deployment in the aftermath of Hurricane Katrina “They have M16s that are locked and loaded.
These troops know how to shoot and kill and I expect they will”. As the musician Kanye West noted “You see a
BookWatch: The Spirit Level: Why more equal societies almost always
do better
Page 14 Volume 14, Issue 3
Laying the foundations for innovative and sustainable policy
Broad definitions of evidence were the rule rather than the exception.
Evidence took many forms, including research findings, data and modelling, views of stakeholders and public, public submissions and surveys and overseas example of similar problems.
Evidence must be fit for purpose, but is always incomplete.
One speaker referred to ‘synthesised empirical knowledge’ rather than gold standard experimental evidence.
Terry O’Brien, Deputy Commission of the Productivity Commission
concluded:
The circumstances suited to a randomised controlled trial are not universal.
No method of evaluation is a substitute for careful thought.
Quantify where possible.
Policy questions take the form of ‘what is the problem? How big is the
problem? What would be the impact of change in policy?’ Advisors need to agree on dimensions of problem, reliable data sources, priorities for action, understand what else is in place, and be able to answer the proposition: ‘what difference will it make?’
Evidence can be generated by policy:
the first stages of an incremental approach can be used as an experiment in Australia to build evidence to be used in later steps of policy. Policy implementation can thus reduce margin of error, producing better odds of good results.
Among many other ideas the conference addressed were: where evidence fitted into the policy process, the lack of incentives for researchers, policy preferences for interacting with researchers, and ways to obtain evidence despite tight timelines.
EVIDENCE BASED POLICY MAKING 2009
28–29 October 2009
Attended by Libby Kalucy, PHC RIS
The credible well positioned speakers at this valuable conference provided diverse perspectives on evidence and policy to an audience which seemed to come mainly from the policy sector.
The term ‘evidence informed’ policy is more realistic and appropriate than the deterministic ‘evidence based’ which assumes that evidence is the only basis for policy. Most speakers referred to the fact that the Prime Minister Kevin Rudd has openly espoused the use of evidence in policy, which suggests the current Australian government is receptive to evidence in its policy decisions.
between the feedback she hears at extensive consultations, which have been useful to identify the likely responses from different areas of the health sector.
“Be aware and be very scared… The health workforce need to be engaged and convinced for reform to work, and need to be driving the change
process”. Dr Mukesh Haikerwal, former commissioner, National Health and Hospitals Reform Commission.
“Look before you leap into a poorly defined future”. Professor Philip Davies, former senior executive in the
Australian Government Department of Health and Ageing, outlined his concerns with the specifics of the approach and the impact on Divisions.
If the role of the Primary Health Care Organisations (PHCOs) was to focus on coordination and planning, accountable to the community not to members, they could not have a role in providing support services for service providers
“Reform is not a modification of a failing system”. Professor Dennis Pashen, President of Australian College
of Rural and Remote Medicine reinforced the importance of professionals owning the reform agenda.
“Never trust politicians – never trust public servants as your friends. They march to the beat of a different drum.
Be very very careful”. Dr Michael Bollen, GP politician involved with the inception of Divisions.
“If you don’t like the technical aspects, use it to give energy. Reform can be used to energise the sector, towards more responsiveness and
accountability”. Dr David Colin Thomé, National Director of Primary Care, Department of Health, UK.
See <www.gpnetworkforum.com.au/
call-for-abstracts> for further details of presentations.
AGPN NATIONAL FORUM 2009
4–7 November 2009
Attended by Libby Kalucy, PHC RIS
AGPN forum debates health reform A good forum provides material and opportunity for debate and discussion.
Reform was a dominant theme at all plenary sessions of this well organised Forum in Sydney in November 2009.
The diverse perspectives shown by the following quotes stimulated vigorous debate among more than 1 000 delegates.
“The Rudd government will not shy away from reform because it can’t be done quickly or easily”. The Minister of Health, Nicola Roxon acknowledged it was rare in health to have profession- led change, and congratulated the Divisions for their role in shaping and leading change, taking the reform agenda in both hands. The Minister is aware of consistencies and differences
Claiming the space: Shaping the future of primary health care
PHC RIS infonet Page 15
Health services research: Reforming, responding, rewarding
on the challenges of health reform in the US as they try to push universal health care legislation through congress. Every healthcare debate is about who we think we are as a society and this theme was taken up by other speakers with Gert Westert, from the Netherlands reflecting that one word to describe their culture of healthcare is
‘solidarity’. Deborah Roche from the Ministry of Health in NZ described the prominence of the concept of
‘community’ within their healthcare system.
We heard many other informative presentations. Sharon Wilcox, past member of the National Health and Hospitals Reform Commission (NHHRC) provided the historical context for health reform in Australia. Jackie Cumming from NZ gave some findings about the Primary Health Organisations from the evaluation of their Primary Health Care Strategy. Colleen Flood from Canada described their Best Brain
Consultations which bring together a group of experts and policy makers to discuss a policy related subject in private, which are ‘a wild success’. The Australian Primary Health Care Research Institute (APHCRI) reviewed the findings of some systematic reviews, and we also attended a session on mental health which gave evaluations of the Better Access initiative, the Suicide Prevention pilot of the Better Outcomes Initiative, Headspace and the Access to Allied Psychological Services (ATAPS) projects, and a great many more presentations which will feed into our work at PHC RIS. It was a great conference: thank you to the organisers and to the many enthusiastic presenters.
6TH HEALTH SERVICES AND POLICY RESEARCH
CONFERENCE 2009
24-27 November 2009
Attended by Eleanor Jackson Bowers and Rachel Katterl, PHC RIS
The Health Services Research
Association of Australia & New Zealand (HSRAANZ) Conference, held in Brisbane on 24-27 November 2009 was a full and varied event with much to interest health researchers and those who use research. A major theme was health reform and the presence of keynote speakers from the USA, Canada, New Zealand and the
Netherlands, provided lively discussion and many opportunities for learning.
Speakers included James Morone, from the USA, author of the book Hell Fire Nation, who gave an entertaining talk
strengthening interventions, while also exploring potential synergies and dangers among those interventions.
Lastly, it shows how better evaluations of health system strengthening initiatives can yield valuable lessons about what works, how it works and for whom.
To quote from the report: “Systems thinking is not a panacea. Its application does not mean that resolving problems and weaknesses
will come easily or naturally or without overcoming the inertia of the
established way of doing things. But it will identify, with more precision, where some of the true blockages and challenges lie. It will help to:
1 explore these problems from a systems perspective;
2 show potentials of solutions that work across sub-systems;
3 promote dynamic networks of diverse stakeholders;
4 inspire learning; and
5 foster more system-wide planning, evaluation and research.”
This report is available from the WHO website: <www.who.int/alliance-hpsr/
resources/9789241563895/en/
index.html>
Libby Kalucy, PHC RIS
The chaos engulfing Haiti in the aftermath of the earthquake illustrates painfully the importance of systems to deliver the basic necessities of life. This report looks at ways of strengthening health systems, by understanding their strengths and weaknesses, and how any intervention will affect the whole system. I found it refreshing to read a report in good plain English, which uses many visual devices to illustrate its messages. Firmly grounded on previous work from the World Health Organization (WHO), it is designed to be practical and workable in contrast to some publications on complexity which leave this reader thinking ‘it’s all too hard’. The complexity of systems can’t be used as an excuse for inaction, nor can it be ignored to make life easier.
In its Ten Steps to Systems Thinking, this Report shows how we can better capture the wisdom of diverse stakeholders in designing solutions to system problems. It suggests ways to more realistically forecast how health systems might respond to
