Health Systems

A health system consists of all organizations, people and actions whose primary intent is to promote, restore or maintain health (World Health Organisation (WHO).  Six basic components, which the WHO refers to as System Building Blocks are common to all health services (service delivery, health workforce, information, medicines and technologies, financing, leadership/governance) and the goals of health systems can be simplified as responsiveness, efficiency, improved health and social and financial risk protection.

Health systems research addresses policy and service delivery questions that have implications for the performance of the health system as a whole. It addresses a wide range of questions, from health financing, governance, and policy to problems with structuring, planning, management, human resources, service delivery, referral pathways, patient pathways, quality of care, performance management and health outcomes. Health systems research, by necessity, is highly multidisciplinary, with a strong emphasis on social and health sciences disciplines.  Often there is considerable involvement with policy makers, managers and other healthcare professionals.

What distinguishes health systems research is its audience which tends to be broader than a particular service, team or unit.  A question that often arises is how does health systems research differ from health services research, operational research and implementation science?  The reality is that they are not mutually exclusive research domains and all of these may form components of a health systems research project.  For example, a project whose aim is to develop a model of community-based management of a chronic condition that is currently managed in a hospital setting, might begin with an epidemiological study to determine need for the service and an operational research study to understand how the condition is currently managed for patients. 

The next step could be trialling a community intervention.  If this proves successful there will be a need for an implementation science study to identify what is necessary to put this successful model into practice throughout the system.  Additional questions that a health systems study might address are how does this new model impact on staffing requirements? What are the positive and negative impacts on other services? Could the same model be applied to other services?  What are the impacts on patient quality of life? What is the impact on productivity, throughput and cost?

“Public health [today] enjoys commitment, resources, and powerful interventions... but the power of these interventions is not matched by the power of health systems to deliver them to those in greatest need, on an adequate scale and on time... This arises, in part, from the fact that research on health systems has been so badly neglected and underfunded... In the absence of sound evidence, we will have no good way to compel efficient investments in health systems.”
Dr Margaret Chan, Director-General, World Health Organization
 

"Yet all too often reform efforts are not evaluated adequately. Each innovation in health systems constitutes a learning opportunity. Not to take advantage of these opportunities condemns us to rediscover at great cost what is already known or to repeat past mistakes”.
Dr. Julio Frenk, President, University of Miami, formerly Faculty Dean, Harvard School of Public Health, Secretary of Health of Mexico

Studying and Researching with the Health Systems Group

Health Systems research students will gain a greater understanding of how health services are being planned and delivered, what may be facilitating or preventing access to health care, and what policy or protocol changes may be necessary to make health systems equitable for all. The doctoral programme in Health Systems will provide students greater depth and preparation to conduct research about the performance of health systems. We offer an interdisciplinary course of study designed to provide students with advanced knowledge, analytical skills, and competencies in health policy, planning, financing, management, evaluation; and research on health systems. The overall goal of the PhD programme in Health Systems is to produce thought leaders in the management, practice, and research dealing with health systems. The PhD programme in Health Systems prepares students to become independent investigators in academic and non-academic research institutions, and emphasises contributions to theory and practice. Graduates of the programme will have developed competencies to play leadership roles in developing and strengthening health systems.

Building upon UCD's role as a leader in transforming health systems and the formalised collaborative relationships UCD has with Ireland East Group Hospitals and the strong partnerships UCD has with major health systems in Europe and Low and Middle Income Countries, the curriculum draws on an interdisciplinary faculty with expertise in nursing and midwifery, health policy, management, psychology, implementation science, social gerontology, disability studies, gender studies and sociology.

• Dr. Aoife De Brún
• Dr. Catherine Browne
• Dr. Deirdre O'Donnell (currently on maternity leave)
• Dr. Éidín Ní Shé
• Dr. Emma Nicholson
• Mr. Fergal Connolly
• Prof. Eilish McAuliffe, Professor of Health Systems and Head of UCD Health Systems 
• Ms. Elena Akelan
• Assoc. Prof. Hasheem Mannan
• Ms. Lisa Rogers
• Ms. Marie O'Shea
• Dr. Marie Ward
• Dr. Moayed Hamza
• Dr. Purity Mwendwa
• Ms. Roisin O'Donovan
• Ms. Sandra Kearney
• Mr. Sean Paul Teeling
• Ms. Sinead McGinley
• Prof. Thilo Kroll, Professor of Health Systems Management and Associate Dean for Research, Innovation and Impact

• Promoting Assisted Decision Making in Acute Care Settings (PADMACS) for Care Planning Purposes 01-Jan-18 to 31-Dec-19
• EOLAS: Building capacity for collaborative education between service users, family members and practitioners within mental health services - starting in 2018, dates TBC
• Children’s unscheduled primary and emergency care in Ireland: decision making, trends, outcomes and parental perspectives (CUPID) 01-Sep-17 to 31-Aug-20
• PPI Ignite Award – University College Dublin 01-Sep-2017 to 31-Aug-20
• Comparative Policy Analysis: Problems, Agendas and Policies in Brazil, France, Scotland, Ireland, Portugal and Spain 01-Jul-17 to 31-Dec-17
• The Development of a Partnership between UCD School of Nursing, Midwifery and Health Systems and Meru University of Science and Technology, School of Nursing, Meru, Kenya 09-Jan-17 to 08-Jan-18
• Identifying the optimum role and function of an Epidermolysis Bullosa (EB) outreach nurse 01-Jan-17 to 31-Dec-17
• SAFE: Systematic Approach to improving care for Frail Older patients 07-Nov-16 to 06-Nov-18
• Access to Prostheses and Orthoses in Cambodia: what works for whom and why? 01-Apr-16 to 30-Sept-17
• Nursing and Midwifery Quality Care Metrics Project  01-Oct-16 to 31-Dec-17
• Collective Leadership and Safety Cultures (CO-LEAD) 01-Dec-15 to 30-Nov-20
• Imbuing Medical Professionalism (IMP) 15-Dec-14 to 31-Dec-17
• Research Emergency Department - Adult Clinical Escalation  (RED-ACE) 01-Dec-14 to 28-Feb-17
• HRB-TMRN (Trials Methodology Research Network) 23-Mar-15 to 30-Sep-17

The information for this section is currently under development.

2017

• Ward, M. (2017) Leading Change in Healthcare. In: Leadership and Change for the Health Professional.  Editors: Elizabeth A. Curtis and John Cullen Publisher: Open University Press – McGraw-Hill Education London. ISBN: 9780335261406
• Ward M., McAuliffe E., Ní Shé É., Duffy A. Geary U. Cunningham U., Holland C., McDonald N., Egan K. and Korpos C. (2017) Imbuing Medical Professionalism in Relation to Safety: A study protocol for a mixed-methods intervention focused on trialling an embedded learning approach that centres on the use of a custom designed board game. BMJ Open 2017;7:e014122. doi:10.1136/ bmjopen-2016-014122
• Abimanyi-Ochom J, Mannan H, Groce NE, McVeigh J (2017) HIV/AIDS knowledge, attitudes and behaviour of persons with and without disabilities from the Uganda Demographic and Health Survey 2011: Differential access to HIV/AIDS information and services. PLoS ONE 12(4): e0174877. https://doi.org/10.1371/journal.pone.0174877
• Visagie S, Eide AH, Dyrstad K, Mannan H, Swartz L, Schneider M, et al. (2017) Factors related to environmental barriers experienced by persons with and without disabilities in diverse African settings. PLoS ONE 12(10): e0186342. https://doi.org/10.1371/journal.pone.0186342
• Gilmore, B., MacLachlan, M., McVeigh, J., McClean, C., Carr, S., Duttine, A., Mannan, H., McAuliffe, E., Mji, G., Eide, A.H. and Hem, K.G., (2017). A study of human resource competencies required to implement community rehabilitation in less resourced settings. Human Resources for Health, 15 (1), p.70.
• Visagie, S., Eide, A.H., Mannan, H., Schneider, M., Swartz, L., Mji, G., Munthali, A., Khogali, M., van Rooy, G., Hem, K.G. and MacLachlan, M., (2017). A description of assistive technology sources, services and outcomes of use in a number of African settings. Disability and Rehabilitation: Assistive Technology, 12(7), pp.705-712.
• Mwendwa, P., McAuliffe E, Ogenna U, et al. The Impact of Supportive Supervision on the Implementation of HRM processes; A Mixed-Methods study in Tanzania. Health Syst Policy Res. 2017, 4:1. doi: 10.21767/2254-9137.100066 
• Valentine L, Kroll T, Bruce F, Lim C, Mountain R (2017). Design Thinking for Social Innovation in Healthcare. The Design Journal (accepted).
• Morris, JH, Kelly C, Joice S, Kroll T, Mead G, Donnan P, Toma M, Williams B (2017). Art participation during stroke rehabilitation for improvement of psychosocial outcomes: a feasibility randomised controlled trial. Disability and Rehabilitation
• Fulton R, Kroll T, McMurdo M, Molloy GJ, Witham M (2017). Interventions to Improve Medication Adherence in Heart Failure – A Systematic Review. Journal of Preventive Cardiology, 6(3), 962-970. 
• Cunningham K, Kroll T, Wells M (2017). Development of the Cancer-related Loneliness Assessment Tool (C-LAT): Using the Findings of a Qualitative Analysis to Generate Questionnaire Items. European Journal of Cancer Care, DOI: 10.1111/ecc.12769.
• Baldie D, Guthrie B, Entwistle V, Kroll T (2017). Exploring the impact and use of patients’ feedback about their care experiences in general practice settings – a realist synthesis. Family Practice, cmx067
• McAuliffe, E., De Brún, A., Ward, M., O’Shea, M., Cunningham, U., O’Donovan, R., McGinley, S., Fitzsimons, J., Corrigan, S., & McDonald, N. (2017). Collective Leadership and Safety Cultures (Co-Lead): Protocol for a pilot evaluation of the impact of a co-designed collective leadership intervention on team performance and safety culture in Ireland. BMJ Open, in press.
• Shan, L., Henchion, M., De Brún, A., Murrin, C., Wall, P., & Monahan, P. (2017). Factors that predict consumer acceptance of processed meat based functional foods. Meat Science, 133, 185-193.
• Kieran, M., Cleary, M., De Brún, A., & Igoe, A. (2017). Supply and Demand: Application of Lean Six Sigma methods to improve drug round efficiency and release nursing time. International Journal for Quality in Healthcare, in press.
• Timba-Emmanuel T., Kroll, T., Renfrew, N. J. and  Steve MacGillivray (2017). Understanding the experiences of married Southern African women in protecting themselves from HIV/AIDS: a systematic review and meta-synthesis. Ethnicity & Health. 
• Zubala, A., Mac Gillivray S., Frost, H. , Kroll, T., Skelton, D. A., Gavine, A., Gray, N.M., Toma M.,   Morris, J. (2017).  “Promotion of physical activity interventions for community dwelling older adults: A systematic review of reviews”. PLOS ONE 12(7).
• Shan, L. C., De Brún, A., Henchion, M., Li, C., Murrin, C., Wall, P. G., & Monahan, F. J. (2017). Consumer evaluations of processed meat products reformulated to be healthier– A conjoint analysis study. Meat Science, 131, 82-89.
• McSwiggan L., Kroll T., Marston J., Campbell M., Kelly T. (2017). Information sharing and knowledge exchange with respite care services for older adults: A qualitative exploration of carers’ experiences. Health and Social Care in the Community (accepted).
• Breckenridge J, Devaney J, Duncan F, Kroll T, Lazenbatt A, Taylor J, Bradbury-Jones C (2017). Conducting Sensitive Research With Disabled Women Who Experience Domestic Abuse During Pregnancy: Lessons From a Qualitative Study. SAGE Research Methods Cases.
• Mji, G., Braathen, S. H., Vergunst, R., Scheffler, E., Kritzinger, J., Mannan, H., & Visagie, S. (2017). Exploring the interaction of activity limitations with context, systems, community and personal factors in accessing public health care services: A presentation of South African case studies. African Journal of Primary Health Care and Family Medicine, 9(1), 1-9.
• De Brún, A., Flynn, D., Ternent, L., Price, C. I., Rodgers, H., Ford, G. A., Rudd, M., Lancsar, E., Simpson, S., Teah, J., & Thomson, R. G. (2017).” Factors that influence clinicians’ decisions to offer intravenous alteplase in acute ischaemic stroke patients with uncertain treatment indication: results of a discrete choice experiment.” International Journal of Stroke.
• Ward M, McAuliffe E, Wakai A, Geary U, Browne J, Deasy C, Schull M, Boland F, McDaid F, Coughlan E, O’Sullivan R. Study protocol for evaluating the implementation and effectiveness of an emergency department longitudinal patient monitoring system using a mixed-methods approach, BMC Health Services Research (2017) 17:67.
• Vallières, F., McAuliffe, E., Hyland, P., Galligan, M., & Ghee, A. (2017). Measuring work engagement among community health workers in Sierra Leone: Validating the Utrecht Work Engagement Scale. Revista de Psicología del Trabajo y de las Organizaciones.

2016

• Hayden D., Byrne C., Higgins L., O’Reilly M., Teeling S.P., MacMahon P., Kavanagh E., Kelly P., Murphy, S. (2016). Lean Six Sigma: A Highly-Effective Approach to Reducing Door-to-Needle Times in Acute Ischemic Stroke. International Journal of Stroke
• O’Toole R., Murphy C., Hogan K., Mullen E., Igoe A., Teeling S.P., Power D. and Duggan J. (2016). Utilisation of Lean Six Sigma process improvement methodologies in acute hip fracture care of the older person. Age and Ageing 45: ii13–ii56 doi: 10.1093/ageing/afw159.83
• Coughlan, E., Geary, U., Wakai, A., O’Sullivan, R., Browne, J., Ward, M., McAuliffe, E., McDaid, F., Deasy, C. (2016) An introduction to the Emergency Department Adult Clinical Escalation Protocol: ED-ACE. Emergency Medicine Journal. 0:1-5. 
• Vallières, F., McAuliffe, E., van Bavel, B., Wall, P.J. & Trye, A. (2016). There’s no app for that: Assessing the impact of mHealth on the supervision, motivation, engagement and satisfaction of community health workers in Sierra Leone. Annals of Global Health, 82(5), 936-949.
• Larkan, F., Uduma, O., Lawal, S. A., & van Bavel, B. (2016). Developing a framework for successful research partnerships in global health. Globalization and Health, 12(1), 17.
• De Brún, A., Heavey, E., Waring, J., Dawson, P., & Scott, J. (2016). “PReSaFe: A model of barriers and facilitators to patients providing feedback on experiences of safety.” Health Expectations.
• McAuliffe, E., Galligan, M., Revill, P., Kamwendo, F, Sidat, M., DePinho, H. and Araujo, E. (2016) “Factors influencing Job Preferences of Health workers providing Obstetric Care: Results from Discrete Choice Experiments in Malawi, Mozambique and Tanzania”. Globalization and Health, 12 (86).
• Chipeta, E., Bradley, S., Chimwaza-Manda, W., McAuliffe, E. (2016) “Working Relationships between Obstetric Care staff and their Managers: Critical Incident Analysis”. BMC Health Services Research, 16 (441).
• Agyapong, V., Farren, C. and McAuliffe, E. (2016) “Improving Ghana's mental healthcare through task-shifting- psychiatrists and health policy directors perceptions about government’s commitment and the role of community mental health workers”. Globalization and Health, 12 (57).
• Gilmore, B., Adams, B., Bartoloni, A., Alhaydar, B., McAuliffe, E., Raven, J., Taegtmeyer, M. & Vallières, F. (2016) 'Improving the performance of community health workers in humanitarian emergencies: a realist evaluation protocol for the PIECES programme', BMJ Open, 6 .
• Gilmore, B., McAuliffe, E., Larkan, F., Vallieres, F, Mollel, H., & Tumwesigye, N.M (2016) 'How do community health committees contribute to capacity building for maternal and child health?: A realist evaluation protocol', BMJ Open.
• McVeigh, J., MacLachlan, M., Gilmore, B., McClean, C., Eide, A.E., Mannan, H., Geiser, P., Duttine, A., Mji, G., McAuliffe, E., Sprunt, B., Amin, M. & Normand, C. (2016) 'Promoting good policy for leadership and governance of health related rehabilitation: a realist synthesis', Globalization and Health, 12 (49).
• Vallières, F., Cassidy, E.L., McAuliffe, E., Gilmore, B., Bangura, A.S. and Musa J. (2016) 'Can Sierra Leone maintain the equitable delivery of their Free Health Care Initiative? The case for more contextualised interventions: results of a cross-sectional survey', BMC Health Services Research, 16 (258).
• McVeigh, J., MacLachlan, M., Gilmore, B., McClean, C., Eide, A. H., Mannan, H., & Sprunt, B. (2016). Promoting good policy for leadership and governance of health related rehabilitation: a realist synthesis. Globalization and health, 12(1), 49.
• MacLachlan, M., Mannan, H., Huss, T., Munthali, A., & Amin, M. (2016). Policies and processes for social inclusion: using EquiFrame and EquIPP for policy dialogue: comment on" Are sexual and reproductive health policies designed for all? Vulnerable groups in policy documents of four European countries and their involvement in policy development". International journal of health policy and management, 5(3), 193.
• Cho, H. Y., MacLachlan, M., Clarke, M., & Mannan, H. (2016). Accessible home environments for people with functional limitations: a systematic review. International journal of environmental research and public health, 13(8), 826.
• Munthali, A. C., Mannan, H., MacLachlan, M., & Swartz, L. (2016). Seeking Biomedical and Traditional Treatment is a Spiritual Lapse Among Zionists: A Case Study of the Zion Church in Malawi. Ufahamu: A Journal of African Studies, 39(2).
• Visagie, S., Eide, A. H., Mannan, H., Schneider, M., Swartz, L., Mji, G.,& MacLachlan, M. (2016). A description of assistive technology sources, services and outcomes of use in a number of African settings. Disability and Rehabilitation: Assistive Technology, 1-8.
• Hussey, M. M., & Mannan, H. (2016). China’s Mental Health Law: Analysis of Core Concepts of Human Rights and Inclusion of Vulnerable Groups. Disability, CBR & Inclusive Development, 26(4), 117-137.
• Maclachlan, M., Mannan, H., Huss, T., Embong, A. R., & Mji, G. (2016). Macropsychology: The Psychology of Policy. International Journal of Psychology, 51, 926-927.
• Killen, A., Flynn, D., De Brún, A., O’Brien, N., O’Brien, J., Thomas, A. J., & Taylor, J. P. (2016). Support and information needs following a diagnosis of dementia with Lewy bodies. International Psychogeriatrics, 28(03), 495-501.
• De Brún, A., Shan, L., Regan, Á., McConnon, Á., & Wall, P. (2016). Exploring coverage of the 2008 Irish dioxin crisis in the Irish and UK newsprint media. Health communication, 31(10), 1235-1241.
• Levesque, J-F, O’Dowd, J., Ní Shé, É., Weenink, J-W., and Gunn, J., 2016). ‘Moving health services planning to a population-based approach: an evaluation of the Regional Operating Model (ROM) in Victoria, Australia’ Australian Health Review
• Ryan, R., Wortley, L., and Ní Shé, É. (2016) ’Evaluations of post-disaster recovery: a review of practice material’ Evidence Base-(4):1-33
• Ryan, R., Hastings, C., Grant, B., Lawrie, A., Ní Shé, É., Wortley, L., (2016) ‘The Australian Experience of Municipal Amalgamation: Asking the Citizenry and Exploring the Implications’ Australian Journal of Public Administration 75(3):373-390
• Uwizeye G, Lee B, Kroll T. (2016). Health System Re-Design Following Sexual Violence During the Genocide in Rwanda. Editorial. International Journal of Public Health 61(8), 959–960. 
• Fulford H, McSwiggan L, Kroll T, MacGillivray S (2016). Exploring the use of information and communication technology by people with mood disorder: A systematic review and meta-synthesis. Journal of Medical Internet Research (JMIR) Mental Health 3(3) DOI: 10.2196/mental.5966.
• Morris J, Oliver T, Kroll T, Joice S, Williams B (2016). Physical activity participation in community dwelling stroke survivors: synergy and dissonance between motivation and capability. A qualitative study. Physiotherapy, doi:10.1016/j.physio.2016.05.001 (Epub ahead of print).
• Niemäla M, Marshall CA, Kroll T, Curran M, Silverberg Koerner S, Räsänen S, Garcia F (2016). Family-Focused Preventive Interventions with Cancer Cosurvivors: A Call to Action. American Journal of Public Health, 106(8), 1381-1387. 
• Adams J, Kroll T, Broom (2016). Prevalence of Glucosamine and Omega 3 Fatty Acid Use and Characteristics of Users Among Mid-Age Women: Analysis of a Nationally Representative Sample of 10,638 Women. The Journal of Nutrition, Health and Aging 20(6):637-644.
• Azar M, Kroll T, Bradbury-Jones C. (2016). Lebanese women and sexuality: A qualitative inquiry. Sexual & Reproductive Healthcare, 8, 13-18. 
• Bradbury-Jones C, Breckenridge JP, Devaney J, Duncan F, Kroll T, Lazenbatt A, Taylor J. (2016). Priorities and strategies for improving disabled women’s access to maternity services when they are affected by domestic abuse: a multi-method study using concept maps. BMC Pregnancy Childbirth.

Presentation on the Sláintecare Report

As part of the Health Sciences Summer School Róisín Shortall T.D and Chairperson of the Special Committee on the Future of Healthcare presented on the Sláintecare report. Following the presentation there was a panel discussion chaired by Prof. Eilish McAuliffe with contributions from those working in the system and members of the public:
Mr Eugene Callan, Disability Federation of Ireland Public representative on the SAFE Project - Systematic Approach to Improving care for Frail Older patients
Dr Diarmuid O Shea, Consultant physician in medicine for the elderly and head of department in St Vincent's University Hospital and clinical lead on the National Programme for Older Persons with the Health Service Executive
Róisín Shortall T.D and Chairperson of the Special Committee on the Future of Healthcare. Watch video

Attendance at the UL Public and Patient Involvement in Research Summer School

Dr Éidín Ní Shé recently attended the UL Public and Patient Involvement in Research  Summer School that was held at the University of Limerick on 22-23 June 2017. Éidín was presented with a copy of the recently published UL Engage report that she had contributed to on 'Creating Community Research Partnerships-Field Notes from the 'Count Me in' Project' by Alphonse Basogomba and Associate Professor Maura Adshead (pictured).

European Association of Work and Organizational Psychology 2017 Congress 

• 3rd Annual HRB-TMRN Trial Methodology Symposium 2017 "Transparency in Trials"  October 20, 2017
• HRB-TMRN Winter School  17-19 October, 2017
• M.Sc. Health Systems Management Information Webinar May 30, 2017
• Open lecture by Mr. Tony O'Brien, Director General, Health Services Executive: "Current Status of Irish Health System: Opportunities and Challenges".  April 4, 2017 view slides
• Open lecture by Dr. Valerie Walsh, HSE: "How is the Irish Health System Financed?" March 9, 2017 view slides
• Health Systems Research Seminar with Dr. Georgina Murphy. December 20, 2016
• HRB-TMRN Monthly Webinar Series - Ms. Marina Zaki, UCD: Factors affecting Statistical Rigour in Clinical Trials - Findings from the Literature. November 22, 2016 watch video
• UCD Co-Lead Team / The King's Fund Workshop (closed event) November 2, 2016
• Health Systems Seminar Series: Professor Federico Lega October 18, 2016 watch video
• Series of Research Workshops in MMUH  May - July 2016
• Health Systems Seminar Series: Dr. Simon Western March 7, 2016 watch video
• Realist Methods Workshop HRB-TMRN/UCD Health Systems event February 25, 2016 watch video
• Health Systems Seminar Series: Professor Michael West  January 22, 2016 watch video
• Health Systems Seminar Series: Professor Donna Wilson  December 10, 2015