Health Systems

Researching the effectiveness of healthcare organisations and resources concerned with promoting, restoring and maintaining health.

The role of a health system is to deliver a quality health service to all people, when and where they need it. Health systems research encompasses diverse research interests, including health policy; healthcare effectiveness and health outcomes; the organisation and (re)configuration of health services; health economics and resource management; performance management; interactions and experiences at the user-health system interface; connected health and healthcare informatics; patient outcomes, patient safety and quality. The Head of the Health Systems Research Group is Professor Eilish McAuliffe.

What is a health system?

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 workorce, 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.

What is health systems research?

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?

Why study health systems?

“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.

Meet Our Team
Our Research Projects
Our Publications

2017

  • 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 Medicine9(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

  • 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 health12(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 management5(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 health13(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 Studies39(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 Development26(4), 117-137.
  • Maclachlan, M., Mannan, H., Huss, T., Embong, A. R., & Mji, G. (2016). Macropsychology: The Psychology of Policy. International Journal of Psychology51, 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 Psychogeriatrics28(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 communication31(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.
Our News & Dissemination Activites

Exchange Visits between Staff from the UCD School of Nursing, Midwifery and Health Systems and the School of Nursing,  Meru University in Kenya

Dr. Gabrielle O'Kelly, Programme Director, Higher Diploma in Mental Health, and Dr. Purity Mwendwa, Post-Doctoral Research Fellow, UCD School of Nursing, Midwifery and Health Systems, recently travelled to Meru University in Kenya to explore the possibility of establishing a collaboration between UCD and Meru University. Two members of staff from the School of Nursing in Meru University, Dr Naomi Mutea, the Dean of the School and MaryJoy Kaimuri then paid a return visit early in April.  Meru University welcomed its first cohort of B.Sc. Nursing students in January of this year and the University is keen to collaborate with nursing programmes that are well established. This visit was made possible through the award of the ESTHER Ireland Small Grant Scheme, a European initiative that involves the twinning of European institutions with those in developing countries to strengthen health care services by building expertise and sharing experience. Because UCD keeps an external focus, seeking to lead and shape agendas through alliances and partnerships with its peers, nationally and internationally, it is envisioned that such a partnership will serve to fulfil this mission and enhance UCD’s reputation as Ireland’s Global University

L-R: Prof. Gerard Fealy, Ms Naomi Mutea, Prof. Eilish McAuliffe, Dr. Maryjoy Kaimuri, Dr. Gabrielle O'Kelly, Dr. Purity Mwendwa.

STAR

HRB-TMRN START Radio Podcast

On March 22, 2017 Ms. Marina Zaki (HRB-TMRN PhD Scholar, UCD Health Systems) was interviewed on Galway Bay FM and Connemara FM Radio stations talking about the HRB-TMRN START (Schools Teaching Awareness of Randomised Trials) Clinical Trials Competition for Children. CLICK HERE TO LISTEN (Skip to 58:30).

 

 Africa Health Agenda International Conference 

Dr. Purity Mwendwa presented a paper at the Africa Health Agenda International Conference held from 7th - 9th March 2017 in Nairobi, Kenya. Title of the Paper: "Assessing the demand for community health workers’ social support: Perspectives of mothers in rural Rwanda". 

 

 

1st National Patient Safety Conference

Dr. Éidín Ní Shé and Karen Egan delivered presentation on Medical Professionalism in Relation to Safety: Junior Doctors’ Experiences in Practice at the 1st National Patient Safety Office conference on 7th and 8th December 2016. Please click here to view the presentation. 

HRB 30-year Anniversary Conference

Professor Eilish McAuliffe delivered a speech about challenging cultures and systems at the HRB National Health Research Conference.  The conference took place in Dublin Castle on November 30, 2016.  Please click on this link to watch Prof. McAuliffe's presentation. The conference programme can be viewed at this link.

2nd Annual HRB-TMRN Trial Methodology Symposium

Ms. Marina Zaki (HRB-TMRN PhD Scholar, UCD) and Mr. David Farrar (HRB-TMRN Summer Scholar, UCD) presented their research in the 2nd Annual HRB-TMRN Trial Methodology Symposium in October, 2016 in the Kingsley hotel in Cork. Please click on this link to watch a few minute video clip on event's highlights. 

Research Conversations in UCD, MMUH and SVUH

A new series of ‘research conversations’ has begun  in the Mater Misericordiae University Hospital, St Vincent’s University Hospital and the College of Health Sciences in UCD. These conversations are open to all staff across the healthcare disciplines in the hospitals and the college and are intended to help foster research communities and collaborations across these sites.

We welcome those who are currently undertaking research as well as those who have not engaged with research for some time and would like to rekindle their interest. The conversations are open to any member of staff interested in hearing about what research is going on as well as those who have ideas for research and would like some support to get their ideas off the ground or to connect with potential collaborators. Thank you to Dr Alison Buick, Dr Aoife DeBrún, Dr Deirdre O'Donnell, Dr Denise O'Leary and Dr Éidín Ní Shé for sharing their knowledge and insights and to all those from the schools and hospitals who have participated to date! 

Global Health Realist Group gives workshop on realist methods 

Members of the Global Health Realist Group from CGH ran a workshop through the HRB - Trials Methodology Research Network at UCD O'Brien Centre fo Sciences on February 25th, 2016. During this workshop Centre for Global Health staff introduced realist methodology, and provided examples of their own work using realist reviews and realist evaluations in global health.

The Global Health Realist Group aims to provide a space for academics and practitioners interested in realist methodology in global health to collaborate, learn together, and work towards the advancement of these research methodologies. If you are interested in joining the group or would like more information, please read more here, or join the LinkedIn group by emailing gilmorb@tcd.ie.

Launch of the HRB-Trials Methodology Research Network (HRB-TMRN)

On the 24th and 25th of September 2015, the launch of the HRB-Trials Methodology Research Network took place in the Gibson Hotel, Dublin. The network (HRB-TMRN) is a new, collaborative initiative between a number of Irish and international higher education institutes and methodology centres. Its mission is to strengthen the methodology and reporting of trials in health and social care on the island of Ireland so that they become more relevant, accessible and influential for patients and other service users, practitioners, policy makers and the public. This will be achieved through a programme of work relating to the methodology of trials and focussed on (i) support (ii) training and education and (iii) research and innovation.

The Director of the network, Professor Declan Devane, the Co-Ordinator, Dr. Sandra Galvin, along with the Executive Committee, and CEO of the HRB, Dr Graham Love, welcomed all attendees to the official launch. Professor Eilish McAuliffe, Head of Health Systems in UCD and Ms. Marina Zaki, who has recently started her PhD programme in the UCD Health Systems group, attended the event and met with the other participants and PhD students from the network’s partner sites.

Sir Iain Chalmers, Co-founder of the Cochrane Collaboration was keynote speaker and gave an interesting account of “The James Lind Library: Illustrating the Evolution of Fair Tests of Treatments”.  The PhD students associated with the network also gave brief presentations on their research.  Day two of the event was dominated by a series of parallel workshops on a variety of topics related to the conduct of trials from Sample Size Calculations to Studies within a Trial/Review (SWATS/SWARS) to Health Behaviour Change Strategies for Clinical Trials.

Above: Prof. Eilish McAuliffe, UCD Health Systems and Prof. Declan Devane, Director of the HRB-TMRN.

Below L-R: Ms. Marina Zaki, PhD student in Health Systems, UCD I Ms. Jessica O’Dowd, PhD student, TCD I Ms. Lydia Emerson, MRC-HTMR PhD Student, Queen’s University, Belfast   I   Sir Iain Chalmers, Co-founder of the Cochrane Collaboration  I Ms. Aislinn Conway, PhD student, NUIG I Ms. Caroline Hurley, PhD student, UCC.

Marina Zaki (on the left of the picture above) is the UCD PhD scholar working on the HRB-TMRN. She obtained her BSc. (Pharmacology) from the School of Biomolecular and Biomedical Sciences in UCD in 2013, carried out her BSc. Research project in the University of Copenhagen (Erasmus) and was awarded her MSc. (Translational Medicine) from King’s College London in 2015. The focus of Marina’s PhD project will be looking at bringing awareness to the benefits of statistician involvement from the beginning of clinical trials; the roles they play, their impact on the conduct of trial designs, decision making, reporting and the publication of trial results. Marina is studying under the supervision of Professor Eilish McAuliffe with co-supervisors Dr. Marie Galligan (Biostatistician and Clinical Research Tutor, School of Medicine, UCD) and Professor Declan Devane (Director of the HRB-TMRN and Professor of Midwifery, NUI Galway).

For additional information on the HRB-TMRN visit http://www.hrb-tmrn.ie/

 

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