Jonathan Erskine

How might healthcare systems influence speed of cancer diagnosis: A narrative review

Striking differences exist in outcomes for cancer between developed countries with comparable healthcare systems. We compare the healthcare systems of 3 countries (Denmark, Norway, Sweden), 3 UK jurisdictions (England, Wales and Northern Ireland), 3 Canadian provinces (British Columbia, Manitoba, Ontario) and 2 Australian states (New South Wales, Victoria) using a framework which assesses the possible contribution of primary care systems to a range of health outcomes, drawing on key characteristics influencing population health. For many of the characteristics we investigated there are no significant differences between those countries with poorer cancer outcomes (England and Denmark) and the rest. In particular, regulation, financing, the existence of patient lists, the GP gatekeeping role, direct access to secondary care, the degree of comprehensiveness of primary care services, the level of cost sharing and the type of primary care providers within healthcare systems were not specifically and consistently associated with differences between countries. Factors that could have an influence on patient and professional behaviour, and consequently contribute to delays in cancer diagnosis and poorer cancer outcomes in some countries, include centralisation of services, free movement of patients between primary care providers, access to secondary care, and the existence of patient list systems. It was not possible to establish a causal correlation between healthcare system characteristics and cancer outcomes. Further studies should explore in greater depth the associations between single health system factors and cancer outcomes, recognising that in complex systems where context is all-important, it will be difficult to establish causal relationships. Better understanding of the interaction between healthcare system variables and patient and professional behaviour may generate new hypotheses for further research.

Leadership and transformational change in healthcare organisations: A qualitative analysis of the North East Transformation System

The research project ‘An Evaluation of Transformational Change in NHS North East’ examines the progress and success of National Health Service (NHS) organisations in north east England in implementing and embedding the North East Transformation System (NETS), a region-wide programme to improve healthcare quality and safety, and to reduce waste, using a combination of Vision, Compact, and Lean-based Method. This paper concentrates on findings concerning the role of leadership in enabling tranformational change, based on semi-structured interviews with a mix of senior NHS managers and quality improvement staff in 14 study sites. Most interviewees felt that implementing the NETS requires committed, stable leadership, attention to team-building across disciplines and leadership development at many levels. We conclude that without senior leader commitment to continuous improvement over a long time scale and serious efforts to distribute leadership tasks to all levels, healthcare organisations are less likely to achieve positive changes in managerial-clinical relations, sustainable improvements to organisational culture and, ultimately, the region-wide step change in quality, safety and efficiency that the NETS was designed to deliver.

New development: First steps towards an evaluation of the North East Transformation System

The North East Transformation System (NETS) is a programme that aims to engage the elements of NHS North East in a common vision, reshape the clinician/employer compact, and use Lean methodology to redesign work processes. After initial implementation in pathfinder sites, NETS is now to encompass other trusts in the region.

Rethinking healthcare building design quality: an evidence-based strategy

Healthcare buildings play a significant role in delivering healthcare services and outcomes (e.g. quality, suitability, cleanliness, patient experience, value for money and risk mitigation). However, the current diffusion of responsibilities in England between central government and healthcare trusts has created gaps and weaknesses in the evidence base, knowledge, skills and tools for creating and assessing healthcare building design quality. How can a national healthcare building design quality improvement strategy be created? This question is explored in relation to policy, strategy and organizational issues. Four evaluation studies and four action research studies indicate the complexity and responsibilities in defining a design quality improvement strategy. It is found that the interdisciplinary development of national standards and tools requires centralized investment to facilitate nationwide learning and improvements in evidence and outcomes. In addition, the inevitable health policy changes made by successive governments require a sustainable and strategic response. The creation and maintenance of capacity and capabilities will require a dedicated team of professionals and a wide interdisciplinary network of long-term contributors who are motivated by a long-term desire to improve healthcare building design quality.

Are there just barriers? Institutional perspective on the development of e-health in Poland

Abstract Development of e-health in Poland has suffered from multiple setbacks and delays. This paper presents views on and experiences with implementation of e-health solutions of three groups of respondents: buyers, suppliers and external experts with the aim of establishing to what extent and in what way e-health development was taking place in Polish public health care and if there were any national policy targets or European targets influencing this development. It is based on desktop studies and interviews conducted in Poland in the spring and summer of 2015. The interviews largely confirmed findings from the desktop study: legal obstacles were the decisive factor hindering the development of e-health, especially telemedicine, with extensive insufficiency of basic IT infrastructure closely following. Stakeholders were deterred from engaging with telemedicine, and from procuring e-health using non-standard procedures, from fear of legal liability. Some doctor’s resistance to e-health was also noted. There are reasons for optimism. Amendment to the Act on the System of Information in Health Care removed most legal obstacles to e-health. The Polish national payer (NFZ) has started introducing reimbursement for remote services, though it is still too early see results of these changes. Some doctors′ reluctance to telemedicine may change due to demographic changes in this professional group, younger generations may regard ICT-based solutions as a norm. In the same time, poor development of basic IT infrastructure in Polish hospitals is likely to persist, unless a national programme of e-health development is implemented (with funds secured) and contracting e-health services by NFZ is introduced on a larger scale.