Focus on Top Tier 2.0 - UNLV Health

UNLV Health seeks to create a healthier Nevada by caring for our communities and by driving the future of healthcare; it will transform the way that care is delivered in Southern Nevada. UNLV\u27s five health science schools (Medicine, Dental Medicine, Public Health, Nursing, and Integrated Health Sciences), along with programs in behavior and mental health, are working together utilizing a model of comprehensive care where those who seek care are provided with a range of highly trained healthcare providers in a single visit.https://digitalscholarship.unlv.edu/top_tier_focus/1020/thumbnail.jp

Community participation for transformative action on women's, children's and adolescents' health.

The Global strategy for women's, children's and adolescents' health (2016-2030) recognizes that people have a central role in improving their own health. We propose that community participation, particularly communities working together with health services (co-production in health care), will be central for achieving the objectives of the global strategy. Community participation specifically addresses the third of the key objectives: to transform societies so that women, children and adolescents can realize their rights to the highest attainable standards of health and well-being. In this paper, we examine what this implies in practice. We discuss three interdependent areas for action towards greater participation of the public in health: improving capabilities for individual and group participation; developing and sustaining people-centred health services; and social accountability. We outline challenges for implementation, and provide policy-makers, programme managers and practitioners with illustrative examples of the types of participatory approaches needed in each area to help achieve the health and development goals

Transforming Health Systems to Serve the Wellbeing of Indigenous and Minority People

This is the report from a conference organised by IDS and the Royal Tropical Institute (KIT) to bring together key stakeholders and experts from Asia, Africa and Latin America to share their expertise and establish a common agenda to address inequities in universal health coverage that affect indigenous and minority peoples. Building on participants’ experiences, the conference explored three themes that highlighted critical issues at the interface between dominant medical norms and practices in state health systems and the socio-cultural realities of indigenous groups. The themes were: 1. territory, mobility and access; 2. traditional medical knowledge and intercultural, culturally sensitive, health care; and 3. gender and sexual and reproductive health, including maternal and child health (MCH). Participants used ‘mind-mapping’ techniques to identify the current state of health systems and their vision of what health care for indigenous groups should look like, in order to develop an ambitious agenda for future collaborative work on bridging divisions. The outcome of the conference was a better understanding of what interventions to transform health systems have worked and why. Participants shared their experiences with significant and promising efforts in improving health access. These experiences included working with and strengthening networks of healers and indigenous selfhelp groups, developing mobile and cross-border programmes, reducing stigma, and promoting initiatives to facilitate community empowerment. Health financing, good governance, poverty alleviation and protection of lands and livelihoods were widely recognised as important across the three themes. Yet in reality, few initiatives actually link or integrate health, livelihoods and governance. There was agreement on the need for improved systematic documentation and recognition of indigenous peoples’ knowledge, including their medical expertise. There was also an emphasis on the need to improve engagement between indigenous health care practitioners and biomedical providers. The relationship of pharmaceutical companies to traditional medicine was also explored. Participants identified the need for a global network to share information about what works and why, when it comes to addressing the health challenges faced by indigenous and minority peoples. Such a network would help strengthen advocacy for international policy responses to these challenges. Recognising the need for a global networ k, at the end of the confer ence, participants decided to establish the Indigenous and Minority Peoples Health Alliance (TIMPHA). The mission of TIMPHA is to transform health systems to serv e the wellbeing and health of indigenous and minority groups and help ensure universal health coverage in Africa, Asia and Latin America for all citizens. Members of the network developed a research agenda and potential joint action r esearch projects to address key knowledge gaps and pilot innovative responses to indigenous health challenges.Rockefeller Foundation, Wellcome Trus

Primary care in the twenty-first century

Summary • The NHS remains one of the world’s better health care systems. But the proportion of the UK’s GDP allocated to health and social care is only about three quarters of that now spent by leading European nations. To meet changing needs health and social care providers in England must improve their capacity to offer convenient access to preventive and ‘common need’ diagnostic and treatment services to people of all ages, and also to provide well-coordinated social and health care to individuals at high risk of suffering avoidable episodes of serious illness and needlessly losing their independence. • If personal and public health is to be raised to the highest possible level improving primary health and health related social care – which together represent little more than a fifth of combined NHS and local authority social service outlays – is vital. Health care will in future move more towards professionally facilitated prevention and primary care supported self-care in the community, backed by the relatively infrequent use of highly specialised services supplied in hospitals. • The unique attributes of British general medical practice will allow it to serve as a central plank for continuing service development. The formation of local Health Federations and related primary care focused organisations could in future lend itself to holding single budgets for health and related social care along the lines proposed by advocates of the Primary Care Home approach to service improvement. This would offer significant gains for service users. Wherever cost effective, services ought to be ‘made’ by local care providers. Where necessary they should be purchased from other sources. • There is a large body of evidence indicating that Community Pharmacy can play an extended part in delivering accessible health care, alongside roles like reducing prescription errors and facilitating better medicines use. Increasing the number of clinical pharmacists working in GP practices is a valuable step. But it cannot substitute for a clear vision for the future of community pharmacies as ‘first contact’ health care providers. • If community pharmacists successfully extend their clinical care roles this would free general practice and linked community capacity to work towards reducing inappropriate hospital admissions and unduly long inpatient stays. Without well planned, pro-active, interventions pharmacy skills will be under-used and the established community pharmacy network lost. Yet if each community pharmacy in England were able to take on just 10 per cent of the average general practice’s existing workload over the next five years, this will release approaching 5,000 GPs and similar volumes of practice staff for additional service provision. • Responsibility for achieving more effective primary care working arrangements lies mainly with GPs, nurses, social workers and pharmacists themselves, because only they are in a position to adequately understand the tasks with which they are engaged and the detailed needs of the people they serve. However, individual professionals alone cannot transform the NHS. Excellent national leadership and appropriate funding and governance systems are also vital for nation-wide success. • Nine out of 10 people in England currently live within a 20 minute walk of a community pharmacy. Some planners may wish to see savings made via concentrating dispensing in warehouse-like facilities and increasing the use of medicines home delivery services. Yet at a system-wide level a potentially more desirable way forward could be to extend pharmacist prescribing and improve shared health record systems. This would combine convenient local medicines supply with more accessible forms of ‘pharmacist first’ care in areas ranging from managing blood pressure to providing better chronic obstructive pulmonary disease (COPD) and type 2 diabetes prevention and care. • The health and social care system in England has been affected by imbalances that are linked to the fact that social care is means tested while NHS care is free. This has created perverse incentives that may in the past have undermined services such as community nursing. Inadequate high level leadership also impairs service quality. But if health gain focused co-operative professional enterprise can be combined with well-informed decision making and robust national and local resource allocation strategies that effectively support the delivery of well-coordinated primary care, further improvements in individual and population health will be achieved

Positive aging, positive dying: Intersectional and daily communicational issues surrounding palliative and end of life care services in minority groups in the UK and the US

As our global demographic shifts towards an increasingly aging population, we have an opportunity to transform how we experience and think about getting older and embrace the diversity and contribution that this population can bring to society. The International Handbook of Positive Aging showcases the latest research and theory into aging, examining the various challenges faced by older adults and the ways in which we can bring a much needed positive focus towards dealing with these. The handbook brings together disparate research from medical, academic, economic and social community fields, with contributions from NHS partners, service users, universities across the UK and collaborations with international research leaders in the field of aging. Divided into sections, the first part of the book focuses on introducing the concept of positive aging before going on to cover the body over the life course, well-being and care delivery. All contributors recognise the fact that we are living longer is providing us with a tremendous opportunity to enjoy and flourish in healthy and fulfilling later lives, and this focus on the importance of patient empowerment is integral to the book. This is a valuable reference source for those working in developmental psychology, clinical psychology, mental health, health sciences, medicine, neuropsychological rehabilitation, sociology, anthropology, social policy and social work. It will help encourage researchers, professionals and policy makers to make the most of opportunities and innovations to promote a person’s sense of independence, dignity, well-being, good health and society participation as they get older

An action research study with health care professionals aiming to improve preparation for childhood hospitalisation

University of Technology, Sydney. Faculty of Nursing, Midwifery and Health.Preparation for hospitalisation is a right of all children and its practice requires improvement. Preparation benefits children and their families because it provides information and appropriate support known to be crucial for positive outcomes. Optimal preparation practice is both difficult to define and challenging to provide. This thesis reports on an action research study undertaken when the concerns of a group of health care professionals at one major children’s hospital presented me with an opportunity to work with these staff to improve preparation for childhood hospitalisation. Applying critical social theory as a model of change helped the action group to understand how to negotiate the bureaucratic structures that can inhibit but also enable change in a hospital setting. The processes of engaging as a group with a shared goal of improving preparation practice highlighted some important challenges and opportunities in relation to the realities of collaborative action within health care settings. A survey of children and their parent/guardian regarding preparation for childhood hospitalisation and an audit of hospital staff’s preparation practices helped to identify children’s and families’ preparation practice experiences and preparation practices occurring at the hospital. As a way of mobilising collective action for desired change the action group facilitated the reinstatement of an approved preparation for childhood hospitalisation booklet. The most important findings of this study fall into three broad areas: the need for inclusive models of collaboration in complex and dynamic health care settings, the need for transformational approaches to leadership that consistently and explicitly support the engagement of staff in collaborative processes of ongoing practice improvement; and the need for transformational approaches to facilitation, which enable person-centred ways of working together and shared professional power and responsibility. To enable sustainable, evidence-based change the workplace must explicitly support staff’s continued engagement in critical reflection on their practice and provide staff with opportunities for taking collaborative action on issues of concern. Collaborative, evolving workplace cultures need to be sustained by inspired leadership at all levels of the organisation. Training and support are critical factors for attaining the inspired leadership required to transform the health care setting into an effective, efficient and supportive workplace. Keywords: preparation for childhood hospitalisation, critical social theory, action research, inclusive models of collaboration, transformational leadership, transformational facilitation

Ending preventable maternal mortality: phase II of a multi-step process to develop a monitoring framework, 2016–2030

Background In February 2015, the World Health Organization (WHO) released “Strategies toward ending preventable maternal mortality (EPMM)” (EPMM Strategies), a direction-setting report outlining global targets and strategies for reducing maternal mortality in the Sustainable Development Goal (SDG) period. In May 2015, the EPMM Working Group outlined a plan to develop a comprehensive monitoring framework to track progress toward the achievement of these targets and priorities. This monitoring framework was developed in two phases. Phase I, which focused on identifying indicators related to the proximal causes of maternal mortality, was completed in October 2015. This paper describes the process and results of Phase II, which was completed in November 2016 and aimed to build consensus on a set of indicators that capture information on the social, political, and economic determinants of maternal health and mortality. Findings A total of 150 experts from more than 78 organizations worldwide participated in this second phase of the process to develop a comprehensive monitoring framework for EPMM. The experts considered a total of 118 indicators grouped into the 11 key themes outlined in the EPMM report, ultimately reaching consensus on a set of 25 indicators, five equity stratifiers, and one transparency stratifier. Conclusion The indicators identified in Phase II will be used along with the Phase I indicators to monitor progress towards ending preventable maternal deaths. Together, they provide a means for monitoring not only the essential clinical interventions needed to save lives but also the equally important political, social, economic and health system determinants of maternal health and survival. These distal factors are essential to creating the enabling environment and high-performing health systems needed to ensure high-quality clinical care at the point of service for every woman, her fetus and newborn. They complement and support other monitoring efforts, in particular the “Survive, Thrive, and Transform” agenda laid out by the Global Strategy for Women’s, Children’s and Adolescents’ Health (2016-2030) and the SDG3 global target on maternal mortality

Aligning Forces for Quality: Local Efforts to Transform American Health Care

Profiles RWJF's initiative to raise healthcare quality in targeted communities; reduce racial/ethnic disparities; and offer models for national reform through performance measurement and public reporting, quality improvement, and consumer engagement

Progress Along the Pathway for Transforming Regional Health: A Pulse Check on Multi-Sector Partnerships

Multi-sector partnerships play an increasingly significant role in the movement to improve heath, equity, and economic prosperity. These partnerships recognize that many of our most pressing challenges defy sector boundaries, and cannot be effectively addressed by any one institution alone. Progress Along the Pathway to Health System Transformation: A Pulse Check on Multi-Sector Partnerships is the only survey of its kind to ask leaders across the U.S. what their partnerships do, how they finance their work, and how their groups have been developing over time. The 2016 Pulse Check report provides a snapshot of 237 multi-sector partnerships throughout the country as well as rich detail around what contributes to—or gets in the way of—moving their important work forward. The survey revealed two sets of findings that are distinct, but closely related. These include characteristics of the partnerships and their efforts, such as composition, portfolio priorities, and financing; as well as developmental phases and the distinctive patterns of momentum builders and pitfalls that groups experience as they evolve. Further, ReThink Health has found that partnerships often face predictable challenges and can catalyze momentum in particularly powerful ways. The Pulse Check explored these barriers and drivers with a view toward understanding how partnerships may evolve along their journey. Pulse Check findings indicate that certain partnership characteristics do indeed show progressive differences across developmental phases (see graphic below). For instance, when compared to respondents in the Earlier and Middle phases, those in the Later phase tend to have partnerships that are more established, with larger staffs, a larger number active sectors, more expansive action portfolios, and longer-term financial plans

Strengthening Primary and Chronic Care: State Innovations to Transform and Link Small Practices

Presents case studies of state policies for reorganizing and improving primary and chronic care delivery among small practices, including leadership and convening, payment incentives, infrastructure support, feedback and monitoring, and certification