2015 brought interesting content to BMC Health Services Research including the articles that featured in the cross journal collection ‘The Many Meanings of Quality in Healthcare’. Now that 2016 is with us, we’d like to take this opportunity to reflect on some of the highlights published in the previous 12 months.
Chronic conditions and multimorbidity represent major concerns in global healthcare yet data on the pressures these place on health infrastructure is limited. In this study, Bahler and colleagues examine the association of multimorbidity, health care utilization and costs in the Swiss community-dwelling population. They report the high prevalence of multimorbidity in the study population and indicate the stark difference in the mean number of consultations in the mulitmorbid compared the non-mulitmorbid sample. The study highlights marked differences in costs in the multimorbid patients and indicates that multimorbid patients were significantly more likely to be hospitalized. Quantified data on the burden of multimorbidity are essential to improving the management of patients and decision-making in resource allocation.
Complex innovations offer great promise in healthcare organizations with potential benefits for patients and physicians alike. Jacobs and colleagues quantitatively examined innovation implementation framework among participants in the Nation Cancer Institute’s Community Clinical Oncology Program using structural equation modeling. They found that perceptions of the implementation climate have a direct effect on the effectiveness of the process. Physician’s perceptions of the implementation climate had an influence on implementation policies practice and enrollment. The findings of this study support the recommendation that managers looking to improve implementation effectiveness should create an environment perceived as encouraging implementation with specific expectations, support and rewards for use.
Sharing our collective knowledge about a broad array of health system concerns may provide the innovation and impetus to accelerate the improvement of those systems worldwide. At the Third Global Symposium on Health Systems Research in late 2014, experts from around the world were challenged to discuss the benefits of their attendance and participation in the event. In the midst of the Ebola crisis, Lazarus and colleagues highlighted the need to meet and discuss a broad range of health systems issues and explained why they should be prioritized at a time when resources were urgently needed to address an acute health crisis. This correspondence article discusses a number of important concerns including the neglect of health systems, the motivation of health workers and reproductive health in the face of the Ebola epidemic.
The information included in patient records has a significant part to play in improving the quality, safety and efficiency of patient care. In this study, Swinglehurst and Greenhalgh explore the work of summarizing and coding records and identify the obstacles these procedures pose to the quality of care. The study used an ethnographic observation approach as part of the Healthcare Electronic Records in Organizations study funded by the UK Medical Research Council. The findings suggest that coding work can be a time-consuming enterprise that is routinely shared or delegated to administrative staff and advocates the requirement for new lines of accountability to be established.
National health research system in Malawi: dead, moribund, tepid or flourishing?
Strengthening health research systems in the World Health Organization’s African Region by improving the capacity of individuals and institutions to generate scientific knowledge is widely acknowledged as an important step in achieving the goal of universal health coverage. In this debate article, Kirigia and colleagues discuss the extent to which Malawi has taken up this challenge and the necessary steps required to meet this objective. They highlight that Malawi (like several other African countries) need to invest more in improving governance, developing and sustaining resources, financing research and using research findings in policy development and public practice.