17 de febr. 2019

what works in wellbeing

What Works Centre for Wellbeing is an independent organisation from UK that produce robust, relevant and accessible evidence on wellbeing.
  • They define the wellbeing concept as a way to understand what’s needed and how best we can all work together to improve our lives in a complex world. It brings together economic, social, environmental, democratic and personal outcomes and avoids focusing on specific areas at the expense of others. We can be better at measuring what matters and using what we know to create a better society. It is about engaging citizens in meaningful deliberation about what better society could look like. 
The What Works Centre for Wellbeing is part of the What Works Centre network. A What Works Centre is a bridge between knowledge and action for decision-makers.

I would like to focus on the report: Good work, wellbeing and changes in performance outcomes. This report published in december 2017 illustrates the effect of good people management with an analysis of National Health Service Trusts in England. The evidence says that the extensive use of good people‐management practices can have benefits for organisational performance and employee wellbeing.

Good people‐management practices are those which, for example:
  • provide opportunities for workers to influence their work directly and allow staff to have input into decisions about their wider working environment;
  • have clear roles and responsibilities for staff;
  • encourage staff to communicate respectfully with each other, to collaborate, to be supportive of each other and to work effectively in their teams.
  • enhance workers’ skills and support workers with access to learning and development opportunities;
  • improve their motivation to perform well, provide feedback on their work through fair, accurate, supportive and effective performance management processes;
  • encourage managers to support their people, through, for example, encouraging staff, giving advice and providing help with work problems.
Key findings
They found that NHS Trusts that made the most extensive use of good people‐management practices were:
  • Over twice as likely to have staff with the highest levels of job satisfaction compared to NHS Trusts that made least use of these practices.
  • Over three times more likely to have staff with the highest levels of engagement.
  • Over four times more likely to have the most satisfied patients.
  • Over three times more likely to have the lowest levels of sickness absence.
  • No link was found between people management practices and patient mortality.  

Things to consider in order to introduce good people management practices
  1. Review where you are at now. Is there a problem with wellbeing, absence, staff turnover or engagement? Are jobs as secure and remuneration and other benefits as good as other similar
  2. Get senior management sponsorship and support for changes to people management practices. Make sure senior management buy into the idea of improvements for the sake of sustainable performance and staff wellbeing and are prepared to make the necessary commitments to make improvements in jobs. Senior managers may publically sign pledges, but also involve senior managers in project management and make regular reports to the senior management team.
  3. Get support and commitment from line managers, HR and relevant management teams. Management commitment to the changes is important at all levels. Involve senior managers in getting commitment from other management groups. It might be useful to hold workshops with managers to discuss why changes are necessary, how the changes might affect them and how they will benefit. Review performance management and other people management practices to ensure managers are also supported appropriately.
  4. Open a dialogue with workers about their jobs to find out what they see as important in the way they do their jobs, how they feel they are managed and how they are supported. Show workers that the changes are intended to have business and personal benefits, and that one of core values underpinning the changes is improved wellbeing. Be specific in identifying what can be changed and how to make jobs more interesting and satisfying, and look for changes that will improve wellbeing and performance. Also, gather information on who is best placed to make the changes. For example, workers themselves are often best placed to know what needs to change but they may not know how to make the changes themselves without appropriate support and training. Workshops and focus groups can be helpful to gather information, and larger organisations may find staff surveys useful.
  5. Identify what needs to change and who is best placed to make the changes. Use the information from the dialogue with workers to identify what can be improved. This is also the stage to make cost‐effectiveness or return‐on‐investment projections to help choose between different courses of action. Improvements need to be feasible and acceptable to the different parties, so it is worth checking and refining plans at this stage. Check that workers have the right skills for any new roles or responsibilities and that their performance requirements are compatible with the changes. Introduce additional training and development and change other people management practices to ensure compatibility. At this stage, also decide on who is best placed to make each of the changes. This might entail a combination of groups, with staff and line managers making changes to how work is done and HR managers making changes to training, development and performance measurement/appraisal practices. Be mindful that you may need to make changes to other practices. Be sure that the changes will not work against other businesses processes and practices. For example, this could be the case if an organisation allows people the chance to use more intellectual skills and to take decisions that affect their work, yet management information systems restrict access to relevant information.
  6. Once you have identified what needs to be done, the changes need to be made. To do so, empower and support those best placed to make the changes. Make sure there is a level of accountability for making the changes. This means that there should be regular, timely and appropriate feedback on how the changes are progressing given to all concerned including senior managers.
  7. Therefore, at the same time, monitor, evaluate, review and revise the changes if necessary – are they delivering wellbeing and other business benefits? Are the changes sticking? What could be done to improve implementation? Through reviewing, revising and monitoring, it is possible to build a continuous improvement cycle so that initial improvements to jobs, performance and wellbeing can lead to cumulative improvements in jobs, performance and wellbeing over time as workers and managers gain more knowledge, capabilities and confidence in making incremental improvements in their work areas. In some organisations it may be possible to introduce changes in one area to see if changes are working, and then take lessons learnt to introduce changes in another area a few months after the initial changes have had chance to bed down.
photo: Jaume Plensa the Heart of Trees, Installation view at Yorkshire Sculpture Park, Wakefield, UK 2011 

27 de gen. 2019

The Spanish National Health Service: chinese porcelain


The principles and goals of the Spanish National Health System focus on universality, free access, equity and fairness of financing. The evolution of performance measures over the last decade shows the resilience of the health system to the recent economic crisis. In terms of mortality and self perceived health it does not seem to have affected heavily at least in the sort term, although some structural reforms may be required in the medium and long term, specially to avoid the increasing income inequality, poverty, and risk of social exclusions that worsen the health indicators.

Here we have some ligth about some policy iniciatives and reforms that experts said should be adressed in the Spanish National Health System
  • Cuadernos Económicos de ICE  scientific journal edited by the Secretariat of State for Trade (Government of Spain) since 1977. The current issue published in january 2019. Eight articles written by well known researchers from health economics and public health reviewing these hot topics: 
  1. The arrival of new technologies with innovative mechanisms and health financing decisions.
  2. Areas of public-private collaboration in health systems. focusing on continuing medical education, health research and health care management.
  3. The healthcare management, its quality and the consideration of the impact of this quality on health outcomes.
  4. The hospital expenditure and hospitalization evolution in the Spanish National Health System (SNS), during the period 2004-2009 and 2010-2015, analyzing their trends and medical practice variability between health areas.
  5. Coordination between the health care system and the long-term care system.
  6. Public health go beyond the performance of health care services. Health problems are global and require actions at a global level.
  7. Good governance is a prerequisite for changing the health policy and the design of the National Health System in the right direction. Good governance in terms of: prioritization, comprehensive health policy, leadership, national health agency, and cultural and intellectual environment.
  8. Economic crisis and health: lessons learned and recommendations for the future,
  Acces Full issue (pdf)  CICE Issue (2018)

Acces (pdf) Spain HiT (2018)

photo: "Homeless", 2005. google search words: name of the 25th richest people in the world in 2004 by Forbes (Joan Fontcuberta)  

16 de des. 2018

10 years of The Catalan Institute for the Evaluation of Public Policies (Ivàlua)

The Catalan Institute for the Evaluation of Public Policies (Ivàlua) was created 10 years ago. It's a public institution depending of the Government of Catalonia. The board of trustees is made up of the founding Academic Institutions (UPF), public institutions (Ministry of the Vice-presidency and of the Economy and Finance, DIBA, CTESC, CIC)

Ivalua promotes the evaluation of public policies among the Catalan public administrations, non-profit entities that pursue objectives that are of public interest and among citizens in general,

The evaluation is a tool for improving government performance and democratic accountability. To accomplish its mission, Ivàlua is guided by the following strategic lines:
  • Evaluation of public policies and advisory activities
  • Training and generation of training resources
  • Promotion and dissemination of evaluation
Ivàlua has traditionally and naturally specialised in social policies, employment policies and educational policies (in this field jointly with Fundació Jaume Bofill they are promoting the #WhatWorks in Education movement)

All the activities done during these 10 years have been done with Independence, Technical Rigor to generate evidence and with maximum Transparency at all times. In their website you can download all the Evaluations carried.


photo: Ivalua Team; Marc Balaguer, Mireia Climent, Núria Comas, Marçal Farré, Laura Kirchner, Jordi Miras. Erika Pérez, Ramon Sabes-Figuera, Jordi Sanz, Anna Segura, Federico Todeschini, Frederic Udina.

22 de nov. 2018

think big... or better not: what the evidence says to hospitals' scale?

One important source of potential inefficiency in the hospital sector relates to hospitals’ scale and scope.
  • Big Hospitals: It might make good economic sense to enlarge the size and scope of a hospital to make better use of available expertise, infrastructure and equipment. However, at some point, a hospital departs from its optimal level of efficiency and begins to exhibit diseconomies of scale. Bigger organizations are harder to manage.
  • Small Hospitals: At the other end of the scale, small hospitals might also be inefficient because the fixed infrastructural and administrative costs are shared across too small a caseload, thereby pushing up the cost of an average hospital visit.
Monica Giancotti, Annamaria Guglielmo, and Marianna Mauro did a huge systematic review from the last 50 years (1964-2014) of research "published in peer-reviewed scientific journals" to try to answer some of these questions:
  • Have mergers contributed to enhance hospitals efficiency?
  • Which is the optimal size of hospitals in terms of beds?
  • Which factors influenced the hospitals scale efficiency?
According to the evidence the main conclusions are:
  1. Studies analysed that economies of scale are present for merging hospitals. Results supported the current policy of expanding larger hospitals and restructuring/closing smaller hospitals
  2. In terms of beds, studies reported consistent evidence of economies of scale for hospitals with 200–300 beds. Diseconomies of scale can be expected to occur below 200 beds and above 600 beds.
  3. There is no evidence that the increase in size may lead to outcome improvements.
  4. Teaching activities are an important cost-driving factor,
  5. Hospitals that have a broader range of specialization are relatively more costly.
  6. According to ownership, public hospitals are more efficiently than other types.
  7. According to location, urban hospitals used resources more efficiently.
Access to the Article (free): (2017) Hospital Size: Systematic Review

photo: 1957. Chicago The LIFE Picture Collection

30 de set. 2018

public sector responsiveness

Despite the recent increase of empirical research and conceptual development in transparency and accountability this has been on the side of citizen action, looking at why and how citizens mobilise around accountability demands and at what makes their actions successful.

Comparatively, there has been much less work exploring the state side of the equation – to explain why and how public officials respond (or not) to citizen demands for accountability.

The research brief from Anuradha Joshi, Rhiannon McCluskey Why and how bureaucrats respond to citizen voice (2018) review the relevant literature on public sector responsiveness and they try to answer the other side of the equation.

Their main conclusions are:

Whether public officials respond to citizen demands depends on several sources of pressure upon them including organisational, professional, elites and citizens. With respect to citizens, the key to whether demands translate into effective pressure is the way in which public officials perceive citizens and their claims:
  • The legitimacy of their claims. Regarding legitimacy, there is a higher likelihood of eliciting responsiveness from public officials if claims relate to existing entitlements in law or policy, as well as if claims are broad and inclusive, rather than narrow.
  • The credibility of who makes the claims. Ensuring that civil society organisations are neutral in respect to political parties might strengthen their credibility. Also, the degree to which they genuinely represent marginalised groups allows for perceptive public officials to take them more seriously.
  • The level of trust between public officials and citizens. Engagement with citizens can transform public officials’ perceptions of citizens’ claims and their legitimacy. Through repeated interactions that demonstrate integrity, they can earn each other’s trust. If this trust exists, public officials will be more willing to ‘stick their neck out’ for citizens.
photo: (*) Photosolde Tanqueu totes les portes

25 de jul. 2018

Back to basics: the 7 enemies of evidence-based policy

Evidence-based policy is focused on research-based evidence to inform policymakers about “what works” and thereby produce better policy outcomes.

Graham Leicester in his 20th century article - 1999- brings us a number of factors that he suggests inhibits the adoption of the evidence based policy

What we could do against them?
  1. Recognise that these enemies are everywhere not only in the governing machine. In the universities, research centres, ... 
  2. We live in a risk society and the whole society is a laboratory. All the things that happen are real life experiences with risky technologies, not experiments conducted in laboratory controlled conditions. That means that when they go wrong—and it is axiomatic in the scientific model that they must go wrong if progress is to be made—they do so for real. There needs to be a much closer relationship therefore between government and research evidence. 
  3. The political management of the evidence in our ‘risk society’ is even more important than the evidence itself. Researches have an obligation not only to be as rigorous as possible, but also to recognise that their research has a political dimension. What they choose to investigate, how and when they present the findings are part of the risk management process. They are all agents of change.
  4. Technological advance is giving a new opportunities to get to grips with complexity. The increase in processing capacity makes all sorts of things possible in the management of complex systems. There is now a capacity for instant information gathering and analysis which makes all policy into a continuous real-time experiment. The researcher’s role will be to monitor, evaluate and adjust continuously. 
  5. We must work harder to develop better data, and true indicators of what really matters to us as a society. We need data that answers the question ‘why’ as well as ‘how much’ or ‘how many’? We need indicators which can stand proxy for the general health of society, measures of the vital signs.
It is important for researchers not only to gather the evidence to describe what is happening and how society is changing, but to provide explanations about why these changes are occurring, and then ideally to suggest things that might be done to adjust the system accordingly.

As a Citizens we want evidence-based policy NOT "policy-based evidence": where evidence is typically used as a weapon — mangled and used selectively in order to claim that it supports a politician’s predetermined position

Acces to the article (restricted): The seven enemies (1999)

photo: Game of Thrones. Jon Snow: You know nothing and Book