Back to basics. Victor Fuchs (1924-2023)

Victor Fuchs was the Henry J. Kaiser, Jr., Professor of Economics and of Health Research and Policy, emeritus in Standford University.

He used economic theory to provide a framework for the collection and analysis of healthcare data. He wrote extensively on the cost of medical care and on determinants of health, with an emphasis on the role of socioeconomic factors. He spent more than five decades diagnosing the ills of the American health system, specially the health costs per capita: "The highest in the world". He also was particularly interested in the role of physician behavior and financial incentives in determining healthcare expenditures.

He was described as the dean of American health economists,

Standford obituary

Victor_Fuchs-CV (pdf)

Photo by Becky Bach

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Leadership skills necessary to improve coordination across primary, community, social and hospital services

The health needs of the population are changing, and many people need more co-ordinated care across primary, community, social and hospital services. More co-ordinated care requires organisations and staff to collaborate well across organisational and professional boundaries.

Effective working across organisations means adopting new practices to navigate challenges such as conflicting organisational goals, competing institutional norms and rules, and any perceived loss of power or resource.

The report conducted by Kings Fund draws on interview and survey data from senior leaders working in integrated care boards, NHS providers, local government and the voluntary, community and social enterprise sector, and shares insights and evidence about how to collaborate well.

The research shows health and care leaders at all levels have a critical role in modelling and rewarding collaborative behaviours but this is insufficient on its own. Leaders also need to pay attention to six leadership practices if they want to build a stronger collaborative ethos.

1. Creating a safe, inclusive and trusting environment in which everyone can contribute fully – leaders need to look at problems from perspectives beyond their own. This means leaders need to be open and trusting, to connect with others and create different spaces in which people feel safe to contribute and be heard; to listen to and value others’ contributions and ensure others do the same. 
2. Building healthy relationships – this requires sustained effort but adopting a more relational way of working based on humility, respect and trust strengthens connections between organisations and individuals leading to increased staff engagement and more co-ordinated services.
3. Developing a shared purpose and shared group identity. It is important to clearly set out the shared purpose around why organisations or/and professional groups are working together and create a shared group identity to promote engagement across the collaboration and to address any power differentials
4. Actively managing any power dynamics – so no organisation or professional group dominates. Introducing processes that create a more open and participatory environment can also be useful to enable individuals to think differently. 
5. Surfacing and managing any conflict – in collaborations you are working with different views and ideas, sometimes these will turn into conflict. It is important to approach any conflict with an open and curious mind, rather than turning away from it. 
6. Developing shared decision-making processes – designing transparent processes that enable all key organisations or groups to contribute to a decision produces a range of benefits, although it takes longer. Benefits include greater ownership over the decisions adopted and strengthening trust across a collaborating group.

This style of working is hard especially in a resource-constrained environment. The report recommend leaders give greater attention to designing more participatory processes and developing the collaborative skills of other groups of staff. Also recommend leaders extend the practice of collaborative leadership to work with a broader range of local organisations as well as local communities.

Access: Article (pdf)

Photo Jordi Soldevila. Retrat de família. Homenatge a Toni Catany

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Strengthening primary care in Europe: How to increase the attractiveness of primary care for medical students and primary care physicians?

The key messages of this policy brief published by the European Observatory on Health Systems and Policies are as follows:

1. The imperative of strengthening primary health care (PHC) has been widely acknowledged, yet many countries in Europe struggle with shortages and geographical maldistribution of general practitioners (GPs).
2. One of the root causes for these challenges is the perception among medical students and doctors that PHC is not an ‘attractive’ career option. In most contexts this is reinforced by substantial pay differentials and perceived low status between GPs and specialists.
3. Evidence on effective strategies to improve attractiveness of PHC is somewhat patchy, but a number of effective interventions covering medical education, working conditions, PHC models and workforce planning may nevertheless be distilled.
4. There is also some evidence on strategies that can help draw GPs to rural and remote areas. They cover various stages of professional life of a GP and usually aim to improve the work-life balance and reduce professional isolation.
5. On the whole, strengthening PHC will require a multifaceted strategy that employs a range of measures and targets not only medical students and physicians, but also nurses and other PHC professions, patients and the general public.
6. Crafting such a strategy will require a very good understanding of the local context and a much better understanding of the effectiveness of various interventions as the evidence for most of them is currently either patchy or absent.

Note that this policy brief presents the results of a literature review conducted in 2018-2019 before the COVID19 crises.

Acces: Policy brief 55 march 2023

Photo Jordi Soldevila. Refugi 3

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Organizational change

This research by Noora Jansson from ouluhealth scrutinizes organizational change by combining discourse and practice approaches. A case study at a public university hospital is conducted with a narrative analysis method.

The key finding of this research is that discursive practices are involved in organizational change through discourse phronesis. Discourse phronesis is a socially and contextually developed phenomenon, and hence discursive practices are particular within context. The case study revealed four particular discursive practices as examples of discourse phronesis: field practices, mandate practices, priority practices and word practices.

The results of this research advance awareness of the concealed power within discursive practices and, more importantly, invite practitioners to pursue the intellectual virtue of discourse phronesis while implementing organizational change. Discourse phronesis may be utilized as a gateway to advance change goals and to translate various discourses and actions that otherwise might remain unexplained.

Download Article full text (pdf)

This post was inspired by an article published in a newspaper by Xavier Marcet about the complexity to undergo a transition or change in an organization.

Photo Jordi Soldevila. Homenatge a Toni Catany Final

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Health Care 2030: the transition from hospital-based systems to primary care, community, and social care–based systems.

Health Care 2030: The Coming Transformation (2021) by Eyal Zimlichman, Wendy Nicklin, Rajesh Aggarwal, and David W. Bates

The problems in our health care systems include subpar quality and patient safety, a misplaced focus on acute care rather than on prevention and population health, inadequate person centeredness, and unsustainable cost.

The next decade will see considerable transformation in how health systems are designed, propelled by opportunities such as digital health, growing consumerism, and mounting financial constraints.

The Covid-19 pandemic has also necessitated and accelerated significant transformations.

The authors discuss gaps and barriers in the current design of health and health systems, and the needed escalation of transformation including transition from hospital-based systems to primary care, community, and social care–based systems.

They also assess the future evolution of payment systems leading toward sustainable health, changes in provider roles, and the entrance of new nontraditional players

Photo Jordi Soldevila. Homenatge a Toni Catany Austeritat

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Health is wealth? Can we substitute UK by Catalonia or Spain?

Andrew Haldane, Chief Executive of the RSA and former Chief Economist at the Bank of England, was invited by the REAL Centre to deliver the 2022 REAL Challenge lecture to generate fresh ideas and debate.

Health is wealth? explores why health is best seen as a societal asset before outlining some of the ways in which the resilience of health outcomes and systems might be strengthened for the benefit of all.

The UK continues to feel the consequences of the COVID-19 pandemic, both through its impact on the nation’s health, as well as the prolonged impact on the UK economy. The lecturer drew lessons from the pandemic and argued for a more holistic economic growth strategy where health and wealth are inextricably linked.

He believes... "the UK is suffering from a weakened, and weakening, societal immune system. As with biological immune systems, this is constraining both our capacity to grow and our resistance to shocks. A weak societal immune system explains why the UK has suffered anaemic growth, has been more prone to shocks and why it has had longer subsequent periods of convalescence than elsewhere – and than in the past. This weakened societal immune system in turn reflects a prolonged period of underinvestment in the sub-systems we rely on for growth and strength: from education and health care to housing and communities, to skills and innovation.

Rebuilding the resilience of these sub-systems holds the key to a strengthened societal immune system overall and, with it, improved growth, greater shock resistance and higher wellbeing for individuals. As society’s sub-systems are tightly coupled, each needs to be strengthened to secure system-wide success. The UK’s health system’s lack of resilience has contributed to the UK’s weakened immune system. But without a strengthening of other economic and social systems this, while necessary, will by itself be insufficient to strengthen society’s immune system".

How this resilience might be bolstered? He proposes a set of directions of travel for policy debate.

• Mesurement
• Stress testing
• Devolution
• Policy integration
• Placemaking
• Food standards
• Education
• Business
• Fiscal finance
• The social safety net

Article (pdf)  
Slides and Video


Photo Jordi Soldevila. Els Monstres d'Ingres. L'hivern

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