An analysis of the transformative potential of Australia's national food policies and policy actions to promote healthy and sustainable food systems.

OBJECTIVE: Despite commitment by many countries to promote food system transformation, Australia has yet to adopt a national food policy. This study aimed to evaluate Australian Federal Government's (AFG) food policies and policy actions potential to promote healthy and sustainable food systems. DESIGN: This study is a desk-based policy mapping followed by a theoretically guided evaluation of policy actions. This involved three steps: (1) identification of government departments and agencies that could influence Australia's food system; (2) identification of food policies and policy actions within these departments and (3) use of a conceptual framework to evaluate policy actions' potential of changing the food system as adjust (first-order change), reform (second-order change) or transform (third-order change). SETTING: Australia. PARTICIPANTS: None. RESULTS: Twenty-four food policies and sixty-two policy actions were identified across eight AFG departments and the Food Regulation System and evaluated based on the order of change they represented. Most policies were led by individual departments, reflecting the absence of a joined-up approach to food policy in Australia. Most policy actions (n 25/ 56·5 %) were evaluated as having adjust potential, whereas no transformative policy action was identified. CONCLUSIONS: These findings suggest that Australia is likely to proceed incrementally towards achieving food system change through adjustments and reforms but lacking transformative impact. To promote transformative change, all three orders of change must be strategically implemented in a coherent and coordinated matter. A comprehensive national food policy and a national coordinating body are needed to ensure a cohesive approach to policy.

Transforming health care systems towards high-performance organizations: qualitative study based on learning from COVID-19 pandemic in the Basque Country (Spain).

BACKGROUND: The COVID-19 pandemic is one of the worst health catastrophes of the last century, which caused severe economic, political, and social consequences worldwide. Despite these devastating consequences, lessons learned provide a great opportunity that can drive the reform of health systems to become high-performing, effective, equitable, accessible, and sustainable organisations. This work identifies areas in which changes must be encouraged that will enable health systems to deal effectively with current and future challenges, beyond COVID-19. METHODS: A realist design was chosen, based on qualitative data collection techniques, content analysis and triangulation to identify key domains of organizational interventions behind the changes implemented to react to the COVID-19 pandemic in the Basque Country. Twenty key informants were used as an expert source of information. Thematic analysis was done using the Framework Method. RESULTS: The analysis of the interviews resulted in the identification of 116 codes, which were reviewed and agreed upon by the researchers. Following the process of methodological analysis, these codes were grouped into domains: seven themes and 23 sub-themes. Specifically, the themes are: responsiveness, telehealth, integration, knowledge management, professional roles, digitisation, and organisational communication. The detailed description of each theme and subtheme is presented. CONCLUSIONS: The findings of this work pretend to guide the transformation of health systems into organisations that can improve the health of their populations and provide high quality care. Such a multidimensional and comprehensive reform encompasses both strategic and operational actions in diverse areas and requires a broad and sustained political, technical, and financial commitment.

Facilitators of and barriers to County Behavioral Health System Transformation and Innovation: an interview study.

BACKGROUND: Inadequate and inequitable access to quality behavioral health services and high costs within the mental health systems are long-standing problems. System-level (e.g., fee-for-service payment model, lack of a universal payor) and individual factors (e.g., lack of knowledge of existing resources) contribute to difficulties in accessing resources and services. Patients are underserved in County behavioral health systems in the United States. Orange County's (California) Behavioral Health System Transformation project sought to improve access by addressing two parts of their system: developing a template for value-based contracts that promote payor-agnostic care (Part 1); developing a digital platform to support resource navigation (Part 2). Our aim was to evaluate facilitators of and barriers to each of these system changes. METHODS: We collected interview data from County or health care agency leaders, contracted partners, and community stakeholders. Themes were informed by the Consolidated Framework for Implementation Research. RESULTS: Five themes were identified related to behavioral health system transformation, including 1) aligning goals and values, 2) addressing fit, 3) fostering engagement and partnership, 4) being aware of implementation contexts, and 5) promoting communication. A lack of fit into incentive structures and changing state guidelines and priorities were barriers to contract development. Involving diverse communities to inform design and content facilitated the process of developing digital tools. CONCLUSIONS: The study highlights the multifaceted factors that help facilitate or hinder behavioral health system transformation, such as the need for addressing systematic and process behaviors, leveraging the knowledge of leadership and community stakeholders, fostering collaboration, and adapting to implementation contexts.

Community health nurses leadership in advancing health equity.

OBJECTIVE: To describe the solutions community health nurses (CHNs) identify to address health inequities during the COVID-19 pandemic and to explore what leadership competencies enable CHNs to enact these solutions. DESIGN: Online survey, distributed to all members of the Community Health Nurses of Canada and associated provincial and territorial networks. PARTICIPANTS: Inclusion criteria included all nurses who were working during the COVID-19 pandemic in Canada. A total of 245 responses were included in the analysis. MEASUREMENT: The survey included 25 open ended and fixed response questions. Descriptive statistics were used to describe the quantitative data. Framework Analysis was used to analyze the qualitative data. RESULTS: Solutions focused on advancing health equity and expanding community relationships and partnerships were identified as priorities. To enact these solutions system transformation, engaging others, and developing coalitions were identified as the main leadership competencies required by CHNs. CONCLUSION: Participants in this study clearly articulated structural and process solutions to address health inequities among priority populations during the pandemic. CHNs described with practice knowledge and confidence that solutions enacted in system transformation with community partners are necessary to advance health equity.

Conceptualizing the Mechanisms of Social Determinants of Health: A Heuristic Framework to Inform Future Directions for Mitigation.

Policy Points A large body of scientific work examines the mechanisms through which social determinants of health (SDOH) shape health inequities. However, the nuances described in the literature are infrequently reflected in the applied frameworks that inform health policy and programming. We synthesize extant SDOH research into a heuristic framework that provides policymakers, practitioners, and researchers with a customizable template for conceptualizing and operationalizing key mechanisms that represent intervention opportunities for mitigating the impact of harmful SDOH. In light of scarce existing SDOH mitigation strategies, the framework addresses an important research-to-practice translation gap and missed opportunity for advancing health equity. CONTEXT: The reduction of health inequities is a broad and interdisciplinary endeavor with implications for policy, research, and practice. Health inequities are most often understood as associated with the social determinants of health (SDOH). However, policy and programmatic frameworks for mitigation often rely on broad SDOH domains, without sufficient attention to the operating mechanisms, and effective SDOH mitigation strategies remain scarce. To expand the cadre of effective SDOH mitigation strategies, a practical, heuristic framework for policymakers, practitioners, and researchers is needed that serves as a roadmap for conceptualizing and targeting the key mechanisms of SDOH influence. METHODS: We conduct a critical review of the extant conceptual and empirical SDOH literature to identify unifying principles of SDOH mechanisms and to synthesize an integrated framework for conceptualizing such mechanisms. FINDINGS: We highlight eight unifying principles of SDOH mechanisms that emerge from landmark SDOH research. Building on these principles, we introduce and apply a conceptual model that synthesizes key SDOH mechanisms into one organizing, heuristic framework that provides policymakers, practitioners, and researchers with a customizable template for conceptualizing and operationalizing the key SDOH mechanisms that represent intervention opportunities to maximize potential impact for mitigating a given health inequity. CONCLUSIONS: Our synthesis of the extant SDOH research into a heuristic framework addresses a scarcity of peer-reviewed organizing frameworks of SDOH mechanisms designed to inform practice. The framework represents a practical tool to facilitate the translation of scholarly SDOH work into evidence-based and targeted policy and programming. Such tools designed to close the research-to-practice translation gap for effective SDOH mitigation are sorely needed, given that health inequities in the United States and in many other parts of the world have widened over the past two decades.

Scaling Family Voices and Engagement to Measure and Improve Systems Performance and Whole Child Health: Progress and Lessons from the Child and Adolescent Health Measurement Initiative.

BACKGROUND: The 1997 legislation authorizing the United States Child Health Insurance Program sparked progress to measure and publicly report on children's healthcare services quality and system performance. To meet the moment, the national Child and Adolescent Health Measurement Initiative (CAHMI) public-private collaboration was launched to put families at the center of defining, measuring and using healthcare performance information to drive improved services quality and outcomes. METHODS: Since 1996 the CAHMI followed an intentional path of collaborative action to (1) articulate shared goals for child health and advance a comprehensive, life-course and outcomes-based healthcare performance measurement and reporting framework; (2) collaborate with families, providers, payers and government agencies to specify, validate and support national, state and local use of dozens of framework aligned measures; (3) create novel public-facing digital data query, collection and reporting tools that liberate data findings for use by families, providers, advocates, policymakers, the media and researchers (Data Resource Center, Well Visit Planner); and (4) generate field building research and systems change agendas and frameworks (Prioritizing Possibilities, Engagement In Action) to catalyze prevention, flourishing and healing centered, trauma-informed, whole child and family engaged approaches, integrated systems and supportive financing and policies. CONCLUSIONS: Lessons call for a restored, sustainable family and community engaged measurement infrastructure, public activation campaigns, and undeterred federal, state and systems leadership that implement policies to incentivize, resource, measure and remove barriers to integrated systems of care that scale family engagement to equitably promote whole child, youth and family well-being. Population health requires effective family engagement.

A thematic analysis of system wide learning from first wave Covid-19 in the East of England.

BACKGROUND: The Covid-19 pandemic has created an unprecedented challenge for health and social care systems globally. There is an urgent need for research on experiences of COVID-19 at different levels of health systems, including lessons from professional, organisational and local system responses, that can be used to inform managerial and policy responses. METHODS: This paper presents the findings from a thematic analysis of front-line staff experiences working across the Norfolk and Waveney integrated care system (ICS) in the East of England during April and October 2020 to address the question "What are the experiences and perceptions of partner organisations and practitioners at multiple levels of the health system in responding to COVID-19 during the first wave of the pandemic?" This question was posed to learn from how practitioners, interdependent partner organisations and the system experienced the pandemic and responded. 176 interview transcripts derived from one to one and focus group interviews, meeting notes and feedback from a "We Care Together" Instagram campaign were submitted for qualitative thematic analysis to an external research team at a regional University commissioned to undertake an independent evaluation. Three phases of qualitative analysis were systematically undertaken to derive the findings. FINDINGS: Thirty-one themes were distilled highlighting lessons learned from things that went well compared with those that did not; challenges compared with the celebrations and outcomes; learning and insights gained; impact on role; and system headlines. The analysis supported the ICS to inform and capitalise on system wide learning for integration, improvement and innovations in patient and care home resident safety, and staff wellbeing to deal with successive waves of the pandemic as well as prioritising workforce development priorities as part of its People Plan. CONCLUSIONS: The findings contribute to a growing body of knowledge about what impact the pandemic has had on health and social care systems and front-line practitioners globally. It is important to understand the impact at all three levels of the system (micro, meso and macro) as it is the meso and macro system levels that ultimately impact front line staff experiences and the ability to deliver person centered safe and effective care in any context. The paper presents implications for future workforce and health services policy, practice innovation and research.

How health systems facilitate patient-centered care and care coordination: a case series analysis to identify best practices.

Large- and small-scale transformation of healthcare delivery toward improved patient experience through promotion of patient-centered and coordinated care continues to be at the forefront of health system efforts in the United States. As part of a Quality Improvement (QI) project at a large, midwestern health system, a case series of high-performing organizations was explored with the goal of identifying best practices in patient-centered care and/or care coordination (PCC/CC). Identification of best practices was done through rapid realist review of peer-reviewed literature supporting three PCC/CC interventions per case. Mechanisms responsible for successful intervention outcomes and associated institutional-level facilitators were evaluated, and cross-case analysis produced high-level focus items for health system leadership, including (1) institutional values surrounding PCC/CC, (2) optimization of IT infrastructure to enhance performance and communication, (3) pay structures and employment models that enhance accountability, and (4) organizing bodies to support implementation efforts. Health systems may use this review to gain insight into how institutional-level factors may facilitate small-scale PCC/CC behaviors, or to conduct similar assessments in their own QI projects. Based on our analysis, we recommend health systems seeking to improve PCC/CC at any level or scale to evaluate how IT infrastructure affects provider-provider and provider-patient communication, and the extent to which institutional prioritization of PCC/CC is manifest and held accountable in performance feedback, incentivization, and values shared among departments and settings. Ideally, this evaluation work should be performed and/or supported by cross-department organizing bodies specifically devoted to PCC/CC implementation work.

Development and Implementation of Businesses That Care in Zacatecas, Mexico.

As part of the Global Smart Drinking Goals campaign launched in 2018 in 6 "City Pilots" around the world, the Businesses That Care (BTC; Empresas Que se Cuidan in Spanish) prevention system was developed and implemented in Zacatecas, Mexico. BTC is a private business sector adaptation of the Communities That Care prevention system. BTC is designed to address underage alcohol use through a combination of a company-led prevention system, an adapted family-based prevention program with parents employed at participating companies, and environmental prevention strategies for company employees. BTC was designed to be congruent with other health and safety efforts in the region (e.g., media campaign, road safety, and school prevention efforts). This study presents the feasibility and adoption of the BTC system in Zacatecas. Process implementation measures indicated successful participant recruitment, retention, and adherence to intervention protocols. The first 4 stages of BTC implementation were completed within 14 months, with Stage 5 being interrupted by the COVID-19 pandemic. BTC Prevention Committee members, made up of employees from BTC participating companies, received 9 out of 10 BTC trainings/workshops during this time. Results provide evidence of the acceptability and feasibility for private companies to implement a prevention system approach for reducing youth alcohol use.

Policy Statement: Mental Well-being among Anthropologists at Universities: A Call for System Transformation.

The Anthropology of Mental Health Interest Group affirms that the state of mental health in Academic Anthropology needs serious attention and transformation. We respond to structural inequities in academia that exacerbate mental distress among graduate students and other anthropologists who experience oppression, by putting forward a policy statement with recommendations to create more equitable learning and working environments.

The Chinese Carbon-Neutral Goal: Challenges and Prospects.

On 22 September 2020, within the backdrop of the COVID-19 global pandemic, China announced its climate goal for peak carbon emissions before 2030 and to reach carbon neutrality before 2060. This carbon-neutral goal is generally considered to cover all anthropogenic greenhouse gases. The planning effort is now in full swing in China, but the pathway to decarbonization is unclear. The needed transition towards non-fossil fuel energy and its impact on China and the world may be more profound than its reform and development over the past 40 years, but the challenges are enormous. Analysis of four representative scenarios shows significant differences in achieving the carbon-neutral goal, particularly the contribution of non-fossil fuel energy sources. The high target values for nuclear, wind, and bioenergy have approached their corresponding resource limitations, with solar energy being the exception, suggesting solar's critical role. We also found that the near-term policies that allow for a gradual transition, followed by more drastic changes after 2030, can eventually reach the carbon-neutral goal and lead to less of a reduction in cumulative emissions, thus inconsistent with the IPCC 1.5°C scenario. The challenges and prospects are discussed in the historical context of China's socio-economic reform, globalization, international collaboration, and development.

Review: System transformation to enhance transitional age youth mental health - a scoping review.

BACKGROUND: Youth mental health challenges are an emerging and persistent global public health issue despite efforts for improvement. As part of a broader social innovation study to transform youth mental health systems, this scoping review assesses interventions that aim for systems-level changes to improve the mental well-being of transitional age youth (TAY) (15-25 years) in high-income countries. METHODS: The scoping review method of Arksey and O'Malley (International Journal of Social Research Methodology, 8, 2005, 19) was used. Seven health and social service databases were utilized with study inclusion criteria applied. Titles and abstracts were screened by two independent reviewers, and four members of the research team were involved in the review and thematic analysis of selected studies. RESULTS: A total of 5652 peer-reviewed articles were screened at the title and abstract level, of which 65 were assessed in full for eligibility, and 29 were included for final analysis. The peer-reviewed articles and gray literature were based in seven different high-income countries and published between 2008 and 2019. Four major themes to support youth mental health were identified in the literature: (a) improving transitions from youth to adult mental healthcare services; (b) moving care from institutions to the community; (c) general empowerment of youth in society; and (d) youth voice within the system. Inconsistent or limited systems-level approaches to TAY mental health care were noted. CONCLUSIONS: There remains a need for innovative, evidence-based approaches to improve TAY mental health care.

Research and innovation as a catalyst for food system transformation.

BACKGROUND: Food systems are associated with severe and persistent problems worldwide. Governance approaches aiming to foster sustainable transformation of food systems face several challenges due to the complex nature of food systems. SCOPE AND APPROACH: In this commentary we argue that addressing these governance challenges requires the development and adoption of novel research and innovation (R&I) approaches that will provide evidence to inform food system transformation and will serve as catalysts for change. We first elaborate on the complexity of food systems (transformation) and stress the need to move beyond traditional linear R&I approaches to be able to respond to persistent problems that affect food systems. Though integrated transdisciplinary approaches are promising, current R&I systems do not sufficiently support such endeavors. As such, we argue, we need strategies that trigger a double transformation - of food systems and of their R&I systems. KEY FINDINGS AND CONCLUSIONS: Seizing the opportunities to transform R&I systems has implications for how research is done - pointing to the need for competence development among researchers, policy makers and society in general - and requires specific governance interventions that stimulate a systemic approach. Such interventions should foster transdisciplinary and transformative research agendas that stimulate portfolios of projects that will reinforce one another, and stimulate innovative experiments to shape conditions for systemic change. In short, a thorough rethinking of the role of R&I as well as how it is funded is a crucial step towards the development of the integrative policies that are necessary to engender systemic change - in the food system and beyond.

Examining partnerships within an international knowledge translation network focused on youth mental health promotion.

BACKGROUND: Systems transformation for health promotion, involving engagement from multiple disciplines and levels of influence, requires an investment in partnership development. Integrated youth service is a collaborative model that brings organisations together to provide holistic care for youth. Frayme is an international knowledge translation network designed to support the uptake and scaling of integrated youth service. Social network analysis (SNA) is the study of relationships among social units and is useful to better understand how partners collaborate within a network to achieve major objectives. The purpose of this paper is to apply SNA to the Frayme network in order to (1) examine the level and strength of partnerships, (2) identify the strategies being employed to promote the main objectives and (3) apply the findings to current research in youth mental health and system transformation. METHODS: The PARTNER tool includes a validated survey and analysis software designed to examine partner interconnections. This tool was used to perform the SNA and 51 of the 75 partners completed the survey (14 researchers, 2 advisory groups and 35 organisations). A network map was created and descriptive frequencies were calculated. RESULTS: The overall network scores for the Frayme network were 20.6% for density, 81.5% for centralisation and 71.7% for overall trust. The Frayme secretariat received a 3.84 out of a possible 4 for value. In addition, the youth and family advisories each received a value score of 4 and all Leadership Team organisations received a score of 2.97 or above. CONCLUSIONS: The Frayme secretariat links many partners who would otherwise be disconnected and acts as a significant conduit for novel information. Frayme may have the opportunity to enhance value perceptions among broader network members by profiling individual organisations and the potential leveraging opportunities that might exist through their work. These findings increase understanding with respect to the mechanisms of network development and will be helpful to inform partnership development in the future. In addition, they contribute to the literature with respect to knowledge translation practice as well as the scaling of collaborative interventions within youth mental health.

The unpredictable journeys of spreading, sustaining and scaling healthcare innovations: a scoping review.

Innovation has the potential to improve the quality of care and health service delivery, but maximising the reach and impact of innovation to achieve large-scale health system transformation remains understudied. Interest is growing in three processes of the innovation journey within health systems, namely the spread, sustainability and scale-up (3S) of innovation. Recent reviews examine what we know about these processes. However, there is little research on how to support and operationalise the 3S. This study aims to improve our understanding of the 3S of healthcare innovations. We focus specifically on the definitions of the 3S, the mechanisms that underpin them, and the conditions that either enable or limit their potential. We conducted a scoping review, systematically investigating six bibliographic databases to search, screen and select relevant literature on the 3S of healthcare innovations. We screened 641 papers, then completed a full-text review of 112 identified as relevant based on title and abstract. A total of 24 papers were retained for analysis. Data were extracted and synthesised through descriptive and inductive thematic analysis. From this, we develop a framework of actionable guidance for health system actors aiming to leverage the 3S of innovation across five key areas of focus, as follows: (1) focus on the why, (2) focus on perceived-value and feasibility, (3) focus on what people do, rather than what they should be doing, (4) focus on creating a dialogue between policy and delivery, and (5) focus on inclusivity and capacity building. While there is no standardised approach to foster the 3S of healthcare innovations, a variety of practical frameworks and tools exist to support stakeholders along this journey.

Therapist Financial Strain and Turnover: Interactions with System-Level Implementation of Evidence-Based Practices.

Therapist turnover is a major problem in community mental health. Financial strain, which is composed of cognitive, emotional, and behavioral responses to the experience of economic hardship, is an understudied antecedent of therapist turnover given the tumultuous financial environment in community mental health. We prospectively examined the relationship between therapist financial strain and turnover in 247 therapists in 28 community mental health agencies. We expected greater therapist financial strain to predict higher turnover and participation in a system-funded evidence-based practice (EBP) training initiative to alleviate this effect. Controlling for covariates, financial strain predicted therapist turnover (OR 1.12, p = .045), but not for therapists who participated in an EBP training initiative. Reducing financial strain and/or promoting EBP implementation may be levers to reduce turnover.

Participatory action as a research method with public health nurses.

AIM: This article explores and describes participatory action research (PAR) as a preferred method in addressing nursing practice issues. This is the first study that used PAR with public health nurses (PHNs) in Canada to develop a professional practice model. BACKGROUND: Participatory action research is a sub-category of action research that incorporates feminist and critical theory with foundations in the field of social psychology. For nurses, critical analysis of long-established beliefs and practices through PAR contributes to emancipatory knowledge regarding the impact of traditional hierarchies on their practice. DESIGN: This study used participatory action, a non-traditional but systematic research method, which assisted participants to develop a solution to a long-standing organizational issue. METHOD: The stages of generating concerns, participatory action, acting on concerns, reflection and evaluation were implemented from 2012 - 2013 in an urban Canadian city, to develop a professional practice model for PHNs. FINDINGS: Four sub-themes specific to PAR are discussed. These are "participatory action research engaged PHNs in development of a professional practice model;" "the participatory action research cycles of "Look, Think, Act" expanded participants' views;" "participatory action research increased awareness of organizational barriers;" and "participatory action research promoted individual empowerment and system transformation." CONCLUSIONS: This study resulted in individual and system change that may not have been possible without the use of PAR. The focus was engagement of participants and recognition of their lived experience, which facilitated PHNs' empowerment, leadership and consciousness-raising.

Iran's Health System Transformation Plan: A SWOT analysis.

Background: Societies are characterized by evolving health needs, which become more challenging throughout time, to which health system should respond. As such, a constant monitoring and a periodic review and reformation of healthcare systems are of fundamental importance to increase the efficiency and effectiveness of healthcare services delivery, equity, and sustainable funding. The establishment of President Rouhani's government in Iran, on May 5, 2014, the settlement of the new Ministry of Health and Medical Education administration (MoHME) and the need for change in the provision of healthcare services has led to the "Health System Transformation Plan" (HSTP). The aim of the current investigation was to critically evaluate the health transformation plan in Iran. Methods: Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis enables to identify and assess the strengths and weaknesses within an organization or program, as well as the threats and opportunities outside the given organization or program. To identify SWOT of the HSTP in Iran, all articles concerning this program published in scholarly databases as well as in the gray literature were systematically searched. Subsequently, all factors identified at the first round were thematically classified into four categories and for reaching consensus on this classification, the list of points and factors was sent to 40 experts - policy- and decisionmakers, professors and academicians, health department workers, health activists, journalists. Results: Thirty-four subjects expressed comments on classification. Incorporating their suggestions, the SWOT analysis of Iran's HSTP was revised, finalized and then performed. Conclusion: HSTP in Iran, like many of the initiatives that have been recently introduced and not fully implemented, have various challenges, difficulties and pitfalls that health policymakers need to pay attention to. Interacting with criticisms, taking into account public opinion and strengthening the plan can make the project more effective, and it can be anticipated that in the future, better conditions in the health sector will be achieved.

The Impact of the Health Transformation Plan on Hospital Performance Indicators: A Meta-analysis Study in an EMRO Region Country.

To adapt to the changing conditions and respond to the needs of society, health systems need continuous changes and reforms in their structure and performance, and subsequently, they need to evaluate their indicators. Therefore, this study aimed to investigate the impact of the health system transformation plan (HTP) on the functional indicators and efficiency of hospitals in a country in the Middle East region (Iran). A systematic literature review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using the online databases Medline, EMBASE, Scopus, Pubmed, SID, Magiran, and Medlib from 2013 to 2022 using a combination of medical subject heading terms ('health system transformation plan [Mesh] OR 'health reform [Mesh] OR implementation of the health transformation plan [Mesh] ''AND ('performance indicators' [Mesh]) ''AND ('Iran' [Mesh]). STATA version 11 were used for data analysis. A total of 20 reports (cross-sectional, cohort, and case-control) were identified for this study. The results showed that after the HTP, the indices of bed occupancy rate and bed turnover rate have increased and the index of bed turnover distance has decreased. On the other hand, after the implementation of this plan in hospitals, the average of patients' length of stay has increased. The implementation of HTP has improved most of the performance indicators of hospitals and has generally led to an increase in the productivity of hospitals compared to that before the implementation of the plan. However, efforts to strengthen weak performance indicators and identify effective indicators along with adopting correct policies to increase the overall efficiency of hospitals can be effective in improving HTP.

The Integrated Care World is a Stage: Applying Goffman's Theory of Dramaturgy to the Activities of Integrated Care.

Among the challenges in delivering integrated health and social care services is the need to attend to the coordination of tasks, roles, activities, and operations, while considering how these efforts are experienced by patients, carers and communities. The literature has noted an important disconnect between how providers and leaders view their efforts to coordinate service delivery, and how patients perceive these efforts on the receiving end. Our team has provided guidance to integrated care efforts in Ontario, Canada by drawing on Goffman's theory of Dramaturgy to help classify the actions of integrated care delivery as linked to the roles individuals play in the delivery of care. Using this framing helps to uncover how "backstage" processes (such as team-functioning, funding models, and digital infrastructures) create a necessary foundation on which "frontstage" actions (or performances) can be effectively delivered.