The future of health systems to 2030: a roadmap for global progress and sustainability.

Most research on health systems examines contemporary problems within one, or at most a few, countries. Breaking with this tradition, we present a series of case studies in a book written by key policymakers, scholars and experts, looking at health systems and their projected successes to 2030. Healthcare Systems: Future Predictions for Global Care includes chapters on 52 individual countries and five regions, covering a total of 152 countries. Synthesised, two key contributions are made in this compendium. First, five trends shaping the future healthcare landscape are analysed: sustainable health systems; the genomics revolution; emerging technologies; global demographics dynamics; and new models of care. Second, nine main themes arise from the chapters: integration of healthcare services; financing, economics and insurance; patient-based care and empowering the patient; universal healthcare; technology and information technology; aging populations; preventative care; accreditation, standards, and policy; and human development, education and training. These five trends and nine themes can be used as a blueprint for change. They can help strengthen the efforts of stakeholders interested in reform, ranging from international bodies such as the World Health Organization, the International Society for Quality in Health Care and the World Bank, through to national bodies such as health departments, quality and safety agencies, non-government organisations (NGO) and other groups with an interest in improving healthcare delivery systems. This compendium offers more than a glimpse into the future of healthcare-it provides a roadmap to help shape thinking about the next generation of caring systems, extrapolated over the next 15 years.

Accomplishing reform: successful case studies drawn from the health systems of 60 countries.

Healthcare reform typically involves orchestrating a policy change, mediated through some form of operational, systems, financial, process or practice intervention. The aim is to improve the ways in which care is delivered to patients. In our book 'Health Systems Improvement Across the Globe: Success Stories from 60 Countries', we gathered case-study accomplishments from 60 countries. A unique feature of the collection is the diversity of included countries, from the wealthiest and most politically stable such as Japan, Qatar and Canada, to some of the poorest, most densely populated or politically challenged, including Afghanistan, Guinea and Nigeria. Despite constraints faced by health reformers everywhere, every country was able to share a story of accomplishment-defining how their case example was managed, what services were affected and ultimately how patients, staff, or the system overall, benefited. The reform themes ranged from those relating to policy, care coverage and governance; to quality, standards, accreditation and regulation; to the organization of care; to safety, workforce and resources; to technology and IT; through to practical ways in which stakeholders forged collaborations and partnerships to achieve mutual aims. Common factors linked to success included the 'acorn-to-oak tree' principle (a small scale initiative can lead to system-wide reforms); the 'data-to-information-to-intelligence' principle (the role of IT and data are becoming more critical for delivering efficient and appropriate care, but must be converted into useful intelligence); the 'many-hands' principle (concerted action between stakeholders is key); and the 'patient-as-the-pre-eminent-player' principle (placing patients at the centre of reform designs is critical for success).

Introducing virtual reality to older adults: A qualitative analysis of a co-design innovation with care staff.

Previous studies of Virtual Reality (VR) in aged care settings have demonstrated that the benefits can be multiple, including improved social connection and engagement and reduced social isolation in later life. However, there remains a lack of widespread uptake of VR in aged care facilities. This prompts an important question: Given the potential benefits, why is there such poor engagement in VR by aged care facilities? The aim of this qualitative study is to investigate the experience of introducing VR into an aged care facility. Our innovative approach supported care staff to introduce VR into aged care facilities. Fieldwork diaries and focus group discussions were used to document experiences of introducing VR, including the obstacles, challenges and benefits and the adaptations to aged care environments that were required to accommodate new VR activities. Thematic analysis of the data revealed that VR can be an important medium to support the wellbeing of older residents. However, our findings also indicate that there are significant challenges associated with introducing VR, including substantial costs in time, money and institutional resources and attention. This study concludes that, to be successful, VR requires substantive care and relational resources from both staff and residents that are only visible when paying attention to the contextual adjustments required to introduce the technology to a new setting. This suggests that other research on gerontechnologies would likely also benefit from further attention to the role of the broader social context - including care and relational resources - in ensuring their successful design and implementation.

Implementing a quality improvement programme in a locality mental health service.

In healthcare, quality improvement (QI) involves organisations and staff aiming to continually improve how they work, quality of care and patient outcomes. In the summer of 2017, a QI programme was endorsed and supported by the clinical director and the head of nursing in the mental health delivery unit of a Welsh health board. This article describes the process of introducing the QI programme in one of the three locality mental health services in the health board. A QI board was established to oversee the process and provide support, and QI champions were introduced to develop QI skills and capacity among staff across the locality mental health service's clinical teams. Improvements made by the QI champions during the first 12 months of the programme included: increased accuracy of electronic transfers of care; reduced readmission rates; the co-production of guides to engage ward-based staff; and the creation of digital staff stories. The authors also reflect on the challenges they experienced in introducing the QI programme and make recommendations for organisations and senior nurses for implementing such programmes effectively.

Systems transformation: learning from change in 60 countries.

PURPOSE: Much work about health reform and systems improvement in healthcare looks at shortcomings and universal problems facing health systems, but rarely are accomplishments dissected and analyzed internationally. The purpose of this paper is to address this knowledge gap by examining the lessons learned from health system reform and improvement efforts in 60 countries. DESIGN/METHODOLOGY/APPROACH: In total, 60 low-, middle- and high-income countries provided a case study of successful health reform, which was gathered into a compendium as a recently published book. Here, the extensive source material was re-examined through inductive content analysis to derive broad themes of systems change internationally. FINDINGS: Nine themes were identified: improving policy, coverage and governance; enhancing the quality of care; keeping patients safe; regulating standards and accreditation; organizing care at the macro-level; organizing care at the meso- and micro-level; developing workforces and resources; harnessing technology and IT; and making collaboratives and partnerships work. PRACTICAL IMPLICATIONS: These themes provide a model of what constitutes successful systems change across a wide sample of health systems, offering a store of knowledge about how reformers and improvement initiators achieve their goals. ORIGINALITY/VALUE: Few comparative international studies of health systems include a sufficiently wide selection of low-, middle- and high-income countries in their analysis. This paper provides a more balanced approach to consider where achievements are being made across healthcare, and what we can do to replicate and spread successful examples of systems change internationally.