Abstract
The growth and aging of population globally poses a significant stress on Healthcare Systems (HCS). Funding of essential healthcare functions is a topic of focus on behalf of governments worldwide. The European Observatory on Health Systems and Policies, a branch of the World Health Organization (WHO), is dedicated to monitoring and publishing changes in national HCSs in Europe. At the same time, the concept of quality in healthcare has become the focus of research in all sectors of the healthcare field. To provide a service of high value health systems around the world are being tasked with maximizing quality while at the same time keeping the costs of healthcare low. This constant pressure for increased value of healthcare services is propagated from the blunt end (upper administration, central government, etc.) to the sharp end (clinical staff, mid-level management, etc.). The models of communication between the sharp and blunt ends of a health system in the field of Quality Improvement (QI) vary from country to country. In the western world (Europe, US, Canada Australia) we have multiple models of healthcare depending on the country/state under the umbrella of the European Union and of the US Federal government. Multiple efforts to improve quality in medicine recently have produced mixed results. There is limited research focusing on the communication and governance models between the sharp and blunt ends of a health system with respect to QI.I proposed a small Southern European country (Greece) as the case study of a project that would focus on the absorption of recent targeted QI initiatives specific to radiotherapy (RT). Since the HCS in Greece is consisted of a private and a public sector a dual case study informed by the DESCARTE model was proposed to study the differences and similarities between the two sectors that comprise the national RT provision. A qualitative approach using semi-structured interviews with local sharp end RT leadership in Greece and representative blunt end government officials is proposed. Through purposive sampling, sixty distinct clinical leaders, administrators and government representatives agreed to participate in the study. Thematic analysis was used as the tool to identify codes and themes from the data collected and findings were extracted.
My findings demonstrate a gap in communication between the central government officials and the sharp end leaders. Local leaders are primarily focused on their day-to-day tasks of managing budgets, patients, and equipment, and delivering care with limited direct communication to their executives, regulators, and health policy makers on QI issues. Feedback is rarely solicited or received when it comes to QI initiatives within the health system. Local leaders struggle to deliver quality care with limited resources. A thirst for continuing education was expressed by almost all participants. A collaboration between industry leaders and government representatives was proposed. Developing a comprehensive national strategy plan that would connect the industry needs and the supply from the educational programs was proposed as a goal. In addition, the terms of employment of those professionals and ways to incentivize them would also need to be developed through that collaboration. Moreover, the establishment of an administrative structure conducive to QI in each department was proposed. A key recommendation by both local leaders and officials suggested the formation of an entity that would monitor the quality of the HCS as a whole. The preferred method of governance that arose from the study specifically to implementing QI initiatives in the HCS I studied is a recent form of hybrid regulation researchers have termed “responsive regulation.”
| Date of Award | 13 Nov 2024 |
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| Original language | English |
| Awarding Institution |
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| Supervisor | Christos Vasilakis (Supervisor) & Piotr Ozieranski (Supervisor) |