Advancing the application of systems thinking in health: a realist evaluation of a capacity building programme for district managers in Tumkur, India

详细信息    查看全文

• 作者：Nuggehalli Srinivas Prashanth (6) (7)
  Bruno Marchal (7)
  Narayanan Devadasan (6)
  Guy Kegels (7)
  Bart Criel (7)
  
  6. Institute of Public Health ; #250 ; 2 C Main ; 2 C Cross ; Girinagar I Phase ; Bangalore ; 560 085 ; Karnataka ; India
  7. Institute of Tropical Medicine ; Nationalestraat 155 ; 2000 ; Antwerp ; Belgium
  
• 关键词：Capacity building ; District health system ; Organisational commitment ; Realist evaluation ; Self ; efficacy ; Systems thinking ; Programme theory
• 刊名：Health Research Policy and Systems
• 出版年：2014
• 出版时间：December 2014
• 年：2014
• 卷：12
• 期：1
• 全文大小：2,512 KB
• 参考文献：1. LaFond, AK, Brown, L, Macintyre, K (2002) Mapping capacity in the health sector: a conceptual framework. Int J Health Plann Manage 17: pp. 3-22 CrossRef
  2. McDaniel, RR, Lanham, HJ, Anderson, RA (2009) Implications of complex adaptive systems theory for the design of research on health care organizations. Health Care Manage Rev 34: pp. 191-199 CrossRef
  3. Adam, T, de Savigny, D (2012) Systems thinking for strengthening health systems in LMICs: need for a paradigm shift. Health Policy Plan 27: pp. iv1-iv3
  Working Together for Health: The World Health Report 2006. World Health Organization, Geneva
  4. Dieleman, M, Gerretsen, B, van der Wilt, GJ (2009) Human resource management interventions to improve health workers鈥?performance in low and middle income countries: a realist review. Heal Res policy Syst 7: pp. 7 CrossRef
  5. Mbindyo, P, Gilson, L, Blaauw, D, English, M (2009) Contextual influences on health worker motivation in district hospitals in Kenya. Implement Sci 4: pp. 43 CrossRef
  6. Rowe, A, Desavigny, D, Lanata, C, Victora, C (2005) How can we achieve and maintain high-quality performance of health workers in low-resource settings?. Lancet 366: pp. 1026-1035 CrossRef
  7. Plsek, PE, Greenhalgh, T (2001) Complexity science: the challenge of complexity in health care. Br Med J 323: pp. 625-628 CrossRef
  8. Potter, C, Brough, R (2004) Systemic capacity building: a hierarchy of needs. Health Policy Plan 19: pp. 336-345 CrossRef
  9. Sturmberg, JP, O鈥橦alloran, DM (2012) Understanding health system reform 鈥?a complex adaptive systems perspective. J Eval Clin Pract 18: pp. 202-208 CrossRef
  10. Patton, MQ (2010) Developmental Evaluation: Applying Complexity Concepts to Enhance Innovation and Use. Guilford Press, New York
  11. Moore, G, Audrey, S, Barker, M, Bond, L, Bonell, C, Cooper, C, Hardeman, W, Moore, L, O鈥機athain, A, Tinati, T, Wight, D, Baird, J (2014) Process evaluation in complex public health intervention studies: the need for guidance. J Epidemiol Community Health 68: pp. 101-102 CrossRef
  12. Craig, P, Dieppe, P, Macintyre, S, Michie, S, Nazareth, I, Petticrew, M (2008) Developing and evaluating complex interventions: the new Medical Research Council guidance. Br Med J 337: pp. a1655-a1655 CrossRef
  13. Pawson, R (2013) The Science of Evaluation: A Realist Manifesto. Sage Publications, London
  14. Pawson, R (2002) Evidence-based policy: the promise of realist synthesis. Evaluation 8: pp. 340 CrossRef
  15. Wong, G, Greenhalgh, T, Westhorp, G, Buckingham, J, Pawson, R (2013) RAMESES publication standards: realist syntheses. BMC Med 11: pp. 21 CrossRef
  16. Pawson, R, Tilley, NN, Clarke, A (1997) Realistic Evaluation. Sage Publications Ltd., London
  17. Bunge, M (2004) How does it work? The search for explanatory mechanisms. Philos Soc Sci 34: pp. 182-210 CrossRef
  18. Astbury, B, Leeuw, FL (2010) Unpacking black boxes: mechanisms and theory building in evaluation. Am J Eval 31: pp. 363-381 CrossRef
  19. Pawson, R, Tilley, N (2008) Realist evaluation. DPRN Thematic Meeting 2006 Report on Evaluation. Development policy review Network, Utrecht, The Netherlandspp. 35
  20. Jagosh, J, Pluye, P, Wong, G, Cargo, M, Salsberg, J, Bush, PL, Herbert, CP, Green, LW, Greenhalgh, T, Macaulay, AC (2013) Critical reflections on realist review: insights from customizing the methodology to the needs of participatory research assessment. Res Synth Methods 5: pp. 131-141 CrossRef
  21. Marchal, B (2011) Why do Some Hospitals Perform Better than Others? A Realist Evaluation of the Role of Health Workforce Management in Well-Performing Health Care Organisations. Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel & Institute of Tropical Medicine, Antwerp
  22. Kernick, D (2004) Complexity and Healthcare Organization: A View from the Street. Radcliffe Publishing Ltd., London
  23. Prashanth, NS, Marchal, B, Criel, B (2013) Evaluating healthcare interventions: answering the 鈥淗ow鈥?question. Indian Anthropol 43: pp. 35-50
  24. Marchal, B, Van Belle, S, De Brouwere, V, Witter, S (2013) Studying complex interventions: reflections from the FEMHealth project on evaluating fee exemption policies in West Africa and Morocco. BMC Health Serv Res 13: pp. 469 CrossRef
  25. Marchal, B, van Belle, S, van Olmen, J, Hoeree, T, Kegels, G (2012) Is realist evaluation keeping its promise? A review of published empirical studies in the field of health systems research. Evaluation 18: pp. 192-212 CrossRef
  26. Sheikh, K (2012) Unlocking the potential of qualitative enquiry into health policy and systems. Second Global Symposium Health Systems Research. World Health Organization, Beijingpp. 23
  27. Westhorp, G (2012) Using complexity-consistent theory for evaluating complex systems. Evaluation 18: pp. 405-420 CrossRef
  28. Sicotte, C, Champagne, F, Contandriopoulos, AP, Barnsley, J, B茅land, F, Leggat, SG, Denis, JL, Bilodeau, H, Langley, A, Br茅mond, M, Baker, GR (1998) A conceptual framework for the analysis of health care organization鈥檚 performance. Health Services Management Research 11: pp. 24-48
  29. Marchal, B, Hoer茅e, T, da Silveira, VC, Van Belle, S, Prashanth, NS, Kegels, G (2014) Building on the EGIPPS performance assessment: the multipolar framework as a heuristic to tackle the complexity of performance of public service oriented health care organisations. BMC Public Health 14: pp. 378 CrossRef
  30. Anil Kumar, TK (2011) Census of India 2011: provisional population totals paper 1 of 2011 India Series 1. Office of the Registrar General & Census Commissioner, New Delhi, India
  Investing in Human Development: Karnataka Human Development Report 2005. Department of Planning and Statistics, GoK, Bangalore
  31. George, A (2007) Persistence of high maternal mortality in Koppal district, Karnataka, India: observed service delivery constraints. Reprod Health Matters 15: pp. 91-102 CrossRef
  32. Devadasan, N, Elias, MA (2008) Training Needs Assessment for District Health Managers. Bangalore. Institute of Public Health, Bangalore
  33. Sathyanarayan, TN, Babu, GR (2011) Creating a public health cadre in India: the development of a framework for interprofessional and inter-sector collaboration. J Interprof Care 25: pp. 308-310 CrossRef
  34. Balabanova, D, Mckee, M, Mills, A (2011) Good Health at Low Cost 25 Years On. What Makes a Successful Health System. London School of Hygiene & Tropical Medicine, London
  35. Das, GM, Desikachari, BR, Shukla, R, Somanathan, TV, Padmanaban, P, Datta, KK (2010) How might India鈥檚 public health systems be strengthened? Lessons from Tamil Nadu. Econ Polit Wkly xlv: pp. 46-60
  36. Hoeree, T, Prasad, V, Jiang, L, Pongsupap, Y (2012) External Evaluation of the Tumkur Training Course. Institute of Public Health, Bangalore
  37. Prashanth, NS, Marchal, B, Hoeree, T, Devadasan, N, Macq, J, Kegels, G, Criel, B (2012) How does capacity building of health managers work? A realist evaluation study protocol. BMJ Open 2: pp. e000882 CrossRef
  38. Lipsey, MW, Pollard, JA (1989) Driving toward theory in program evaluation: more models to choose from. Eval Program Plann 12: pp. 317-328 CrossRef
  39. Prashanth, NS, Marchal, B, Kegels, G, Criel, B (2014) Evaluation of a capacity-building programme of district health managers in india: a contextualised theoretical framework. Front. Public Health 2: pp. 89 CrossRef
  40. Bandura, A (1982) Self-efficacy mechanism in human agency. Am Psychol 37: pp. 122-147 CrossRef
  41. Meyer, JP, Paunonen, SV, Gellatly, IR, Goffin, RD, Jackson, DN (1989) Organizational commitment and job performance: it鈥檚 the nature of the commitment that counts. J Appl Psychol 74: pp. 152-156 CrossRef
  42. Meyer, JP, Allen, NJ (1991) A three-component conceptualization of organizational commitment. Hum Resour Manag Rev 1: pp. 61-89 CrossRef
  43. Bandura, A Guide for constructing self-efficacy scales. In: Pajares, F, Urdan, TC eds. (2006) Self-Efficacy Beliefs Adolesc. Information Age Publishing, Charlotte, NC, pp. 307-337
  44. Oldham, GR, Cummings, A (1996) Employee creativity: personal and contextual factors at work. Acad Manag J 39: pp. 607-634 CrossRef
  45. Cammann, C, Fichman, M, Jenkins, G, Klesh, J (1978) The Michigan Organizational Assessment Package. University of Michigan Survey Research Center, Ann Arbor, MI
  46. Kirkpatrick, DL, Kirkpatrick, JD (1998) Evaluating Training Programmes: The Four Levels. Berrett-Koehler Publishers, Inc., San Francisco, CA
  47. Clarke, N (2005) Workplace learning environment and its relationship with learning outcomes in healthcare organizations. Hum Resour Dev Int 8: pp. 185-205 CrossRef
  48. Marchal, B, Dedzo, M, Kegels, G (2010) A realist evaluation of the management of a well-performing regional hospital in Ghana. BMC Health Serv Res 10: pp. 24 CrossRef
  Report of the High Power Committee for Redressal of Regional Imbalances. Government of Karnataka, Bangalore
  49. Marchal, B, Dedzo, M, Kegels, G (2010) Turning around an ailing district hospital: a realist evaluation of strategic changes at Ho Municipal Hospital (Ghana). BMC Public Health 10: pp. 787 CrossRef
  50. Parsons, T (1977) Social Systems and the Evolution of Action Theory. The Free Press, New York, NY
  51. Stame, N (2004) Theory-based evaluation and types of complexity. Evaluation 10: pp. 58 CrossRef
  52. De Souza, DE (2013) Elaborating the Context-Mechanism-Outcome configuration (CMOc) in realist evaluation: a critical realist perspective. Evaluation 19: pp. 141-154 CrossRef
  53. Greenhalgh, T, Humphrey, C, Hughes, J, Macfarlane, F, Butler, C, Pawson, R (2009) How do you modernize a health service? A realist evaluation of whole-scale transformation in London. Milbank Q 87: pp. 391-416 CrossRef
  54. Pratschke, J (2003) Realistic models? Critical realism and statistical models in the social sciences. Philosophica 71: pp. 13-39
  
• 刊物主题：Health Administration; Social Policy; Quality of Life Research;
• 出版者：BioMed Central
• ISSN：1478-4505

文摘

Background Health systems interventions, such as capacity-building of health workers, are implemented across districts in order to improve performance of healthcare organisations. However, such interventions often work in some settings and not in others. Local health systems could be visualised as complex adaptive systems that respond variously to inputs of capacity building interventions, depending on their local conditions and several individual, institutional, and environmental factors. We aim at demonstrating how the realist evaluation approach advances complex systems thinking in healthcare evaluation by applying the approach to understand organisational change within local health systems in the Tumkur district of southern India. Methods We collected data on several input, process, and outcome measures of performance of the talukas (administrative sub-units of the district) and explore the interplay between the individual, institutional, and contextual factors in contributing to the outcomes using qualitative data (interview transcripts and observation notes) and quantitative measures of commitment, self-efficacy, and supervision style. Results The talukas of Tumkur district responded differently to the intervention. Their responses can be explained by the interactions between several individual, institutional, and environmental factors. In a taluka with committed staff and a positive intention to make changes, the intervention worked through aligning with existing opportunities from the decentralisation process to improve performance. However, commitment towards the organisation was neither crucial nor sufficient. Committed staff in two other talukas were unable to actualise their intentions to improve organisational performance. In yet another taluka, the leadership was able to compensate for the lack of commitment. Conclusions Capacity building of local health systems could work through aligning or countering existing relationships between internal (individual and organisational) and external (policy and socio-political environment) attributes of the organisation. At the design and implementation stage, intervention planners need to identify opportunities for such triggering alignments. Local health systems may differ in their internal configuration and hence capacity building programmes need to accommodate possibilities for change through different pathways. By a process of formulating and testing hypotheses, making critical comparisons, discovering empirical patterns, and monitoring their scope and extent, a realist evaluation enables a comprehensive assessment of system-wide change in health systems.