A realist synthesis attempts to provide policy makers with a transferable theory that suggests a certain program is more or less likely to work in certain respects, for particular subjects, in ...specific kinds of situations. Yet realist reviews can require considerable and sustained investment over time, which does not always suit the time-sensitive demands of many policy decisions. 'Rapid Realist Review' methodology (RRR) has been developed as a tool for applying a realist approach to a knowledge synthesis process in order to produce a product that is useful to policy makers in responding to time-sensitive and/or emerging issues, while preserving the core elements of realist methodology.
Using examples from completed RRRs, we describe key features of the RRR methodology, the resources required, and the strengths and limitations of the process. All aspects of an RRR are guided by both a local reference group, and a group of content experts. Involvement of knowledge users and external experts ensures both the usability of the review products, as well as their links to current practice.
RRRs have proven useful in providing evidence for and making explicit what is known on a given topic, as well as articulating where knowledge gaps may exist. From the RRRs completed to date, findings broadly adhere to four (often overlapping) classifications: guiding rules for policy-making; knowledge quantification (i.e., the amount of literature available that identifies context, mechanisms, and outcomes for a given topic); understanding tensions/paradoxes in the evidence base; and, reinforcing or refuting beliefs and decisions taken.
'Traditional' realist reviews and RRRs have some key differences, which allow policy makers to apply each type of methodology strategically to maximize its utility within a particular local constellation of history, goals, resources, politics and environment. In particular, the RRR methodology is explicitly designed to engage knowledge users and review stakeholders to define the research questions, and to streamline the review process. In addition, results are presented with a focus on context-specific explanations for what works within a particular set of parameters rather than producing explanations that are potentially transferrable across contexts and populations. For policy makers faced with making difficult decisions in short time frames for which there is sufficient (if limited) published/research and practice-based evidence available, RRR provides a practical, outcomes-focused knowledge synthesis method.
Systems Thinking to Improve the Public's Health Leischow, Scott J., PhD; Best, Allan, PhD; Trochim, William M., PhD ...
American journal of preventive medicine,
08/2008, Letnik:
35, Številka:
2
Journal Article
Recenzirano
Odprti dostop
Abstract Improving population health requires understanding and changing societal structures and functions, but countervailing forces sometimes undermine those changes, thus reflecting the adaptive ...complexity inherent in public health systems. The purpose of this paper is to propose systems thinking as a conceptual rubric for the practice of team science in public health, and transdisciplinary, translational research as a catalyst for promoting the functional efficiency of science. The paper lays a foundation for the conceptual understanding of systems thinking and transdisciplinary research, and will provide illustrative examples within and beyond public health. A set of recommendations for a systems-centric approach to translational science will be presented.
Chronic diseases are a serious and urgent problem, requiring at-scale, multi-component, multi-stakeholder action and cooperation. Despite numerous national frameworks and agenda-setting documents to ...coordinate prevention efforts, Australia, like many countries internationally, is yet to substantively impact the burden from chronic disease. Improved evidence on effective strategies for the prevention of chronic disease is required. This research sought to articulate a priority set of important and feasible action domains to inform future discussion and debate regarding priority areas for chronic disease prevention policy and strategy.
Using concept mapping, a mixed-methods approach to making use of the best available tacit knowledge of recognised, diverse and well-experienced actors, and national actions to improve the prevention of chronic disease in Australia were identified and then mapped. Participants (ranging from 58 to 78 in the various stages of the research) included a national sample of academics, policymakers and practitioners. Data collection involved the generation and sorting of statements by participants. A series of visual representations of the data were then developed.
A total of 95 statements were distilled into 12 clusters for action, namely Inter-Sectoral Partnerships; Systems Perspective/Action; Governance; Roles and Responsibilities; Evidence, Feedback and Learning; Funding and Incentive; Creating Demand; Primary Prevention; Social Determinants and Equity; Healthy Environments; Food and Nutrition; and Regulation and Policy. Specific areas for more immediate national action included refocusing the health system to prevention over cure, raising the profile of public health with health decision-makers, funding policy- and practice-relevant research, improving communication about prevention, learning from both global best-practice and domestic successes and failures, increasing the focus on primary prevention, and developing a long-term prevention strategy with an explicit funding commitment.
Preventing chronic diseases and their risk factors will require at-scale, multi-component, multi-stakeholder action and cooperation. The concept mapping procedures used in this research have enabled the synthesis of views across different stakeholders, bringing both divergent and convergent perspectives to light, and collectively creating signals for where to prioritise national action. Previous national strategies for chronic disease prevention have not collated the tacit knowledge of diverse actors in the prevention of chronic disease in this structured way.
The way we think about how research, policy and practice inform and interact with each other shapes our efforts to improve health and social outcomes. In this paper we describe linear, relationship ...and systems models with regard to how they approach bridging evidence and policy/practice, or turning knowledge into action. We contribute to the knowledge to action (KTA) systems thinking discussion by highlighting four interconnected aspects of this model we believe merit exploration: evidence and knowledge, leadership, networks and communications. We conclude with the challenge of developing measurement methods for systems research to better understand the KTA process.
Context: An evidence base that addresses issues of complexity and context is urgently needed for large—system transformation (LST) and health care reform. Fundamental conceptual and methodological ...challenges also must be addressed. The Saskatchewan Ministry of Health in Canada requested a six-month synthesis project to guide four major policy development and strategy initiatives focused on patient- and family-centered care, primary health care renewal, quality improvement, and surgical wait lists. The aims of the review were to analyze examples of successful and less successful transformation initiatives, to synthesize knowledge of the underlying mechanisms, to clarify the role of government, and to outline options for evaluation. Methods: We used realist review, whose working assumption is that a particular intervention triggers particular mechanisms of change. Mechanisms may be more or less effective in producing their intended outcomes, depending on their interaction with various contextual factors. We explain the variations in outcome as the interplay between context and mechanisms. We nested this analytic approach in a macro framing of complex adaptive systems (CAS). Findings: Our rapid realist review identified five "simple rules" of LST that were likely to enhance the success of the target initiatives: (1) blend designated leadership with distributed leadership; (2) establish feedback loops; (3) attend to history; (4) engage physicians; and (5) include patients and families. These principles play out differently in different contexts affecting human behavior (and thereby contributing to change) through a wide range of different mechanisms. Conclusions: Realist review methodology can be applied in combination with a complex system lens on published literature to produce a knowledge synthesis that informs a prospective change effort in large-system transformation. A collaborative process engaging both research producers and research users contributes to local applications of universal principles and mid-range theories, as well as to a more robust knowledge base for applied research. We conclude with suggestions for the future development of synthesis and evaluation methods.
Worldwide, policymakers, health system managers, practitioners and researchers struggle to use evidence to improve policy and practice. There is growing recognition that this challenge relates to the ...complex systems in which we work. The corresponding increase in complexity-related discourse remains primarily at a theoretical level. This paper moves the discussion to a practical level, proposing actions that can be taken to implement evidence successfully in complex systems. Key to success is working with, rather than trying to simplify or control, complexity. The integrated actions relate to co-producing knowledge, establishing shared goals and measures, enabling leadership, ensuring adequate resourcing, contributing to the science of knowledge-to-action, and communicating strategically.
Editorial Maniatopoulos, Gregory; Hunter, David; Best, Allan
Journal of health organization and management,
05/2020, Letnik:
34, Številka:
3
Journal Article
Editorial Maniatopoulos Gregory; Hunter, David; Best, Allan
Journal of health organization and management,
04/2020, Letnik:
34, Številka:
3
Journal Article
Recenzirano
The recent coronavirus disease 2019 (COVID-19) pandemic is a timely reminder of the need for health systems to take co-ordinated and rapid emergency responses to prevent and reduce the risks of ...infection, sickness and loss of life. With health systems globally facing new and complex challenges such as unprecedented life expectancy; an increase in the prevalence of non-communicable diseases and multimorbidity much of which is avoidable; and the globalization of infectious diseases, transforming the way services are organised and provided to improve population health, quality and patient safety has become an urgent priority for policymakers (WHO, 2016, 2018; Braithwaite, 2018; Hunter, 2016; Bestet al., 2012). However, at a time of ongoing political and economic uncertainty and epidemiological transition characterized by demographic, societal and health status changes, large-scale health systems transformation (HST) is not always an easy task. It requires new reconfigurations of practice at multiple levels reflecting the dense interconnections of highly complex systems (Greenhalgh et al., 2017, 2012; Maniatopoulos et al., 2015). But many health systems lack the infrastructure, resources and capacity to respond to policy pressures for health reform and systems improvement. At the same time, competing priorities, intra- and inter-organisational boundaries across care settings, fragmentation of services and the rapid pace of change within the policy environment impose huge challenges for the successful implementation of HST programmes.
Purpose
– The questions addressed by this review are: first, what are the guiding principles underlying efforts to stimulate sustained cultural change; second, what are the mechanisms by which these ...principles operate; and, finally, what are the contextual factors that influence the likelihood of these principles being effective? The paper aims to discuss these issues.
Design/methodology/approach
– The authors conducted a literature review informed by rapid realist review methodology that examined how interventions interact with contexts and mechanisms to influence the sustainability of cultural change. Reference and expert panelists assisted in refining the research questions, systematically searching published and grey literature, and helping to identify interactions between interventions, mechanisms and contexts.
Findings
– Six guiding principles were identified: align vision and action; make incremental changes within a comprehensive transformation strategy; foster distributed leadership; promote staff engagement; create collaborative relationships; and continuously assess and learn from change. These principles interact with contextual elements such as local power distributions, pre-existing values and beliefs and readiness to engage. Mechanisms influencing how these principles sustain cultural change include activation of a shared sense of urgency and fostering flexible levels of engagement.
Practical implications
– The principles identified in this review, along with the contexts and mechanisms that influence their effectiveness, are useful domains for policy and practice leaders to explore when grappling with cultural change. These principles are sufficiently broad to allow local flexibilities in adoption and application.
Originality/value
– This is the first study to adopt a realist approach for understanding how changes in organizational culture may be sustained. Through doing so, this review highlights the broad principles by which organizational action may be organized within enabling contextual settings.
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