Promoting evidence-based
health policy making: The
European Observatory on Health
Systems & Policies
(in association with the
University of Pennsylvania)
Context
 Common health system challenges
 Cross country learning potential
– Transference of models and ideas
 Limited availability of evidence about impact
– Reforms rich in ideology but poor in knowledge
– Transitory fashions
 When available does not reach policy makers
Mission
The European Observatory on Health Systems
and Policies supports and promotes evidencebased health policy-making through
comprehensive and rigorous analysis of the
dynamics of health care systems in Europe
Principles
 Working in partnership with governments to
comprehensively describe health care
systems and the changes they undergo
 Comparative analysis of existing evidence
 Bridging the gap between scientific
evidence and the needs of policy makers
 Development of practical lessons and
options in health policy making
Partners
 WHO Regional Office for Europe
 8 governments (Belgium, Finland, Greece,
Norway, Slovenia, Spain, Sweden, Veneto
Region of Italy),
 European Investment Bank, World Bank
 Open Society Institute
 London School of Hygiene & Tropical
Medicine, London School of Economics &
Political Science, CRP-Santé Luxembourg
Health Care Systems in
Transition (HiT) country profiles


Analytical description of health
care system and of reform
initiatives in progress or under
development
Covers (almost) all 52 Member
States of WHO European Region
(European Union, central and
eastern Europe, former Soviet
Union, South-East Europe, Turkey,
Israel etc.) plus Mongolia
2. Comparative analysis / studies
2. Comparative analysis / studies
www.observatory.dk
The health workforce:
From today’s newspaper
Jobs shortage for new doctors
BMA chief warns that thousands trained in
Britain may need to emigrate
The Observer, 25th June 2006
Who is in charge?
• “in four days my bedding was only changed once although
soiled by blood, IV fluids, and a leaky catheter”
• “despite high fever and being constrained by attachment to
an IV, my sheets were never even straightened”
• “a cannula was replaced at one point but the old one was
not removed for three hours because the nurses and the
phlebotomist could not agree whose responsibility this
was”
• “three staff nurses remarked in a 10 minute period on how
I was due for paracetamol but none returned to give me the
tablet”
Anonymous: Four days in a strange place. J Health Serv Res Pol 2006
… to put it mildly
• “perhaps the most telling example, though, was
the struggle over my attempt to get discharged. …
the only reason for detaining me was that I was
receiving IV antibiotics. I pointed out firmly and
repeatedly that this was absurd, since I could
easily come and get these as an outpatient… junior
clinicians told me it was organisationally
impossible, but the consultant let slip that the
problem was that they would have to ask the
nurses to do them a favour by agreeing to manage
the infusion”
The problem…
• “Care was being delivered by a group of
professional and semi-professional workers,
each of whom occupied their own silo,
occasionally picking up information from
others to initiate some action, or acting in
ways that triggered actions by others, but
who were unable to see how they formed
part of a whole system”
Moving ahead
• Supply strategies
– Need for vastly improved forecasting methods
– … which take account of the unknowable
• Education and training strategies
– Adapting training to needs
– Life long learning
• Working environment strategies
– Creating places where people want to work
The unknowable
“there are known knowns; there
are things we know we know. We
also know there are known
unknowns; that is to say we know
there are some things we do not
know. But there are also unknown
unknowns, the ones we don’t know
we don’t know. And … it is the
latter category that tend to be the
difficult ones.”
Moving ahead
• Supply strategies
– Need for vastly improved forecasting methods
– … which take account of the unknowable
• Education and training strategies
– Adapting training to needs
– Life long learning
• Working environment strategies
– Creating places where people want to work
… as does a trained workforce
“OK, we’ll vote.
How many say the
heart has four
chambers?”
… Trained staff
don’t appear
overnight
Moving ahead
• Supply strategies
– Need for vastly improved forecasting methods
– … which take account of the unknowable
• Education and training strategies
– Adapting training to needs
– Life long learning
• Working environment strategies
– Creating places where people want to work
A happy workforce makes a
difference
• 39 hospitals defined
prospectively as providing a
good nursing environment;
• matched with 195 controls with
similar characteristics in other
areas;
• after adjustment for severity;
magnet hospitals had a 4.6%
lower mortality rate
• board certification, technology
etc.. not relevant
Source: Aiken & Sloane
Further reading
What are the critical gaps in the
health workforce
• What are the critical challenges facing the health care
workforce in the 21st century?
– Nigel Edwards
• What are the critical skills that we will need (and who will
have them) to meet those challenges?
– Bonnie Sibbald
• What are the regulatory challenges to closing these critical
workforce gaps?
– Carl Ardy Dubois
• Discussion
– Julie Sochalski