Whole Health System Change in Ireland: A Collaborative Inquiry Into the Enablers and Challenges of Implementation

Abstract BackgroundAcross the world, health and care systems are struggling to contain costs and improve quality of services by improving prevention, developing wellness programmes, and providing person-centred coordinated health and care. The development of the National Clinical Programmes (NCPs) in Ireland in 2009 coincided with a profoundly challenging period for the Irish economy and consequently for publicly funded health services. These programmes are focused on implementing clinical and operational models of care that have access, quality and value at their core. By 2012, there was a clear recognition among senior health leaders that the desired outcome of nationalising best practice and achieving whole system change had not been achieved through the NCPs and a series of world café events were then planned to assess the challenges that had been experienced by the programmes in order to inform the next phase.MethodsA Multi-Stakeholder Engagement Process using the World Café method of collaborative participatory inquiry, was conducted to obtain a rich, in-depth understanding of the development and implementation of health service reform in Ireland. Three keys questions were explored through an inductive approach to analysis of themes that emerged from conversations with key stakeholders.ResultsThere were 59 participants. A total of 408 responses were received. Using an inductive approach to analysis of themes 5 key themes emerged; Integrated care; Patient Centred Care; Clinical Governance; Funding models and e-Health.ConclusionHaving a clear vision, a prescribed methodology and clinician buy and involvement in the design of new models of care is not sufficient to ensure implementation. A whole system approach to the design and implementation of new models of care must be supported by essential enablers such as policy, financial and human resource models and knowledge management systems. This research informed the planning and design for the second phase of the programmes and sought to overcome the barriers and work with operations and policy makers to improve outcomes for patients by implementing person centered evidence-based models of integrated care.