Overview

The key messages of this policy brief published by the European Observatory on Health Systems and Policies are as follows:

• The transformation of health service delivery is about achieving large-scale change to meet population health needs and expectations, despite resource constraints. Innovative ways of delivering health services, such as new models of care and technology-based solutions, can improve the quality and efficiency of care if widely and appropriately implemented.
• Health systems are so complex that change cannot be imposed from the top. Transforming service delivery means engaging with multiple actors, their different interests and interactions. Combining top-down and bottom-up initiatives throughout the process helps.
• The main role of policy-makers in the transformation of health service delivery is:
  • providing leadership, by setting out a clear vision and strategy for change, aligning governance mechanisms and cultivating shared commitment; and
  • ensuring sufficient resources for transformation at the local level.
• Developing a clear vision and strategy for change includes:
  • identifying transformation targets, by leveraging tools such as health system performance assessment, surveys and stakeholder consultation;
  • choosing possible solutions that are effective, affordable, equitable and implementable using tools such as:
    • horizon scanning mechanisms and dedicated funding streams (national and international) to identify and/or test potential options;
    • Health Technology Assessment, to make a compelling case for change and help ensure solutions are good for patients and add value; and
    • analysis of the political economy around change to anticipate and address resistance.

• Governance mechanisms need to be adapted and aligned to facilitate change which means:

  • deciding which entities are involved in the change process and clarifying their relationships, the processes for making and implementing decisions and accountability;
  • adapting relevant regulatory elements (formal legislation, professional standards, etc.); and
  • adjusting payment and accountability mechanisms so they are geared towards transformation and its context.
• Generating the commitment to implement change is critical, because transformation requires substantial buy-in from stakeholders to succeed. Policy-makers need the right skills to achieve this. A system level strategy informed by stakeholder analysis and articulating all the elements of stakeholder engagement, as well as coalition building with civil society, professional associations and others are essential.
• The resources for transformation at the local level must be aligned with its objectives. This means that policymakers must:
  • put in place sufficient funding channelled through tailored payment mechanisms;
  • use multi-professional and intersectoral workforce planning to put the right staff and skill mix in the right place;
  • nurture organizational and clinical leadership by supporting training opportunities and empower frontline staff by ensuring opportunities for skills development and the space to implement changes on the ground;
  • support the necessary technical infrastructures, such as health information systems;
  • foster the availability of robust information on good practice and progress on transformation goals, and its communication.

• Transformation is not a one-off or a quick thing:

  • transformation takes time, so expectations need to be managed to sustain momentum;
  • effective change requires ongoing monitoring and adaptation, and good communication of successes and challenges; and
  • success is very context-specific, so while international lessons and good practices can be shared, initiatives will always need to be tailored to local circumstances.

  The other Tallinn policy briefs:

  Trust: The foundation of health systems
  Health system performance assessment: A renewed global framework for policy-makings
  Assessing health system performance: Proof of concept for a HSPA dashboard of key indicators
  Financing for health system transformation: Spending more or spending better (or both)?