Статті в журналах: "Health services and systems"

1

Al Khawashki, H. "Emergency health services systems." Eastern Mediterranean Health Journal 5, no. 4 (August 15, 1999): 778–84. http://dx.doi.org/10.26719/1999.5.4.778.

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2

Thomas, Cynthia, and Howard R. Kelman. "Health services use among the elderly under alternative health service delivery systems." Journal of Community Health 15, no. 2 (April 1990): 77–92. http://dx.doi.org/10.1007/bf01321313.

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3

Bintier, Paul R. "Information Systems and Mental Health Services." Computers in Human Services 9, no. 1-2 (April 22, 1993): 47–57. http://dx.doi.org/10.1300/j407v09n01_08.

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4

Ingram, Richard C., Patrick M. Bernet, and Julia F. Costich. "Public Health Services and Systems Research." Journal of Public Health Management and Practice 18, no. 6 (2012): 515–19. http://dx.doi.org/10.1097/phh.0b013e31825fbb40.

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5

Ellis, Randall P., and Thomas G. McGuire. "Optimal payment systems for health services." Journal of Health Economics 9, no. 4 (January 1990): 375–96. http://dx.doi.org/10.1016/0167-6296(90)90001-j.

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6

Scutchfield, F. Douglas, and Robert M. Shapiro. "Public Health Services and Systems Research." American Journal of Preventive Medicine 41, no. 1 (July 2011): 98–99. http://dx.doi.org/10.1016/j.amepre.2011.04.001.

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7

Scutchfield, F. Douglas, Alex F. Howard, and Glen P. Mays. "Public Health Services and Systems Research." American Journal of Preventive Medicine 42, no. 5 (May 2012): S84—S86. http://dx.doi.org/10.1016/j.amepre.2012.01.024.

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8

Larkin, Michelle A., and James S. Marks. "Public Health Services and Systems Research." American Journal of Preventive Medicine 42, no. 5 (May 2012): S79—S81. http://dx.doi.org/10.1016/j.amepre.2012.01.025.

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9

Scutchfield, F. Douglas, James S. Marks, Debra J. Perez, and Glen P. Mays. "Public Health Services and Systems Research." American Journal of Preventive Medicine 33, no. 2 (August 2007): 169–71. http://dx.doi.org/10.1016/j.amepre.2007.03.013.

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10

Avison, D. E., and C. P. Catchpole. "Information systems for the community health services." Medical Informatics 13, no. 2 (January 1988): 117–26. http://dx.doi.org/10.3109/14639238809010087.

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11

Krug, Etienne, and Alarcos Cieza. "Strengthening health systems to provide rehabilitation services." Bulletin of the World Health Organization 95, no. 3 (March 1, 2017): 167. http://dx.doi.org/10.2471/blt.17.191809.

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12

Krug, Etienne, and Alarcos Cieza. "Strengthening Health Systems to Provide Rehabilitation Services." Annals of Rehabilitation Medicine 41, no. 2 (2017): 169. http://dx.doi.org/10.5535/arm.2017.41.2.169.

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13

Manyuchi, Albert Edgar, Coleen Vogel, Caradee Y. Wright, and Barend Erasmus. "Systems approach to climate services for health." Climate Services 24 (December 2021): 100271. http://dx.doi.org/10.1016/j.cliser.2021.100271.

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14

Cinque, Marcello, Antonio Coronato, and Alessandro Testa. "Dependable Services for Mobile Health Monitoring Systems." International Journal of Ambient Computing and Intelligence 4, no. 1 (January 2012): 1–15. http://dx.doi.org/10.4018/jaci.2012010101.

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The design and realization of health monitoring systems has attracted the interest of large communities both from industry and academia. Remote and continuous monitoring of patient’s vital signs is the target of an emerging business market that aims both to improve the quality of life of patients and to reduce costs of national healthcare services. Such applications, however, are particularly critical from the point of view of dependability. This presents the design of a set of services for the assurance of high degrees of dependability to generic mobile health monitoring systems. The design is based on the results of a detailed failure modes and effects analysis (FMEA), conducted to identify the typical dependability threats of health monitoring systems. The FMEA allowed the authors to conceive a set of configurable monitoring services, enriching the system with the ability to detect failures at runtime, and enabling the realization of dependable services for future mobile health monitoring systems.

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15

Tiwari, Vikram, Joseph J. Quinlan, and Wilton C. Levine. "Scaling Perioperative Services Across Health Care Systems." International Anesthesiology Clinics 57, no. 1 (2019): 1–17. http://dx.doi.org/10.1097/aia.0000000000000218.

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16

Krug, Etienne, and Alarcos Cieza. "Strengthening health systems to provide rehabilitation services." Neuropsychological Rehabilitation 29, no. 5 (May 2017): 672–74. http://dx.doi.org/10.1080/09602011.2017.1319391.

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17

Sarris, A., and M. G. Sawyer. "Automated Information Systems in Mental Health Services." International Journal of Mental Health 18, no. 4 (December 1989): 18–30. http://dx.doi.org/10.1080/00207411.1989.11449141.

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18

Martin, Laurie T., Alonzo Plough, Katherine G. Carman, Laura Leviton, Olena Bogdan, and Carolyn E. Miller. "Strengthening Integration Of Health Services And Systems." Health Affairs 35, no. 11 (November 2016): 1976–81. http://dx.doi.org/10.1377/hlthaff.2016.0605.

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19

Siddamallaiah, H. S. "Guest Editorial: Health Information Systems and Services." DESIDOC Journal of Library & Information Technology 33, no. 2 (March 1, 2013): 81–82. http://dx.doi.org/10.14429/djlit.33.2.4190.

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20

Krug, Etienne, and Alarcos Cieza. "Strengthening Health Systems to Provide Rehabilitation Services." American Journal of Physical Medicine & Rehabilitation 96, no. 6 (June 2017): 438–39. http://dx.doi.org/10.1097/phm.0000000000000753.

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21

Blobel, Bernd, and Martin Holena. "CORBA security services for health information systems." International Journal of Medical Informatics 52, no. 1-3 (October 1998): 29–37. http://dx.doi.org/10.1016/s1386-5056(98)00122-1.

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22

Krug, Etienne, and Alarcos Cieza. "Strengthening health systems to provide rehabilitation services." Canadian Journal of Occupational Therapy 84, no. 2 (April 2017): 72–73. http://dx.doi.org/10.1177/0008417417705853.

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23

Saxena, Shekhar, Mark van Ommeren, Antonio Lora, and Benedetto Saraceno. "Monitoring of mental health systems and services." Social Psychiatry and Psychiatric Epidemiology 41, no. 6 (March 25, 2006): 488–97. http://dx.doi.org/10.1007/s00127-006-0053-3.

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24

Krug, Etienne, and Alarcos Cieza. "Strengthening health systems to provide rehabilitation services." Physiotherapy Research International 22, no. 3 (July 2017): e1691. http://dx.doi.org/10.1002/pri.1691.

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25

Tan, Joseph, H. Joseph Wen, and Neveen Awad. "Health care and services delivery systems as complex adaptive systems." Communications of the ACM 48, no. 5 (May 2005): 36–44. http://dx.doi.org/10.1145/1060710.1060737.

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26

Moghaddasi, Hamid, and Alireza Tabatabaei Tabrizi. "Applications of Cloud Computing in Health Systems." Global Journal of Health Science 9, no. 6 (October 28, 2016): 33. http://dx.doi.org/10.5539/gjhs.v9n6p33.

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Анотація:

INTRODUCTION: Equitable access to health services is one of the health justice criteria. E-health can sometimes be helpful in this regard. This study is aimed to find the use of cloud computing services across health system.METHOD: In the present review article, numerous research papers from different resources, such as MEDLINE, IEEE and Science direct, were studied. Based on the subject, 210 studies were found. After quality analysis of the papers, 78 studies were selected, from which 53 articles were directly related to the applications of cloud computing in health system.FINDINGS: Cloud computing services are widely used in various industries. Therefore, health system takes advantage of the services. Findings indicate that, the applications of cloud computing in health system, including telemedicine, medical imaging, public and personal health, clinical and hospital information systems, medical decision support system, care, secondary use of health data, serve as different types of specialized software used to analyze gene sequences and archive huge biological data. Generally cloud computing services are available in two sectors in any health system as follows: E-health services and Bioinformatics.CONCLUSION: Facilitated access to the E-health services and big data in health systems are the main features of exploiting cloud computing services in health systems. Using cloud computing in health systems not only makes health services more affordable, but also helps nations to achieve health equity.

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27

Hernández, Fé Fernández. "Photovoltaic Sun Energy Supporting the Health Services." Journal of Clinical Case Reports and Studies 2, no. 1 (July 1, 2021): 01–02. http://dx.doi.org/10.31579/2690-8808/051.

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Background. In Cuba all health services are covered by the fiscal resources. That’s why the Cuban government most takes heavy decisions to support the transportation and electrician services for health services. The majority from the electricity generated in Cuba is obtained by gross petroleum. Then, the health services and the patient’s satisfaction are close related to the importation of gross petroleum to support the electrician and the health services transportation demand. The use of photovoltaic sun energy contributes to reduce the electrician demand generated by fossil fuel, to reduce the importation of gross petroleum to generate electricity and the save in international currency obtained may be used to cover the importation costs related to transportation services for the health services. Objective. To value the use of photovoltaic sun energy to support the hospital services in Havana. Materials and methods. Was made a descriptive research about the benefits utilizing the photovoltaic sun energy to support the hospital services in Havana. As theorical methods were utilized the inductive – deductive, the comparative and the historical – logical. As empiric methods were used the document and bibliographic research and the arithmetic calculus. Results. If these hospitals considered should install 5000 photovoltaic cell, they should generate 236.25 MW during 350 days at year. This electricity represents the substitution of 65677.5 MT of this fossil fuel annually. Conclusions. Photovoltaic sun energy shows several benefits for developing countries in tropical zones as Cuba. The example showed before should be taken account in health systems of tropical countries as example to reduce the health services costs and increase the patient satisfaction too.

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28

Bailit, H. L. "Health Services Research." Advances in Dental Research 17, no. 1 (December 2003): 82–85. http://dx.doi.org/10.1177/154407370301700119.

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The major barriers to the collection of primary population-based dental services data are: (1) Dentists do not use standard record systems; (2) few dentists use electronic records; and (3) it is costly to abstract paper dental records. The value of secondary data from paid insurance claims is limited, because dentists code only services delivered and not diagnoses, and it is difficult to obtain and merge claims from multiple insurance carriers. In a national demonstration project on the impact of community-based dental education programs on the care provided to underserved populations, we have developed a simplified dental visit encounter system. Senior students and residents from 15 dental schools (approximately 200 to 300 community delivery sites) will use computers or scannable paper forms to collect basic patient demographic and service data on several hundred thousand patient visits. Within the next 10 years, more dentists will use electronic records. To be of value to researchers, these data need to be collected according to a standardized record format and to be available regionally from public or private insurers.

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29

Taylor, Paul. "Evaluating telemedicine systems and services." Journal of Telemedicine and Telecare 11, no. 4 (June 1, 2005): 167–77. http://dx.doi.org/10.1258/1357633054068955.

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The evaluation of telemedicine involves attempts to answer a wide range of questions involved in making decisions about safety, about practicality and about utility. Roughly speaking, if we wish to provide a telemedicine service we should first establish that it is safe, next that it is practical and finally that it is worthwhile. In establishing safety, most laboratory studies of telemedicine have a common structure, and consist of the following steps: (1) selection of cases; (2) interpretation; (3) comparison with a gold standard; (4) statistical analyses. Most of the studies to establish the practicality of telemedicine have been carried out as demonstrations, to show that a proposed application can be implemented in a chosen setting. In terms of utility, telemedicine has been used to improve the efficiency of an existing service or to make an existing service available to a new community. One of the difficulties is that the vendors of relatively expensive telemedicine systems and services disseminate much of the information on the topic. We have to focus not on the glamorous technology but on the underlying issue of how the participants in health care (patients, general practitioners, specialists) can communicate more effectively, using the range of technological options open to them. Ensuring that the most appropriate technology is used in the most effective way should be the primary aim of telemedicine research. There is now sufficient evidence for us to be confident that telemedicine is a safe alternative to conventional care in a variety of situations and for a number of clinical conditions. Reliable evidence that it is a practical and cost-effective alternative is, at the time of writing, harder to find.

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30

Farahmandian, Vahid, and Abbas Asosheh. "Implicit, Context Management Systems for Mobile Health Services." E-Health Telecommunication Systems and Networks 04, no. 01 (2015): 1–9. http://dx.doi.org/10.4236/etsn.2015.41001.

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31

McGee, Heather M., and Lori H. Diener. "Behavioral Systems Analysis in Health and Human Services." Behavior Modification 34, no. 5 (September 2010): 415–42. http://dx.doi.org/10.1177/0145445510383527.

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This article provides a behavioral systems approach to improve operational performance in health and human service organizations. This article provides six performance truths that are relevant to any organization and a case study from a community mental health network of agencies. A comprehensive analysis, as described here, will help health and human service leaders identify the critical areas in which to focus improvement efforts to better achieve their organizational mission.

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32

Diaz-Rossello, Jose Luis. "Health services research, outcomes, and perinatal information systems." Current Opinion in Pediatrics 10, no. 2 (April 1998): 117–22. http://dx.doi.org/10.1097/00008480-199804000-00001.

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33

Martins, Dwayne. "Book Review: Information Systems for Health Services Administration." Healthcare Management Forum 12, no. 1 (April 1999): 44–45. http://dx.doi.org/10.1016/s0840-4704(10)60691-6.

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34

Thompson, R. S. "Systems approaches and the delivery of health services." JAMA: The Journal of the American Medical Association 277, no. 8 (February 26, 1997): 670–71. http://dx.doi.org/10.1001/jama.277.8.670.

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35

Scutchfield, F. Douglas, Debra Joy Pérez, Judith A. Monroe, and Alex F. Howard. "New Public Health Services and Systems Research Agenda." American Journal of Preventive Medicine 42, no. 5 (May 2012): S1—S5. http://dx.doi.org/10.1016/j.amepre.2012.01.027.

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36

Harris, Jenine K., Kate E. Beatty, Colleen Barbero, Alex F. Howard, Robin A. Cheskin, Robert M. Shapiro, and Glen P. Mays. "Methods in Public Health Services and Systems Research." American Journal of Preventive Medicine 42, no. 5 (May 2012): S42—S57. http://dx.doi.org/10.1016/j.amepre.2012.01.028.

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37

Thompson, Robert S. "Systems Approaches and the Delivery of Health Services." JAMA: The Journal of the American Medical Association 277, no. 8 (February 26, 1997): 670. http://dx.doi.org/10.1001/jama.1997.03540320072039.

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38

Wahlbeck, K. "European comparisons between mental health services." Epidemiology and Psychiatric Sciences 20, no. 1 (March 2011): 15–18. http://dx.doi.org/10.1017/s2045796011000060.

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When developing accessible, affordable and effective mental health systems, exchange of data between countries is an important moving force towards better mental health care. Unfortunately, health information systems in most countries are weak in the field of mental health, and comparability of data is low.Special international data collection exercises, such as the World Health Organization (WHO) Atlas Project and the WHO Baseline Project have provided valuable insights in the state of mental health systems in countries, but such single-standing data collections are not sustainable solutions. Improvements in routine data collection are urgently needed. The European Commission has initiated major improvements to ensure harmonized and comprehensive health data collection, by introducing the European Community Health Indicators set and the European Health Interview Survey. However, both of these initiatives lack strength in the field of mental health. The neglect of the need for relevant and valid comparable data on mental health systems is in conflict with the importance of mental health for European countries and the objectives of the ‘Europe 2020’ strategy.The need for valid and comparable mental health services data is today addressed only by single initiatives, such as the Organisation for Economic Co-operation and Development work to establish quality indicators for mental health care. Real leadership in developing harmonized mental health data across Europe is lacking. A European Mental Health Observatory is urgently needed to lead development and implementation of monitoring of mental health and mental health service provision in Europe.

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39

Wilson, Claire, Mohammad Taghi Yasamy, Jodi Morris, Atieh Novin, Khalid Saeed, and Sebastiana D. Nkomo. "Mental health services: the African gap." Journal of Public Mental Health 13, no. 3 (September 9, 2014): 132–41. http://dx.doi.org/10.1108/jpmh-09-2013-0059.

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Purpose – Neuropsychiatric disorders account for a substantial proportion of disease burden and disability in Africa. Despite this, mental health systems are under-resourced in Africa, as in most parts of the world, creating a “treatment gap” and denying the African population the right to mental health achieved through access to mental health services. The paper aims to discuss these issues. Design/methodology/approach – The mental health systems of African countries were compared with figures for all low- and middle-income countries (LAMICS) using data from the World Health Organization Assessment Instrument for Mental Health Systems. Comparable global figures were also available for some indicators from the WHO's World Mental Health Atlas 2011. Findings – Selected indicators of mental health systems are presented for 14 African countries and shows that they are lower as compared to figures for all other LAMICS and also global figures. The treatment gap for mental disorders is much higher in Africa than comparable global figures. For example, the treatment gap for mood disorders has been estimated from 95 to 100 per cent for some African countries. Originality/value – There is an imbalance between need and service provision in the area of mental health across the world but particularly in Africa. Despite this, there are a greater number of outpatient than inpatient services in Africa which provides an opportunity for development of community-based services. There are also many encouraging examples of effective approaches to reducing the burden of neuropsychiatic disease in Africa.

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40

Oyebode, Femi, Giles Berrisford, and Liz Parry. "Commission for Health Improvement and mental health Services." Psychiatric Bulletin 28, no. 7 (July 2004): 238–40. http://dx.doi.org/10.1192/pb.28.7.238.

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The Commission for Health Improvement (CHI) ceased to function at the end of March 2004. This provides the opportunity to review its contribution and achievements as a new body, the Commission for Healthcare Audit and Inspection (CHAI), takes over its functions∗. CHI recently published its assessment of mental health services (http://www.chi.nhs.uk/eng/news/2003/dec/11.shtml). The report is based on the 35 clinical governance reviews, in England and Wales, published between July 2001 and October 2003; two investigations into serious service failures; and a report on safeguarding arrangements for children in England and a self-audit of child protection arrangements. CHI concluded that mental health services lag behind acute health services in developing clinical governance systems and processes that promote high-quality care and continuous improvement. It specifically highlighted the shortages of psychiatrists and in-patient nurses, and the reliance on agency nurses and locum staff; the unsuitability of buildings and facilities; the pressures on in-patient beds; the lack of management capacity and poor information systems; and the low priority given to services for children and older people.

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41

Perez, Miguel A., Antonio Gonzalez, and Helda Pinzon-Perez. "Cultural Competence in Health Care Systems." Californian Journal of Health Promotion 4, no. 1 (March 1, 2006): 102–8. http://dx.doi.org/10.32398/cjhp.v4i1.737.

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Анотація:

This study studied cultural competence training needs in a health services system in California. Results indicated that the major training needs were related to (1) cultural factors that affect consumers’ access to services, (2) ethnic and cultural beliefs, traditions, and customs, (3) training for interpreters, and (4) crosscultural communication. Significant differences were found in regard to administrator and staff participation in cultural awareness activities, perception of the work environment as culturally competent, perception of culturally-related barriers, and perceived training needs. The findings support the importance of a continuous assessment of the educational needs of employees regarding cultural competence.

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42

Lopez-Casasnovas, Guillem. "Converging trends in national health services and social health insurance systems." Journal of Medical Economics 10, no. 4 (January 2007): 587–90. http://dx.doi.org/10.3111/13696990701817400.

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43

Parkhurst, Justin Oliver, Loveday Penn-Kekana, Duane Blaauw, Dina Balabanova, Kirill Danishevski, Syed Azizur Rahman, Virgil Onama, and Freddie Ssengooba. "Health systems factors influencing maternal health services: a four-country comparison." Health Policy 73, no. 2 (August 2005): 127–38. http://dx.doi.org/10.1016/j.healthpol.2004.11.001.

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44

Kriegel, Johannes, Franziska Jehle, Marcel Dieck, and Patricia Mallory. "Advanced services in hospital logistics in the German health service sector." Logistics Research 6, no. 2-3 (February 12, 2013): 47–56. http://dx.doi.org/10.1007/s12159-013-0100-x.

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45

Amaddeo, Francesco, and Michele Tansella. "Information systems for mental health." Epidemiologia e Psichiatria Sociale 18, no. 1 (March 2009): 1–4. http://dx.doi.org/10.1017/s1121189x00001378.

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Анотація:

The use of information systems and computer science applications in the health sector is now entrenched and widespread. In mental health services there are the typical applications of information systems concerning administrative, clinical and research issues, as well as innovative applications concerning diagnostic procedures, self-help, communication and delivery of psychotherapy.

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46

Littlejohns, Peter, Katharina Kieslich, Albert Weale, Emma Tumilty, Georgina Richardson, Tim Stokes, Robin Gauld, and Paul Scuffham. "Creating sustainable health care systems." Journal of Health Organization and Management 33, no. 1 (March 18, 2019): 18–34. http://dx.doi.org/10.1108/jhom-02-2018-0065.

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Анотація:

Purpose In order to create sustainable health systems, many countries are introducing ways to prioritise health services underpinned by a process of health technology assessment. While this approach requires technical judgements of clinical effectiveness and cost effectiveness, these are embedded in a wider set of social (societal) value judgements, including fairness, responsiveness to need, non-discrimination and obligations of accountability and transparency. Implementing controversial decisions faces legal, political and public challenge. To help generate acceptance for the need for health prioritisation and the resulting decisions, the purpose of this paper is to develop a novel way of encouraging key stakeholders, especially patients and the public, to become involved in the prioritisation process. Design/methodology/approach Through a multidisciplinary collaboration involving a series of international workshops, ethical and political theory (including accountability for reasonableness) have been applied to develop a practical way forward through the creation of a values framework. The authors have tested this framework in England and in New Zealand using a mixed-methods approach. Findings A social values framework that consists of content and process values has been developed and converted into an online decision-making audit tool. Research limitations/implications The authors have developed an easy to use method to help stakeholders (including the public) to understand the need for prioritisation of health services and to encourage their involvement. It provides a pragmatic way of harmonising different perspectives aimed at maximising health experience. Practical implications All health care systems are facing increasing demands within finite resources. Although many countries are introducing ways to prioritise health services, the decisions often face legal, political, commercial and ethical challenge. The research will help health systems to respond to these challenges. Social implications This study helps in increasing public involvement in complex health challenges. Originality/value No other groups have used this combination of approaches to address this issue.

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47

MONTALVO NÚÑEZ, KATHERINE ALESSANDRA, MARISEL ROXANA VALENZUELA RAMOS, ALBERTO VALENZUELA MUÑOZ, RAFAEL DOUGLAS SCIPIÓN CASTRO, and PAUL ORESTES MENDOZA MURILLO. "Management and administration of dental health services." Llamkasun 2, no. 1 (March 15, 2021): 97–104. http://dx.doi.org/10.47797/llamkasun.v2i1.34.

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Анотація:

Within medical informatics there’s dental informatics, which deals with the management of information, communication, and the application of new technologies in clinical practice and research. These computer systems involve the storage of information and will be in charge of organizing the work in the dental clinic.(Specified, 2009) Objective: The primary objective of this research work is to know the need to manage and administer dental health services through computer systems in the city of Chiclayo. Method: It is a cross-sectional, descriptive, observational, and prospective study. Which comprised conducting questionnaires to the owners of dental clinics, administrative personnel, dentists, and patients who attend the different dental clinics that are in the City of Chiclayo. Results: We verified that there were contrasting hypotheses. Conclusions: We conclude that there is a need to implement dental clinics with computer systems.

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48

Martin, Carmel M., and Joachim P. Sturmberg. "Perturbing ongoing conversations about systems and complexity in health services and systems." Journal of Evaluation in Clinical Practice 15, no. 3 (June 2009): 549–52. http://dx.doi.org/10.1111/j.1365-2753.2009.01164.x.

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49

Baum, Fran, Helen van Eyk, and Catherine Hurley. "Re-orientation of Health Services towards Health Promotion: An Australian Case Study of Aborted Health Service Reform." Australian Journal of Primary Health 12, no. 2 (2006): 24. http://dx.doi.org/10.1071/py06019.

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Анотація:

This paper examines a case study of local health care reform in Australia that had as one of its aims the desire to increase the health promotion and partnership work of the region. The case study highlights the pressures contemporary health systems are facing and the challenge of re-orientating health services towards health promotion in this environment. Qualitative research, including interviews, focus groups, a staff survey and policy analysis were used to identify health system professionals? perceptions of the impact of health care reform. The case study portrays a complex system that is subject to frequent change but little reform. Our case study indicates that features of health systems that encourage collaborative partnerships are those where there is: an environment that encourages trust; a common purpose among the key players; a supportive external environment; practical projects to work on; organisational stability; commitment from staff throughout organisations; willingness to commit resources; evidence that change is likely to improve outcomes for users; and an organisational environment in which learning from past experience is encouraged. A number of constraints and tensions that work against introducing a greater emphasis on health promotion and collaboration within the system studied are discussed, including tensions between central funding bureaucracies and health care agencies and the reform fatigue and increasing cynicism among staff resulting from continuous change. The paper concludes that against the chaotic background of contemporary health service reform it is very difficult to bring about genuine reform to achieve a shift to more emphasis on health promotion and partnerships.

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50

Mays, Glen P., and F. Douglas Scutchfield. "Improving Population Health by Learning From Systems and Services." American Journal of Public Health 105, S2 (April 2015): S145—S147. http://dx.doi.org/10.2105/ajph.2015.302624.

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