EUROHEALTH

10
Transforming health services
further, long-term evaluation is needed to
assess whether, and to what extent, these
results can be further enhanced through
improving quality and greater citizen and
provider engagement.
Conclusions
The GK model demonstrates that a focus
on population health management and
providing a continuum of care, including
health promotion and primary prevention,
can lead to cost-effective solutions,
while also strengthening communities
and healthier people. The model also
underlines the importance of taking
an inter-sectoral approach even when
working at the local and regional level,
since so many determinants outside the
health system influence the health and
wellbeing of people. Establishing lasting,
trusting and respectful relationships with
and between health service providers,
social and community services, private
enterprises and local councils was another
factor in developing these successful
people-centred services. Finally, longterm
and sustainable change can only
be achieved with the help of a strong
evaluation and monitoring framework
in order to understand the impact of
the interventions, identify risk factors
early on, and design and improve the
services based on evidence and predictive
modelling. Looking more closely at health
inequalities and strengthening patientrelated
outcomes and experience measures
are also essential.
References
1
Gallinat A. The chronic disease challenge.
Pan European Networks: Government 2015(16):42.
2
World Health Organization. Global strategy on
people-centred and integrated health services. Interim
Report. Geneva: WHO, 2015.
3
Stange KC. The problem of fragmentation and
the need for integrative solutions. Annals of family
medicine 2009;7(2):100 –3.
4
Nolte E, McKee M. Integration and chronic care:
a review. In: Nolte E and McKee M (eds.) Caring for
People with Chronic Conditions. A Health System
Perspective. London: European Observatory on
Health Systems and Policies Series, 2008:64-91.
5
Alderwick H, Ham C, Buck D. Population health
systems. Going beyond integrated care. London:
The King’s Fund, 2015.
6
Berwick DM, Nolan TW, Whittington J. The
Triple Aim: Care, health and costs. Health Affairs
2008;27:759-69.
7
Ferrer L. Engaging patients, carers and
communities for the provision of coordinated/
integrated health services: strategies and tools.
Working Document. Copenhagen: WHO Regional
Office for Europe, 2015.
8
Conrad DA, Dowling WL. Vertical integration in
health services: theory and managerial implications.
Health care management review 1990;15(4):9–22.
9
Shortell SM, Jones RH, Rademaker AW.
Assessing the impact of total quality management
and organizational culture on multiple outcomes
of care for coronary artery bypass graft surgery
patients. Medical care 2000;38(2):207–17.
10
Skelton-Green JM, Sunner JS. Integrated
delivery systems: the future for Canadian health care
reform? Canadian journal of nursing administration
1997;10(3):90 –111.
11
Groene O, Garcia-Barbero M. Integrated care.
A position paper of the WHO European office for
integrated health care services. Int J Integr Care
2001;1:1-16.
12
Vázquez ML, Vargas I, Unger J-P, et al. Integrated
health care networks in Latin America: toward
a conceptual framework for analysis. [Revista
Panamericana de Salud Pública]. Washington: Pan
American Health Organization, 2009;26(4).
13
Groene O, Hildebrandt H. Integrated Care in
Germany. In: Amelung V, Stein V, Goodwin N, Balicer
R, Nolte E, Suter E (eds.) Handbook Integrated Care.
Springer, forthcoming 2016.
14
Hildebrandt H, Stunder B, Schulte T. Triple Aim
in Kinzigtal, Germany: Improving population health,
integrating health care and reducing costs of care
– lessons for the UK? Journal of Integrated Care
2012;20:205-22.
15
Schulte T, Pimperl A, Fischer A, Dittmann B,
Wendel P, Hildebrandt H. [A quasi-experimental
cohort study: propensity score matching of
participants vs non-participants of the integrated
care network GK – secondary data analysis] Eine
quasi-experimentelle Kohortenstudie: Propensity
Score-Matching von Eingeschriebenen vs. Nicht-
Eingeschriebenen der Integrierten Versorgung
Gesundes Kinzigtal auf Basis von Sekundärdaten,
Optimedis Health Data Analytics, 2014. Available at:
http://optimedis.de/files/Publikationen/Studienund-Berichte/2014/Mortalitaetsstudie-2014/
Mortalitaetsstudie-2014.pdf
Lessons from transforming
health services delivery:
Compendium of initiatives in the
WHO European Region
Copenhagen: WHO Regional Office for Europe, 2016
Available for download at: http://www.euro.who.int/en/
health-topics/Health-systems/health-service-delivery/
publications/2016/lessons-from-transforming-health-servicesdelivery-compendium-of-initiatives-in-the-who-europeanregion-2016
is compelling. In the context of both new challenges and
opportunities, initiatives to transform services delivery across
the WHO European Region has emerged.
This Compendium demonstrates the diversity in activity,
describing examples of health services delivery transformations
from each Member State in the Region. The initiatives vary
greatly in their scope and stages of implementation, from early
changes to initiatives at-scale. When taken together, these
examples offer unique insights for setting-up, implementing and
sustaining transformations. A summary of 10 lessons learned
attempts to synthesize key findings and consolidate insights
derived from experiences.
In order for health services delivery to accelerate gains in health
outcomes it must continuously adapt and evolve according to
the changing health landscape. At present, the case for change
Eurohealth — Vol.22 | No.2 | 2016