11.M. Round table: Capability to implement systemic innovations in PHC: enablers and barriers to effective change
Authors:   Organised by: European Observatory on Health Systems and Policies, Berlin University of Technology (Germany),   Chair persons: Katherine Polin (Germany)
Published: October 2023

Abstract

Background
Primary healthcare (PHC) is an increasingly prominent health reform area in Europe. Rising chronic conditions and costs and commitments to universal health coverage require PHC systems to become more proactive, enhance prevention and coordination and integrate care. At the frontline of care provision and delivered by a diverse workforce, PHC covers most health needs. COVID-19 highlighted PHC's potential and role in strengthening system resilience and sustainability. PHC reforms vary, covering changes to services provided, workforce (e.g. new professionals, roles, skill-mixes), service delivery models and institutional relationships. Their introduction and uniform scale-up is challenging, involving multiple stakeholders in fragmented environments with diverse, independent (and intersectoral) providers. Extant lack of trust and cooperation among stakeholders and opposition to changes that conflict with self-interest or customs can undermine efforts. While much is known about organizational innovations, evidence on their implementation is limited. The country expert (HSPM) network of the European Observatory has launched a cross-country study to better understand PHC reform implementation processes in European countries. While each country has its own methods, commonalities in reform type, implementation challenges and practices suggest several levels of influence. At macro level (health system), governance mechanisms, appropriate funding and a unified information system are important. Clinical guidelines and regulatory frameworks must also be considered. Change management functions at meso level (institution) must be guaranteed. (Re)training and trust cultivation are necessary to introduce new services, tools and working arrangements at micro level (individual). Patient perspectives must also be accounted for. This study explores both the conditions for successful implementation and their underlying enablers and barriers across levels. An ensuing analytical framework will be of actionable value as policymakers look to develop effective policies and strategies.

Objectives
This workshop will present the preliminary framework and foster discussion around enabling environments for PHC reform implementation. Specifically, it aims to:
• Provide insights into recent experiences of implementation via country case studies
• Present a preliminary analytical framework of levels of influence and possible actions towards implementation
• Solicit active audience engagement on other country experiences to further the relevance of the framework
• Explore what's needed to strengthen state/regional capability for PHC change implementation

Format
A keynote will introduce the background and methods of the work, and preliminary framework. An interactive, moderated roundtable with panelists from case studies (Austria, Finland, Italy, Slovenia) and the European Observatory will delve into the framework and its implications. Audience input will be encouraged.

Key messages
• Implementation of PHC innovation is complex, requiring strong system governance, solid institutional change management, and provider ownership to ensure same scope of services of good quality to all.
• Sharing experiences, existing practices and available evidence is important to inform the development of effective policies and strategies to implement PHC reforms.

Speakers/Panelists
Nathan Shuftan
Berlin University of Technology, Berlin, Germany
Pia Vracko
NIJZ, Ljubljana, Slovenia
Michela Bobini
Bocconi University, Milan, Italy
Liina-Kaisa Tynkkynen
Finnish Institute for Health and Welfare, Tampere, Finland
Maximilian Schwarz
GöG, Vienna, Austria