May 16, 2016 Europe Practice

Shifting acute care delivery from hospitals to homes in Ireland

Community-based acute care services delivered by mobile nursing teams were introduced by Caredoc, a private nonprofit organization contracted by the Irish Health Services Executive; first-hand insights of providers enabled identification of services delivery challenges and supported development of relevant solutions; supportive senior management generated momentum for change and helped secure necessary approval for activities from authorities; stakeholder engagement was described as time consuming, but crucial to success; electronic medical records and new technologies facilitated the creation of a simple, connected and user-friendly service; training for nursing staff was important for establishing the necessary clinical competencies to deliver acute care services in home settings.

Sept. 6, 2016 Europe Practice

Shifting towards community-oriented mental health care in Belgium

Changes to legislation, policy and care guidelines at the national level guided mental health reform and government funding was made available to promote the implementation of local community mental health projects aligned with the new national vision for mental health; top-down support for bottom-up ideas ensured both the necessary resources and local ownership needed to optimize mental health reform; a supportive legislative framework helped solidify a common vision for mental health reform, providing a unified focus for local efforts to align with; space for experimentation in the delivery of mental health care was allowed for, motivating locally-adapted projects and sparking grassroots innovation; increasing the provision of community- and home-based care supported greater consideration of patients’ environments.  

Oct. 11, 2016 Europe Practice

Using medical trains to improve access to health services across Kazakhstan

Kazakhstan was ranked among countries with the lowest life expectancy in the WHO European Region; health professionals were distributed inequitably across the country and geographic disparities in health status were seen between rural and urban populations.

The concept of transport medicine was conceived: Using the country’s existing transportation infrastructure, a series of trains now travel to stations across the country to provide health services to rural populations; aligning the initiative with overarching health system reforms (the State Health Care Development Programme for 2011–2015 “Salamatty Kazakhstan”), and gaining cross-sector buy-in from the government, helped to support implementation of medical trains; building upon existing infrastructure helped to alleviate the burden of additional resources in the setup and rollout of the initiative; solutions for population health problems were based in a strong understanding of current challenges and were adapted to population and geographic contexts.