Key messages

• The transformation of health service delivery is about achieving large-scale change to meet population health needs and people’s 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 they are 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 policymakers 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, by combining enablers at the system level and support to organizations and people within the system.
• 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.

    ◦

    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 what 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.).
  • 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.
  • 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.

Contents

• Acronyms
• Executive summary
• POLICY BRIEF
  • 1. Introduction
  • 2. Leadership and governance for transformation
  • 3. Ensuring sufficient resources for transformation
  • 4. Policy implications
  • 5. Conclusions
• References
• The Policy Brief Series

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Suggested citation. Panteli D, Mauer N, Winkelmann J, Fahy N. Transforming health service delivery: what can policy-makers do to drive change? Copenhagen: European Observatory on Health Systems and Policies, WHO Regional Office for Europe; 2024. Licence: CC BY-NC-SA 3.0 IGO.

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What is a Policy Brief?

The Observatory is a partnership, hosted by the WHO Regional Office for Europe, which includes other international organizations (the European Commission); national and regional governments (Austria, Belgium, Finland, Ireland, Netherlands, Norway, Slovenia, Spain, Sweden, Switzerland, the United Kingdom and the Veneto Region of Italy (with Agenas)); other health system organizations (the French National Union of Health Insurance Funds (UNCAM), the Health Foundation); and academia (the London School of Economics and Political Science (LSE) and the London School of Hygiene & Tropical Medicine (LSHTM)). The Observatory has a secretariat in Brussels and it has hubs in London (at LSE and LSHTM) and at the Berlin University of Technology.