Translating evidence into practice: Translating evidence into practice: a shared priority in public health?a shared priority in public health?

Helen McAneneyHelen McAneney

Centre for Public HealthCentre for Public HealthSchool of Medicine, Dentistry and Biomedical Sciences,School of Medicine, Dentistry and Biomedical Sciences,

Queen’s University BelfastQueen’s University Belfast

Submitted Soc. Sci. Med.

OutlineOutline

• Background– Context & setting

• Public Health CoE– Aims & Objectives

– Launch

• Networks within Public Health– Network Measures,

– Trans-sectoral network,

– RMSS

• Conclusions

Context

• The NI health care system has gone under major reforms in the last few years. In November 2005, the Secretary of State for Northern Ireland announced a radical restructure of public administration structures within the province. The number of public bodies have been reduced significantly to make the public sector more streamlined and economically efficient. The impact on health and social care has been significant [1].

• The details given below were correct at the time of the launch of the CoE for Public Health in 2008, prior to the further reforms initiated on 1st April 2009.

[1] Jordan et al., 2006. Health Systems in Transition: Northern Ireland. WHO Regional Office for Europe.

Context

Chart 1: Organizational structure of the Northern Ireland Health Service [1].

Background: The NI Health Care System

Table 1: Population sizes of the four Health and Social Services Boards, 2002 [1].

Figure 1: The four Health and Social Services Boards [1].

Background: The NI Health Care System

Figure 2: The five Health and Social Care Trusts within NI.

Source http://fgcforumni.org/index.php

BHSCT

• Belfast Health and Social Care Trust largest Health Care Trust

in the UK [2].

• 22,000 staff provide services to more than 340,000 people in

Belfast and regional service to NI.

• From 1 April 2007, BHSCT responsible for services provided by

Belfast City Hospital, The Royal Hospitals, The Mater Hospital,

Greenpark Healthcare Trust, North and West Belfast and South and

East Belfast HSS Trusts.

[2] http://www.belfasttrust.hscni.net/

Abbreviations

Table 2: Abbreviations of organisational names

BHSCT Belfast Health & Social Care Trust DHSSPS Department of Health, Social Services & Public Safety EHSSB Eastern Health & Social Services Board HSCT Health & Social Care Trusts IPH Institute of Public Health in Ireland NICR Northern Ireland Cancer Registry QUB Queen’s University Belfast QUB_CCPS Queen’s University Belfast, Centre of Clinical &

Population Sciences QUB_NM Queen’s University Belfast, School of Nursing &

Midwifery RDO Research & Development Office UU University of Ulster

UKCRC Public Health Research Centres of Excellence.

• In 2006, the major funders of public health research in the UK came together under the auspices of the UKCRC to develop a coordinated approach to improving the UK public health research environment.

• Consortium of eight funding partners to create five UKCRC Public Health Research Centres of Excellence.

• The successful Centres, announced in January 2008, are based in

– Newcastle, Cardiff, Belfast, Cambridge and Nottingham.

   

CoE for Public Health: Aims and Objectives

• Build academic capacity

• Increase infra-structure

• Multi-disciplinary working

• Sustain partnerships with practitioners, policy makers and the public, through leadership, networking and collaboration

• Promote excellence

• Increase evidence base

• Tackle challenging methodology, exploit and share datasets

• Complement other Research Council initiatives

CoE Network in Public Health

• Launch of UKCRC CoE in

Public Health (NI) June 2008

• Questionnaire to provide

baseline data

• Create a map of PH community

in NI

• 98 participants from 44

organisations & research

clusters

• 193 nodes (organisations)

nominated

Table 3: Profile of participants

Table 3: How academic and non-academicspersonal goals related to those of CoE.

Table 4: Expectations at launch of CoE for Public Health (NI)

CoE Network in Public Health

193 organisations and research clusters

Figure 3: Complete network

Network Measures

• Centrality measures

• Elevated position of the RDO in eigenvector and betweenness

centrality.

Out-Degree In-Degree Eigenvector Betweenness 1. QUB_CCPS DHSSPS BHSCT DHSSPS 2. EHSSB BHSCT DHSSPS BHSCT 3. NICR IPH QUB_CCPS QUB_NM 4. DHSSPS HSCT UU UU 5. QUB_NM QUB EHSSB IPH 6. BHSCT UU RDO RDO

Table 5: Top 6 nodes by degree, eigenvector and betweenness centrality measures of Figure 3. See Table 2 for meaning of abbreviations.

Network Measures

• Centralisation

• Eigenvector centralisation, indicates a cluster of a few dominate organisations, central in the network structure. Other values indicate a robust network.

Centralisation measure Percentage

In-Degree 5 Out-Degree 16 Eigenvector 51 Betweenness 4

Table 6: Centralisation measures of the network.

Network Measures

Table 7: Core organisations within Figure 3 as ranked by the four centrality measures investigated. All organisations are regional to Northern Ireland with the exception of academics who are international.

Trans-sectoral Network

• A trans-sectoral network is calculated by grouping the individual actors according to some pre-described attribute and then aggregating the number of ties directed towards each group [3,4].

• In mathematical terms, the adjacency matrix is rearranged to form a specified number of groups, wherein each group contains nodes with the same attribute.

• The 193 organisations depicted in Figure 3 organised according to their work sector, as listed in Table 3.

[3] Norman and Huerta, 2006, Implementation Science 1, 20.[4] Lewis et al., 2008, Soc. Sci. Med. 67, 280–291.

Trans-sectoral Network

Figure 4: Trans-sectoral network where nodes have been partitioned into equivalent groups according to work setting.

Quantifying Connections

• To quantify the connections, participants indicated the

– impact (x)

– strength (y)

of the collaboration.

• Likert scale of 1 (strong) – 3 (weak)

• Correlation of parameters? Consider one or both? How?

Correlation of Parameters

0

0.5

1

1.5

2

2.5

3

3.5

0 0.5 1 1.5 2 2.5 3 3.5

Impact

Str

eng

th

Figure 5: A bubble chart of values attributed to impact and strength of collaboration. Both measures were rated from strong (1) to weak (3). A bubble chart is a two-dimensional scatter plot where a third variable is represented by the size of the points, in this case the frequency of choice. The coefficient of correlation between impact and strength is r = 0.5869. Therefore both are duly considered in Table 7.

Root Mean Sum of Squares (RMSS)

• RMSS of impact (x) and strength (y) of collaboration

• allows for greater distinguishability of the given values.

• For example, given two samples

– (x1,y1;x2,y2)=(1,1;2,3) and (X1,Y1;X2,Y2)=(1,2;2,2)

– RMSS equates to 7.5 and 6.5 respectively,

– arithmetic mean is 7 in both cases.

RMSS of Trans-sectoral Network

Table 8: RMSS of impact (x) and strength (y),

Entry (i; j) from row i and column j, gives the RMSS from group i to group j. Strongest if 2, weakest if 32

Conclusions

• Identified difference in attitudes/goals of academics & non-academics.

• Core organisations

• Influential organisation

– good or bad?

• Sectors with little or no interaction.

• Network robust to removal of Academics

• ‘Value’ of trans-disciplinary interaction (RMSS).

Questions for the future

• CoE’s translational message,

– improving cross collaboration

– improving effectiveness for clinical or PH outcomes

• Future structure of NI PH Community

• Health reforms in NI (1st April 2009)

– new PH Agency,

– One HSCB

Acknowledgements

• Centre for Health Improvement - QUB

• “The work was undertaken by the Centre of Excellence for Public Health (Northern Ireland), a UKCRC Public Health Research: Centre of Excellence. Funding from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, Research and Development Office for the Northern Ireland Health and Social Services and the Wellcome Trust, under the auspices of the UK Clinical Research Collaboration is gratefully acknowledged ”.

Acknowledgements

• Dr Jim McCann

– School of Mathematics and Physics, QUB

• Prof. Lindsay Prior

– School of Sociology, Social Policy and Social Work, QUB

• Jane Wilde CBE

– The Institute of Public Health in Ireland

• Prof. Frank Kee

– Director UKCRC Centre of Excellence for Public Health (NI)

– www.qub.ac.uk/coe