The Israeli health-care system does certain things well, but the Jewish state would benefit significantly from more of a focus on an area called “implementation science,” researchers who work in that discipline in Israel wrote this month in the Israel Journal of Health Policy Research.
Adam Rose, of the Hebrew University School of Public Health in Jerusalem and lead author of the study, told JNS that implementation science is an outgrowth of Health Services Research, “the field that highlights areas with room for improvement.”
He said, “There is an idea of a ‘pipeline’ or a multi-step process in implementation science leading to improved care delivery. Step one is to describe and quantify the gap between best practice and current practice. Step two is to investigate the contributing factors to this gap to get a sense of what levers we need to push to produce the change we want.”
The next step, he continued, is to put changes into practice and to see how they impact the delivery, outcomes and cost of care, with the field’s central question being “How can we best close the gap between the way the health system works now and the way we think it should be working?”
Rose and his co-authors, Sivan Spitzer and Moriah Ellen—of Bar-Ilan University in Ramat Gan and Ben-Gurion University of the Negev; and the University of Toronto, respectively—work in implementation science in Israel and think the Jewish state could do better in that area.
“There are several entities that can be said to ‘own’ the process of innovating in health care in Israel today. This includes the Ministry of Health, the four health funds (kupot cholim), individual hospitals, institutions similar to hospitals such as psychiatric or rehabilitation hospitals and public health systems such as Tipat Chalav,” they write. “All of these, at various times, have pursued various innovations in care delivery. However, it is not clear how much experience any of these entities have with IS or with another closely related field, such as program evaluation.”
‘We have a long way to go’
To their knowledge, the researchers write, the four health funds, the Health Ministry and large Israeli hospitals with research centers don’t employ any researchers with IS experience. (JNS sought comment from the Israeli Health Ministry on Friday evening in Israel.)
“While research groups based at health funds, hospitals and the Ministry of Health do publish extensively, they do not publish evaluations of program impact, even for large and otherwise extremely ambitious projects,” the scholars write. “For example, Israel’s Ministry of Health has been pursuing a program called Efshari Bari (‘A Healthy Option’) for over a decade. To our knowledge, there have not been any publications about the effectiveness of this program.”
Among the challenges in Israel are a lack of access for scholars to data that could identify gaps in quality, “structural barriers to doing implementation research,” including those that grants prohibit and a lack of IS expertise at Israeli universities and major health organizations, according to Rose.
“We have a long way to go,” he said.
Rose told JNS that the article stresses “the importance of courageous leadership as another contextual factor that can support or impede adoption.” That’s why the article is titled “Israel should build capacity in implementation science,” also known as IS.
“It really could have said, ‘Policymakers in Israel should,’” he told JNS, noting that the article addresses “far-sighted leaders” within the U.S. systems at the Veterans Health Administration and Intermountain Health who opted “to invest in building capacity for IS and stayed the course.”
“As we say in the paper, this does not happen by chance but comes as a result of deliberative investments in encouraging IS to grow through grant funding, places to publish and an environment that encourages meaningful partnerships between clinical leaders who want to improve something and IS experts who know how to do it effectively,” he said.
He and his colleagues published in the Israel Journal of Health Policy Research, he added, because “we believe that the people who need to hear this message, and change Israel’s direction in this regard, are among the readers of this journal.”
“Israel’s health system has many strengths that would actually help it succeed if it did decide to build capacity in IS,” he added. “It takes deliberate, long-term investments to build capacity in IS, and the payoff may be years in the future.”