Assessing the performance of mental health service facilities for meeting patient priorities and health service responsiveness

Abstract

The World Health Organisation has defined health service responsiveness as one of the key-objectives of health systems. Health service responsiveness relates to the ability to respond to service users’ legitimate expectations on non-medical issues when coming into contact with the services of a healthcare system. It is defined by the areas showing respect for persons and patient orientation. Health service responsiveness is particularly relevant to mental health services, due to the specific vulnerability of mental health patients but also because it matches what mental health patients consider as good quality of care as well as their priorities when seeking healthcare. As (mental) health service responsiveness applies equally to all concerned services it would be suitable as a universal indicator for the quality of services’ performance. However, performance monitoring programs in mental healthcare rarely assess health service performance with respect to meeting patient priorities. This is in part due of patient priorities as an outcome being underrepresented in studies that evaluate service provision. The lack of studies using patient priorities as outcomes transmits into evidence based guidelines and subsequently, into underrepresentation of patient priorities in performance monitoring. Possible ways out of this situation include more intervention studies using patient priorities as outcome, considering evidence from qualitative studies in guideline development and developing performance monitoring programs along the patient pathway and on key-points of relevance for service quality from a patient perspective.

Health system responsiveness: a systematic evidence mapping review of the global literature

“…For example, it is observed that the early WHO framing emerged out of key informant interviews with experts, but it is not clear who these experts were, and where they were drawing their experience from [ 69 ]. Others have observed that while this framing was intended to produce quantifiable indicators to allow for easier comparison across countries, services, and population groups [ 72 ], measuring the performance of a complex health system is not so easily done, and a single tool is unlikely to be adequate to assess a multi-dimensional compound measure such as responsiveness – or allow for fair comparison across vastly different health systems contexts [ 69 ].…”

Perception of the primary health care response capacity by patients with and without mental health problems, and health professionals: qualitative study

“…In all medical specialties, including Primary Health Care and Mental Health Care, evidence is growing that there is a gap between what is considered optimal care and what is actually provided [ 19 ]. Therefore, it is relevant to evaluate and compare the performance of health services and specifically mental health attention, by using a universal indicator, which does not need any adjustment for specific risks, such as the response to the domains found in health services [ 19 ]. In addition, it is important to incorporate patients in the generation of knowledge about health systems, and to involve them in health care planning with a view to co-production in health with contextualized, biopsychosocial and salutogenic care models.…”

“…Yet, of the four intrinsic goals of health systems, that is, improving health, ensuring fairness in financing, efficiency, and responsiveness, it is responsiveness that is the least studied [17]. Besides, to our knowledge, there are few studies that analyze the opinions of patients with mental health disorders towards the HSRC [19][20][21][22], and furthermore, those that do, do not focus specifically on PHC.…”

Consumers’ role in mental health care: a research perspective

“…It is interesting to compare this perspective with the approach presented by Bramesfeld and Stegbauer in the second editorial of the same issue of Epidemiology and Psychiatric Sciences (Bramesfeld & Stegbauer, 2016). The authors support the concept of responsiveness as a central feature identified by users for quality of mental health services.…”

“…Bramesfeld & Stegbauer (2016) warn that if we do not address the lack of representation of users’ views, this lack will continue to inform guidelines and shape quality monitoring, thus perpetuating quality standard not centred on consumers and, even more serious, eventually confirming that inclusion of their views is no worth. They suggest four ways to overcome this: use of key outcomes representing patient experiences (an example can be, again, empowerment, which is a core component of the experience of care of all individuals); a more convinced acceptance and appreciation of evidence from qualitative studies; focus on the patients’ pathways, i.e., the true relationship users have with services and professionals; use not only of surveys consisting of questions, but also more observational approaches, where facts, interactions, behaviour and procedures are observed and assessed according to their responsiveness.…”