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Current Research Projects

Resilience To Reform: Towards Dynamic Resilience in Health System Performance and Reform

Research Leader Award – November 2020- October 2025

The RESTORE research programme examines the key challenges facing the Sláintecare reform programme and evaluates strategies to facilitate its effective and thorough implementation in a complex adaptive system. It reviews the causality of how shocks to the system (such as COVID and the 2008 financial crisis) challenge or even facilitate reform. In particular, it evaluates public sector staff engagement over time as both a sign of resilience and a precondition for the implementation of effective change. The proposed research combines both qualitative data from stakeholder and key informant interviews, with quantitative data from surveys of health sector staff, alongside a review of key system metrics and the progress of reform. It will develop evidence-based strategies for policy makers in government to manage the competing tensions between system performance and reform to achieve universal care through enhanced resilience.

RESTORE project Components:

  1. Evaluating Health System Resilience
  2. Evaluating the challenges to large-scale reform and proposing strategic direction
  3. Assessing Staff Engagement Trends
  4. Building Resilience Theory

PI: Professor Steve Thomas

Centre Researchers: Dr Pádraic Fleming, Catherine O’Donoghue and Dr Arianna Almirall-Sanchez

Foundations’ team researching how the COVID-19 response facilitates Irish health system reform

Health system foundations for Sláintecare implementation in 2020 and beyond - co-producing a Sláintecare Living Implementation Framework with Evaluation: Learning from the Irish health system’s response to COVID-19 is a Health Research Board Applied Partnership Award funded from 2019 to 2021.

Dr Sara Burke is the Principal Investigator on the Foundations’ project with co-applicants Prof Steve Thomas and Dr Sarah Barry, all based in the School of Medicine’s Centre for Health Policy and Management. The Foundations’ core team previously worked with the Oireachtas Committee on the Future of Healthcare that devised Sláintecare in 2017 and currently lead the Irish team which is monitoring the COVID-19 response monitor for the European Commission and WHO Europe through the European Observatory on Health Systems and Policy.

This research project is informing the implementation of Sláintecare with Laura Magahy, Deputy Secretary General in the Department of Health and Executive Director of the Sláintecare Implementation Office as the lead knowledge user. Dr Colm O’Reardon, Acting Secretary General in the Department of Health, Dr Josep Figeuras, Director of the European Observatory on Health Systems and Policies, Dean Sullivan, Chief Strategy and Planning Officer, HSE, Dr Colm Henry, Chief Clinical Officer, HSE and Liam Woods, Acute Operations, HSE are also co-applicants.

A study protocol was recently published on HRB Open available here

This applied research uses qualitative and quantitative research methods to coproduce a Living Implementation Framework with Evaluation (LIFE) linking evidence, policy and practice that feeds into real-world Sláintecare implementation. In partnership with senior leadership in the Sláintecare Programme Implementation Office, the Department of Health and the HSE, the researchers are scoping, documenting, measuring and analysing the Sláintecare relevant COVID-19 responses.

The LIFE initially takes the form of clusters of COVID-19 health system responses most relevant to Sláintecare. For each response, indicators will be collected which enables monitoring overtime. The LIFE is accompanied by a series of rapid reviews, narrative descriptions of multiple case studies, research papers, stakeholder engagement and formative feedback. These collectively make up the ‘LIFE’, informing dialogue with the project partners and co-applicants, which is happening in real time (living), influencing health policy and system decision-making and implementation as the project progresses.

The first publication from the project is entitled ‘Understanding Service Reorganisation in the Irish Health & Social Care System 1998 to 2020’. This work led by Dr Sarah Barry includes a policy analysis, key informant interviews and a rapid review of relevant international literature will be published shortly. The aims of this specific study are to learn from reorganisation in the Irish health and social care system over the past 20 years, to inform the implementation of regions as part of the Sláintecare programme of health reform, and to create a space for system reflection and learning.

Already the Foundations’ project is credited with influencing the 2020 Programme for Government, the HSE 2020 Winter Plan as well as informing more long-term health system reform in Ireland and contributing to international health systems and policy research. It is an example of excellent policy-relevant research, collaborative partnerships between researchers and knowledge users, building relationships and evidence that are embedded in policy and system reform.

Enhancing the Evidence Base for Cost-Effectiveness Analysis in Ireland: Building Improvements from the Intervention-Specific to System-Wide Levels

Dr James O'Mahony, Assistant Research Professor at the Centre for Health Policy and Management, is Principal Investigator of a research programme titled "Enhancing the Evidence Base for Cost-Effectiveness Analysis in Ireland: Building Improvements from the Intervention-Specific to System-Wide Levels". Funded under the HRB’s Emerging Investigator Award scheme, the programme runs from August 2018 to September 2022. It involves three primary components: (i) enhancing cost-effectiveness modelling methods in cancer screening; (ii) improving our understanding of cost-effectiveness thresholds in the context of Ireland's hospital waiting lists; and, (iii) continued research within the CERVIVA consortium on the optimal prevention of HPV-related disease, including cervical cancer. Dr O'Mahony will be supervising a PhD candidate as part of the project. The programme involves collaboration with research partners from TCD, RCSI, Erasmus University Rotterdam, the NTPF and the ESRI

Palliative Care Economics (PaCE)

The Palliative Care Economics (PaCE) research group at Trinity College Dublin is among the most active in the field worldwide.

In the context of rising costs and poor outcomes associated with serious illness, we work with clinicians, policymakers and other social scientists to generate high-quality evidence on what care and interventions should be provided to and prioritised for which groups of patients. 

Our current research programme covers studies in Ireland, England, the United States, Jordan, and elsewhere.  We welcome collaboration with other investigators and centres interested in questions that relate to the quality, cost-effectiveness and appropriateness of care for people with serious and life-limiting illness.

Find out more

INCA: Interaction Analytics for Automatic Assessment of Communication Quality in Primary Care

At the core of health care is the relationship between clinician and patient. Clinical communication skills play a key role in accurate diagnosis, effective treatment, and motivating patients to adopt healthier lifestyles. Poor communication imposes avoidable costs of billions of euros across Europe each year. There is urgent need for better tools to assess clinical communication skills.
The INCA project leverages cutting edge techniques in signal processing and computational linguistics to analyse key features of clinicians' communication styles. INCA uses audiovisual recordings of interactions with patients, in real life settings and in role plays, to train machine learning algorithms to parameterise features such as: 

  • Turn-taking: how often a patient speaks, how long before a patient is interrupted
  • Prosodic features such as pitch, pace, related to intonation and perceptions of empathy
  • Use of medical terminology
  • Repetition of key concepts as an indicator of shared understanding
  • Body language

The project is funded by a three year Health Research Award grant from the Health Research Board (2016 – 2019). The Principal Investigator is Professor Charles Normand. He works with Centre colleague Dr Padhraig Ryan and a Trinity College Dublin team spanning the School of Medicine, the School of Computer Science and Statistics, together with strong input from the University of Edinburgh and Dartmouth College. Padhraig's role is in content analysis - he conducts sentiment analysis, produces algorithms to quantify repetition of key concepts and effectiveness of knowledge transfer during emergency responses, and evaluates clustering algorithms that characterise the nature of each interaction. This project seeks to enhance the scalability and affordability of quality assessment, and to create actionable knowledge for improved care and value.

PI: Prof. Charles Normand
Project Co-ordinator Dr. Padhraig Ryan

CERVIVA - Cervical cancer and HPV-related disease prevention

CERVIVA  ( is a multidisciplinary research consortium with components drawing from the fields of health psychology, epidemiology, health economics and molecular medicine. CERVIVA's initial research focus was on cervical cancer prevention through screening, but this has broadened in recent years to encompass the prevention of other diseases caused by the human papillomavirus (HPV).  

CERVIVA is led by Principal Investigators Professor John O'Leary and Assistant Professor Cara Martin, both of whom hold positions at the Coombe Women and Infants University Hospital and Trinity College Dublin. Professor Charles Normand of the Centre for Health Policy and Management is the Principal Investigator on the health economics component of CERVIVA's research programme. He works with Dr James O'Mahony, a health economist investigating the cost-effectiveness of alternative HPV-associated cancer prevention strategies.  

James' role with CERVIVA primarily concerns the simulation modelling of the cost-effectiveness of cervical cancer screening. The objective of which is to determine what novel screening tests offer the most appropriate balance of improved screening effectiveness to women and costs to the health system. This research relates both to current screening technologies of cervical cytology and HPV testing and to a new generation of potential testing technologies including p16(INK4a) dual staining and HPV mRNA testing. James is also considering the potential for a candidate screening test for head and neck cancer to be cost-effective, given what is currently known about the incidence of HPV-positive cancers and their health burden.  

The need for an ongoing research effort on HPV-associated disease stems from Ireland's relatively high incidence of cervical cancer and the emerging threat of HPV-positive head and neck cancer. Ireland had lagged behind other countries in establishing an organised, population based national screening programme. Accordingly, screening coverage and consequent disease prevention had been less complete than that achieved in other countries. While Ireland has now achieved good screening coverage there remain challenges in deciding what novel screening tests to apply within CervicalCheck. Similarly, although HPV vaccination has been offered in Ireland since 2009, there is an emerging problem of incomplete vaccination coverage due to unfounded fears of adverse effects of the vaccine. Over the past decade there has been growing recognition of the role of HPV as a cause of head and neck cancer. CERVIVA recently extended its research programme to investigate if the success of cervical cancer prevention through screening can be replicated using analogous testing technologies in head and neck cancer.

PI: Prof Charles Normand
Centre Researcher Dr James O'Mahony, Dr Padhraig Ryan and Margaret Martin-Carroll

The Irish Longitudinal Study of Aging (TILDA)

The Irish LongituDinal Study on Ageing (TILDA) is a large-scale, nationally representative, longitudinal study on ageing in Ireland, the overarching aim of which is to make Ireland the best place in the world to grow old.

TILDA collects information on all aspects of health, economic and social circumstances from people aged 50 and over in a series of data collection waves once every two years. TILDA is unique amongst longitudinal studies in the breadth of physical, mental health and cognitive measures collected. This data, together with the extensive social and economic data, makes TILDA one of the most comprehensive research studies of its kind both in Europe and internationally.

The study is a multidisciplinary project supported and guided by a cross-institutional team of experts from the Dundalk Institute of Technology, the Economic and Social Research Institute, the National University of Ireland Galway, Queen’s University Belfast, the Royal College of Surgeons in Ireland, Trinity College Dublin, University College Cork, University College Dublin and the Waterford Institute of Technology.
Funding has been provided by Irish Life, the Atlantic Philanthropies and the Department of Health.

Principal Investigator: Prof Rose-Anne Kenny
Co-PI:Professor Charles Normand

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