the Alkartu Gastronomic Association of Elorrio (c/ Berriotxo 27) has organized these talks to analyze the impact of the Funcor experience in the municipality
The following conferences will be available from 10:30 onwards:
Andoni Esparza and Funcor. The person and his work Julia Itoiz (chronicle of a conference here given by Andoni Esparza)
Funcor College and “Credit to honor” Iñigo Agirre
An experimental pedagogical project Mikel Onandia
Funcor and Mondragon, two opposing cooperative models Jabier Lertxundi (here the chronicle of a conference on this topic)
Founded by Andoni Esparza Gallastegi in Funcor Elorrio at the age of 23
Today it is 10 years of his death (1 June 2012 in Pamplona)
In the words of the organizing association of the conference
"Andoni Esparza Gallastegi was the seed of a business family that throughout its life promoted and supported numerous business projects
The cooperatives Funcor (Elorrio) and Euskaldunak (Marcilla) were their main business initiatives
Esparza's idea was to make popular cooperativism
which worked with the idea of focusing on the people
Andoni Esparza's project lasted until the 1970s
The association of the same name explains that there was a legal issue on which the termination was based: "In the Durango Court
a criminal complaint alleging monetary embezzlement was filed
Alleging the absence of sufficient grounds for rejection by the incumbent judge
the substitute judge imposed a provisional prison sentence
it was a trial and all the defendants were acquitted."
Intense interview with Miel A. Elustondo to Andoni Esparza: "It's too open here!"
organized by the Andoni Esparza Gallastegi Social Action Association
was attended by the following entities: Municipality of Elorrio
Sociedad Laumunarrieta and Asociación Gerediaga
The Andoni Esparza Association is a group founded in 2012: "The objective of the association is to give continuity to the trajectory undertaken by Andoni Esparza
building a Basque Country based on people and cooperativism
taking into account the characteristics and values of Basque existence"
Metrics details
Healthcare is amongst the most complex of human systems
Coordinating activities and integrating newer with older ways of treating patients while delivering high-quality
Three landmark reports in 2018 led by (1) the Lancet Global Health Commission
(2) a coalition of the World Health Organization
the Organisation for Economic Co-operation and Development and the World Bank
and (3) the National Academies of Sciences
Engineering and Medicine of the United States propose that health systems need to tackle care quality
create less harm and provide universal health coverage in all nations
but especially low- and middle-income countries
The objective of this study is to review these reports with the aim of advancing the discussion beyond a conceptual diagnosis of quality gaps into identification of practical opportunities for transforming health systems by 2030
We analysed the reports via text-mining techniques and content analyses to derive their key themes and concepts
Initiatives to make progress include better measurement
using the capacities of information and communications technologies
supporting systems to be constantly improving
creating learning health systems and undergirding progress with effective research and evaluation
Our analysis suggests that the world needs to move from 2018
We propose three initiatives to support this move: first
modifiable to each country’s circumstances
to give effect to the reports’ recommendations; second
to make tangible steps to reduce inequities within and across health systems
including redistributing resources to areas of greatest need; and third
learning from what goes right to complement current efforts focused on reducing things going wrong
We provide examples of targeted funding which would have major benefits
promote universality and be better at learning from successes as well as failures
10-year action plan for the next decade to give effect to their aims to improve care to the most vulnerable
save lives by providing high-quality healthcare and shift to measuring and ensuring better systems- and patient-level outcomes
This article signals what needs to be done to achieve these aims
This demanded extensive supporting structures and coordination
and accelerating the need to be even better at coordination so all in the healthcare orchestra sing from the same song sheet
They offer recommendations for how to create better delivery systems and improve care quality
to put care on an improvement gradient—to make it safer
and more responsive to demands across time
They also suggest that systems are becoming tougher to manage and coordinate
we analyse these reports individually and as a whole
as Academicians of the International Academy of Quality and Safety (IAQS) established by the International Society for Quality in Health Care (ISQua)
we aim to describe the commonalities and differences and establish the platform from which we can improve care internationally
We begin with a synthesis of the main thrust of the arguments in the three reports
The Lancet report (Box 1) makes a set of recommendations for how national governments and funding partners can take the lead in creating better
It argues that a core enabler for achieving these goals will be a research agenda to underpin the key advances which need to be achieved (see Box 1 for a summary)
The WHO/OECD/World Bank report (Box 2) envisages widespread enabling action by governments
It suggests that these bodies and groups should be encouraged to collaborate and conspire to deliver improved care across-the-board (see Box 2 for a summary)
The National Academies’ report (Box 3) represents a clarion call for more research
better measurement and concerted international efforts
It suggests creating a learning health system which contrasts with today’s forgetting system
and encourages people to think in systems terms rather than in silos or episodes (see Box 3 for a summary)
Synthesis of three reports—themes and concepts
Synthesis of three reports—theme frequency summary
WHO/OECD/World Bank report—themes and concepts
WHO/OECD/World Bank report—theme frequency summary
National Academies of Sciences, Engineering and Medicine report: Crossing the Global Quality Chasm: Improving Health Care Worldwide—themes and concepts
Engineering and Medicine report—theme frequency summary
“data” and “countries” are the most frequently occurring themes
These key themes show how the report is mostly focused on people and data in healthcare systems across all countries of the world
“universal” and “accessed” are the most frequently occurring themes
These key themes suggest the report is mostly focused on the improvement of quality of care and access to care
“use” and “patients” are the most frequently occurring themes
These key themes suggest the report is focused more on providers of care than are the other reports and recommends they offer quality care and effective services to users of health systems
Both the Leximancer automated content analyses and our boxed summaries demonstrate that there are more commonalities than differences running through the reports
One intriguing question is why three extraordinarily influential reports in the same domain saw the light in the same year
There are plenty of historical examples of an idea whose time has come
may signal we have arrived at a crossroads
and the time is ripe to expedite transformational efforts
Particularly important areas of convergence in these documents are the idea of universal coverage and raising the bar on quality of care and of health systems performance so all citizens in all countries benefit
Instead of seeing healthcare in silos (acute settings
aged care) or in terms of clinical conditions
the reports seek coordination and integration of care across the continuum
centred on patients’ rather than providers’ needs
The reports urge countries to provide incentives in the right place to improve care for best effect
They do not shy away from how complex an undertaking healthcare delivery is and each argues that taking a systems view to problems is critical
Strategies the reports discern as most useful for improvement include better leadership and governance
judicious and cost-effective use of proven ICT
more training and education for workforces
such as via the use of clinical practice guidelines
safe surgical checklists and vaccinations across entire populations for herd immunity
The reports’ authors advocate for a patient-based rather than a provider-focused perspective and want those across caring systems to be better at implementation science
translation and disseminating the success exhibited in one setting to others
Each argues for the importance of measuring progress longitudinally
conducting well-designed evaluation to learn from what is working and what is not
and underpinning improvement efforts with a suitably resourced
As to differences between the reports and their recommendations
The Lancet report focuses on health systems and is more data-rich and research-intensive (there are 327 references cited) and it hones in on saving lives
measurement of outcomes and transformation of current care systems
The WHO/OECD/World Bank volume links quality improvement to universal health coverage and makes recommendations to four stakeholder groups (governments
seeking to enrol these groups in the work ahead
Authors of Crossing the Global Quality Chasm are focused on the six dimensions of quality (safety; effectiveness; person-centredness; accessibility
establishing agreed principles for systems redesign and seeking to harness digital progress across countries
They also mount strong arguments for change proponents to focus on informal care and carers
They all note that poor-quality care remains an entrenched
the authors of the three volumes challenge those presiding over every health system to lift their game and do better for the benefit over the medium to long term of billions of people
Going beyond the extensive learnings within these documents
The combined recommendations of the reports will doubtless shape the work of the international community over at least the next 10 years
Yet a very real concern we have is that too often with almost all authoritative reports on health systems reform
much effort is expended on conducting the studies and formulating the recommendations and then the study task force membership dissolves and individuals go back to their normal activities
Less attention is later given to how recommendations might be implemented
translated into learning and adoption strategies
and for political and policy impetus for change to match the importance of the recommendations
We hesitate to call for yet another report to document how to put the recommendations into action; however
we need a blueprint for change and a plan to measure progress
as everything cannot be done simultaneously
the optimal stages to be followed in addressing all the change suggested by the reports
who should do what and with what levels of accountability
and how the interactions between stakeholders will play out
We also need a much clearer idea of how the international community and individual health systems might design rigorous evaluation studies to assess progress and feed that progress back to stakeholders in the system responsible for the improvements
we must find better ways to document how to disseminate best-practice models
and incorporate these in the blueprint for 2030
collectively the reports plead for every country to move along an improvement gradient; implementation is proposed as a country-level responsibility but with a global commitment
supported by international bodies such as the UN’s agencies
which each of the three contributions uses emblematically and often
Say we wanted to do the very best we can for the 7.7 billion people in the world
taking what these reports have said to heart
It will need to be something that would galvanise the international community and seek to create sufficient leverage for major step-changes in the healthiness of the world
As this would capture sufficient funding for US student debt forgiveness
and as well two thirds of all US students would receive free college tuition for this amount
imagine the good that could be done if the richest OECD countries did the same and diverted even 1% annual tax on the wealthy to low-income health systems
improving the health of the world and reducing disparities
This would be politically difficult of course
Add initiatives such as these to the new emphasis on integrity in the US’s National Academies report
and the need to fight corruption as a new dimension of quality
we also call for greater integrity in its application
buttressed by more robust accountability mechanisms
We propose the creation of a database of successful case studies and learnings from things going right
built from the combined experience of the major international bodies (e.g
Specific country experiences with national- or regional-level programs
would be of substantial benefit to others grappling with similar problems
And this takes us back to call to the first call to action—we need a persuasive blueprint for change
including allocating responsibilities for mining and using such information
it is recognised that the approaches we are suggesting may not receive sufficient attention in the present pandemic era
The current pandemic itself raises serious questions about health system resilience and the quality of Covid-19 and routine non-Covid-19 care
The Covid-19 pandemic amplifies the need for health system strengthening to address gnawing quality of care gaps that have intensified in the wake of the global crisis
rather than wait for resources to be released from the benevolence of rich countries
the Covid-19 pandemic teaches that it is time for resource-constrained countries to reprioritize health resource allocation
has demonstrated this through activation of local manufacturing of personal protective equipment
While these recommendations are for the long term
If we actioned these calls to arms over the decade of the 2020s
and move the reports’ proposals into the real world with a template for change which synthesises and incorporates their recommendations
we might find ourselves on a path to progress in a strategic rather than piecemeal or fragmented way
galvanising the world’s expertise into an actionable plan
buying better care for less fortunate populations and more thoroughly understanding the whole caring enterprise
The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request
International Academy of Quality and Safety
International Society for Quality in Health Care
The Organisation for Economic Co-operation and Development
United States Agency for International Development
Crossing the global quality chasm: improving health care worldwide
Organisation for Economic Co-Operation and Development
Delivering quality health services: a global imperative for Universal Health Coverage
High-quality health systems in the sustainable development goals era: time for revolution
Lancet Glob Health Comm High Qual Health Syst SDG Era
New York: Ingram Publishing Services; 2012
Health care systems in low- and middle-income countries
Healthcare systems: future predictions for global care
Complexity science in healthcare – aspirations
applications and accomplishments: a white paper
Sydney: Australian Institute of Health Innovation
Leximancer concept mapping of patient case studies
Knowledge-based intelligent information and engineering systems
Mainstreaming gender and promoting intersectionality in Papua New Guinea’s health policy: a triangulated analysis applying data-mining and content analytic techniques
Automated content analysis: addressing the big literature challenge in ecology and evolution
Fact-checking Elizabeth Warren on the campaign trail
Organisation for Economic Co-Operation and Development. Health spending (indicator). 2018. https://data.oecd.org/healthres/health-spending.htm
The World Bank. Population, total. 2018. https://data.worldbank.org/indicator/sp.pop.totl
The World Bank. Current health expenditure (% of GDP). 2019. https://data.worldbank.org/indicator/SH.XPD.CHEX.GD.ZS?locations=XM
Health systems improvement across the globe: success stories from 60 countries
The future of health systems to 2030: a roadmap for global progress and sustainability
The economics of public health care reform in advanced and emerging economies
Washington DC: International Monetary Fund; 2012
Markets and health care: a comparative analysis
de Looper M, Lafortune G. Measuring disparities in health status and in access and use of health care in OECD countries. OECD health working papers, no. 43. Paris: OECD Publishing; 2009. https://doi.org/10.1787/225748084267
2: the resilience of everyday clinical work
Resilient health care volume 3: reconciling work-as-imagined and work-as-done
Resilient health care volume 4: delivering resilient health care
Abingdon: Routledge: Taylor & Francis Group; 2018
Resilient health care volume 5: working across boundaries
Boca Raton: Routledge: Taylor & Francis Group; 2019
Download references
We would like to thank and acknowledge research assistants Ms
Kelly Nguyen for their editorial and research assistance
JB is Professor of Health Systems Research and Founding Director of the Australian Institute of Health Innovation at Macquarie University
This work was supported by the Australian Institute of Health Innovation which receives 80% of its core funding from category one
the National Health and Medical Research Council (NHMRC) and Australian Research Council (ARC) funding which includes the NHMRC Partnership Grant for Health Systems Sustainability (ID: 9100002)
Centre for Healthcare Resilience and Implementation Science
Institute for Clinical Effectiveness and Health Policy (IECS)
Graduate School of Medicine and Faculty of Medicine
International Society for Quality in Health Care (ISQua)
drafting and finalisation of the manuscript
The authors read and approved the final manuscript
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations
unless otherwise stated in a credit line to the data
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DOI: https://doi.org/10.1186/s12916-020-01739-y
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Joan edukira
The prestigious travel magazine Condè Nast Traveler has published its selection of the "top ten" towns in the Basque Country
The magazine notes that the Basque Country¿s "culture
essence and grace" resides in "the small towns which line its valleys
It adds that many of the towns "have managed to preserve their beauty and their monuments" and that these constitute "a gift for visitors"
The list includes two towns from the Rioja Alavesa: Elciego ¿ which the magazine claims is "much more than just the Marqués del Riscal hotel" ¿ and Laguardia
which is praised for its rich heritage as well as the wineries which have made the region so famous
The Basque Coast is represented by Elantxobe
Getaria (recommended by The New York Times
and home to the Balenciaga Museum); Lekeitio (with a special mention for its spectacular beaches); Hondarribia
which boasts both a sea port and medieval sights of interest; and Mundaka
which the magazine claims "will win the hearts of everyone who visits it"
The Basque Country¿s areas of natural beauty are also featured on the list
including Azpeitia (in particular the Loiola Sanctuary); Oñati (specifically "its succession of monuments and palatial homes" as well as the University of Sancti Spiritus and the Arantzazu Sanctuary); and Elorrio
whose heritage is defined as "astonishing and original"
Eusko Jaurlaritzaren Web Zerbitzuak garatutako eta kudeatutako webgunea
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Irazabal has been able to collect a number of data
most notably the identification of the names of 44 military personnel
So far the military has been identified by types
but now they have been able to unite them with real names
Irazabal estimates that 95% of those involved in the bombing are identified
Mayor Aitziber Irigoras explains that they will receive the report from Irazabal and start working with the lawyers
"The first step is to present yourself and be admitted to the procedure," he says
they will consider whether there are other possibilities of denunciation other than that made to the military; governments would have a subsidiary responsibility
Irazabal adds that it is "clear" that the bombing was against the civilian population
he has demonstrated that the coup plotters had the support of the German military in their planning
he found the phrase All objectives have been met
The objectives were to measure the damage caused by bombs on buildings
and to show the international political community what Hitler was capable of
It has been 80 years since the Italian fascists bombed Durango and Elorrio on March 31 on the orders of General Mola
Bombs and gunfire killed 336 people and destroyed several buildings in the village
This news has been published by Anbou and we have brought it to LUZ thanks to the CC-by-sa license
Spanish mayor slammed for racist comment after Real Madrid loss
Pep Guardiola’s secret Barcelona trip: A last-ditch effort to save his marriage?
His timely run and precise finish from a low cross ensured Spain's record-breaking fourth European Championship title
not everyone in Spain celebrated his goal as a heroic act.
Oyarzabal hails from the small town of Elorrio
located in the eastern part of the Basque Country
the atmosphere in his hometown is anything but celebratory
is unable to leave her house as the town has labeled her son a traitor.
A banner accusing Oyarzabal and fellow Basque players Mikel and Merino of betraying the Basque Country for playing for the Spanish national team was prominently displayed on a building
Adding to the offensive nature of the banner
it was accompanied by a crossed-out swastika
the banner remained untouched for over 24 hours after it was put up.
"Residents refuse to comment on the graffiti and the banner when asked
Not only do they avoid condemning the message
but some justify it by claiming the players are traitors
Only a few exceptions express regret over the incident
though they prefer not to speak out loudly," reported a journalist from OK Diario in the town.
This controversy is particularly striking considering that Spain's coach
included nine Basque players in his squad for the Euro 2024 in Germany
the highest number of players from this northern region ever selected for a major tournament.
The divide between national pride and regional loyalty has created a tense situation in Elorrio
highlighting the complex and often conflicting identities within Spain
As Oyarzabal basks in the glory of his national triumph
the challenges back home serve as a stark reminder of the deeply rooted regional sentiments that persist
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