THRIVE Transforming Health Systems: Social Mechanisms Enabling Institutional Change

Health systems worldwide are transforming due to demographic changes, fragmented service delivery and workforce crisis. While health reforms aim to improve performance, care quality and population health, their implementation often proves challenging. Despite the scale of these reforms, it remains largely unexplored how organisations respond and how people experience transformational changes.

The THRIVE project will advance the understanding of health systems transformation by explaining how reform intentions translate into observable changes in behaviour, organisational practices and system performance.

The project will explore the social mechanisms behind institutional change that shape agency, resource reallocation and reasoning in health reform implementation. By adopting a realist approach, it will develop a middle-range theory of social mechanisms in the context of public healthcare delivery. Drawing on qualitative cross-case analysis, interviews, policy documents and literature reviews, THRIVE will shed light on bottom-up implementation and translation of reform goals into actions. Three case studies on multi-level health system governance will examine local strategies, resource mobilisation and collaborative agency to illustrate how reform intentions are interpreted in service delivery.

Finland’s ongoing radical health reform offers exceptional longitudinal research data for observing real-time implementation through in-depth case studies. In parallel, value-based reform strategies will be analysed in seven countries with varying timelines of health system modernisation. International comparison of health reform experiences will explain key mechanisms driving change and produce scalable research results to improve health system performance.

THRIVE will deliver a robust theoretical framework for examining mechanisms of change within health systems. By integrating perspectives from public governance and organisation studies, it will enhance understanding of health reform implementation and institutional change. Using realist methodology, the results will inform methodological learning by clarifying the mechanisms needed to create societal value and effective care.

THRIVE will generate evidence to inform policy design and effective implementation through cross-national learning, drawing on lessons from Finland’s health reform. Ultimately, the project will support more effective, equitable and financially sustainable public healthcare systems.