How can the healthcare system deliver sustainable performance? A scoping review.
HEALTH SERVICES ADMINISTRATION & MANAGEMENT
Health policy
PUBLIC HEALTH
Journal
BMJ open
ISSN: 2044-6055
Titre abrégé: BMJ Open
Pays: England
ID NLM: 101552874
Informations de publication
Date de publication:
24 05 2022
24 05 2022
Historique:
entrez:
25
5
2022
pubmed:
26
5
2022
medline:
28
5
2022
Statut:
epublish
Résumé
Increasing health costs, demand and patient multimorbidity challenge the sustainability of healthcare systems. These challenges persist and have been amplified by the global pandemic. We aimed to develop an understanding of how the sustainable performance of healthcare systems (SPHS) has been conceptualised, defined and measured. Scoping review of peer-reviewed articles and editorials published from database inception to February 2021. PubMed and Ovid Medline, and snowballing techniques. We included articles that discussed key focus concepts of SPHS: (1) definitions, (2) measurement, (3) identified challenges, (4) identified solutions for improvement and (5) scaling successful solutions to maintain SPHS. After title/abstract screening, full-text articles were reviewed, and relevant information extracted and synthesised under the five focus concepts. Of 142 included articles, 38 (27%) provided a definition of SPHS. Definitions were based mainly on financial sustainability, however, SPHS was also more broadly conceptualised and included acceptability to patients and workforce, resilience through adaptation, and rapid absorption of evidence and innovations. Measures of SPHS were also predominantly financial, but recent articles proposed composite measures that accounted for financial, social and health outcomes. Challenges to achieving SPHS included the increasingly complex patient populations, limited integration because of entrenched fragmented systems and siloed professional groups, and the ongoing translational gaps in evidence-to-practice and policy-to-practice. Improvement strategies for SPHS included developing appropriate workplace cultures, direct community and consumer involvement, and adoption of evidence-based practice and technologies. There was also a strong identified need for long-term monitoring and evaluations to support adaptation of healthcare systems and to anticipate changing needs where possible. To implement lasting change and to respond to new challenges, we need context-relevant definitions and frameworks, and robust, flexible, and feasible measures to support the long-term sustainability and performance of healthcare systems.
Sections du résumé
BACKGROUND
Increasing health costs, demand and patient multimorbidity challenge the sustainability of healthcare systems. These challenges persist and have been amplified by the global pandemic.
OBJECTIVES
We aimed to develop an understanding of how the sustainable performance of healthcare systems (SPHS) has been conceptualised, defined and measured.
DESIGN
Scoping review of peer-reviewed articles and editorials published from database inception to February 2021.
DATA SOURCES
PubMed and Ovid Medline, and snowballing techniques.
ELIGIBILITY CRITERIA
We included articles that discussed key focus concepts of SPHS: (1) definitions, (2) measurement, (3) identified challenges, (4) identified solutions for improvement and (5) scaling successful solutions to maintain SPHS.
DATA EXTRACTION AND SYNTHESIS
After title/abstract screening, full-text articles were reviewed, and relevant information extracted and synthesised under the five focus concepts.
RESULTS
Of 142 included articles, 38 (27%) provided a definition of SPHS. Definitions were based mainly on financial sustainability, however, SPHS was also more broadly conceptualised and included acceptability to patients and workforce, resilience through adaptation, and rapid absorption of evidence and innovations. Measures of SPHS were also predominantly financial, but recent articles proposed composite measures that accounted for financial, social and health outcomes. Challenges to achieving SPHS included the increasingly complex patient populations, limited integration because of entrenched fragmented systems and siloed professional groups, and the ongoing translational gaps in evidence-to-practice and policy-to-practice. Improvement strategies for SPHS included developing appropriate workplace cultures, direct community and consumer involvement, and adoption of evidence-based practice and technologies. There was also a strong identified need for long-term monitoring and evaluations to support adaptation of healthcare systems and to anticipate changing needs where possible.
CONCLUSIONS
To implement lasting change and to respond to new challenges, we need context-relevant definitions and frameworks, and robust, flexible, and feasible measures to support the long-term sustainability and performance of healthcare systems.
Identifiants
pubmed: 35613812
pii: bmjopen-2021-059207
doi: 10.1136/bmjopen-2021-059207
pmc: PMC9125771
doi:
Types de publication
Journal Article
Review
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e059207Informations de copyright
© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
Références
Minn Med. 2012 Nov;95(11):37-9
pubmed: 23243752
Patient Educ Couns. 2021 Feb;104(2):352-359
pubmed: 32888756
Hum Resour Health. 2004 Jun 7;2(1):6
pubmed: 15182378
Health Care Manage Rev. 2005 Jul-Sep;30(3):270-9
pubmed: 16093893
Implement Sci. 2012 Mar 14;7:17
pubmed: 22417162
BMC Health Serv Res. 2019 Dec 27;19(1):1006
pubmed: 31881884
Int J Qual Health Care. 2016 Dec 01;28(6):830-837
pubmed: 28423164
Anesth Analg. 2011 Oct;113(4):869-76
pubmed: 21788319
Futures. 2020 Sep;122:102605
pubmed: 32834076
Int J Health Policy Manag. 2020 Jan 01;9(1):6-16
pubmed: 31902190
PLoS One. 2011 Apr 27;6(4):e19222
pubmed: 21556357
Med J Aust. 2006 Aug 21;185(4):213-6
pubmed: 16922667
Med Care. 2019 Oct;57 Suppl 10 Suppl 3:S206-S212
pubmed: 31517789
BMJ Open. 2019 May 5;9(5):e024231
pubmed: 31061019
Can J Public Health. 2017 Apr 20;108(1):e1-e6
pubmed: 28425892
BMC Health Serv Res. 2017 Dec 19;17(1):836
pubmed: 29258521
N Engl J Med. 2012 Mar 15;366(11):1020-7
pubmed: 22417255
Physician Exec. 1998 Jul-Aug;24(4):52-5
pubmed: 10186385
Implement Sci. 2018 Feb 09;13(1):27
pubmed: 29426341
JAMIA Open. 2019 Jan 16;2(1):2-9
pubmed: 31984339
Ann Ist Super Sanita. 2019 Jul-Sep;55(3):270-275
pubmed: 31553322
Health Policy Plan. 2019 Oct 1;34(8):605-617
pubmed: 31378811
Health Serv Manage Res. 2014 Feb-Jun;27(1-2):1-9
pubmed: 25595012
J Health Serv Res Policy. 2013 Oct;18(4):193-4
pubmed: 24097072
Proc Natl Acad Sci U S A. 2019 Nov 26;116(48):23930-23935
pubmed: 31712415
J Health Serv Res Policy. 2008 Oct;13(4):251-4
pubmed: 18806185
PLoS Med. 2009 Jul 21;6(7):e1000097
pubmed: 19621072
Healthc Q. 2006;9(1):62-6, 4
pubmed: 16548436
J Interprof Care. 2019 Jul-Aug;33(4):361-368
pubmed: 31106641
Med J Aust. 2009 Jul 6;191(1):30-2
pubmed: 19580534
Health Policy Plan. 2015 Apr;30(3):368-85
pubmed: 24561988
Aust Health Rev. 2011 May;35(2):152-5
pubmed: 21612726
Hosp Pediatr. 2016 Jul;6(7):412-9
pubmed: 27260565
London J Prim Care (Abingdon). 2011 Jul;4(1):64-8
pubmed: 25949650
Perm J. 2019;23:
pubmed: 31634111
Health Res Policy Syst. 2018 Sep 10;16(1):90
pubmed: 30200985
BMC Health Serv Res. 2012 Mar 26;12:81
pubmed: 22448876
Qual Health Res. 2002 Nov;12(9):1284-99
pubmed: 12448672
Health Policy. 2008 Sep;87(3):359-68
pubmed: 18358556
Int J Health Serv. 2014;44(1):73-92
pubmed: 24684085
Int J Health Policy Manag. 2019 Sep 01;8(9):570-572
pubmed: 31657182
Lancet. 2016 Oct 8;388(10053):1603-1658
pubmed: 27733283
Int J Environ Res Public Health. 2020 Aug 03;17(15):
pubmed: 32756390
Healthc Q. 2012;15(2):40-5
pubmed: 22688204
BMC Health Serv Res. 2020 Nov 26;20(1):1087
pubmed: 33243214
Int J Health Serv. 2004;34(2):229-43
pubmed: 15242156
BMJ. 2015 Jan 02;350:g7647
pubmed: 25555855
Health Policy Plan. 2017 Nov 1;32(suppl_3):iii91-iii94
pubmed: 29149319
P T. 2016 Sep;41(9):565-89
pubmed: 27630525
BMJ Open. 2017 Nov 08;7(11):e017708
pubmed: 29122796
Public Health Genomics. 2019;22(1-2):8-15
pubmed: 31330522
Int J Integr Care. 2015 Dec 15;15:e047
pubmed: 27118964
Aust Health Rev. 2018 Sep;42(5):501-513
pubmed: 30135003
Clin Ther. 1997 Nov-Dec;19(6):1572-8
pubmed: 9444463
J Public Health (Oxf). 2018 Dec 1;40(4):891-898
pubmed: 29590431
Healthc Q. 2017;19(4):17-22
pubmed: 28130947
Int J Qual Health Care. 2016 Jun;28(3):412-4
pubmed: 26980115
Med J Aust. 2013 Sep 2;199(5 Suppl):S14-7
pubmed: 25370086
Healthc Pap. 2014;14(2):4-7
pubmed: 25880857
Int J Qual Health Care. 2019 Mar 1;31(2):159-163
pubmed: 30476117
Health Res Policy Syst. 2019 Feb 7;17(1):17
pubmed: 30732616
Public Health. 2015 Oct;129(10):1335-43
pubmed: 26410181
Collegian. 2015;22(3):319-24
pubmed: 26552203
BMC Med. 2018 Apr 30;16(1):63
pubmed: 29706132
Stud Health Technol Inform. 2013;193:24-66
pubmed: 24018510
Clinicoecon Outcomes Res. 2020 Aug 24;12:459-472
pubmed: 32922051
Health Policy Plan. 2009 May;24(3):167-74
pubmed: 19224955
Health Policy. 2018 Dec;122(12):1340-1347
pubmed: 30360999
Implement Sci. 2013 Oct 02;8:117
pubmed: 24088228
Milbank Q. 2012 Sep;90(3):516-47
pubmed: 22985280
BMJ Open. 2019 Jan 17;9(1):e025892
pubmed: 30782754
Healthc Policy. 2007 Nov;3(2):19-28
pubmed: 19305776
Rev Esp Cardiol (Engl Ed). 2016 Sep;69(9):880-1
pubmed: 27387051
Healthc Q. 2015;17 Spec No:44-7
pubmed: 25562134
J Health Serv Res Policy. 2015 Apr;20(2):109-14
pubmed: 25504826
Expert Rev Pharmacoecon Outcomes Res. 2014 Feb;14(1):71-9
pubmed: 24350863
Value Health. 2013 Jan-Feb;16(1 Suppl):S46-51
pubmed: 23317645
BMJ Open. 2019 Jan 29;9(1):e024385
pubmed: 30700481
Health Serv Manage Res. 2009 Aug;22(3):136-9
pubmed: 19633182
Educ Prim Care. 2019 Sep;30(5):267-269
pubmed: 31307273
Health Care Manag (Frederick). 2007 Jan-Mar;26(1):19-30
pubmed: 17314623
N Z Med J. 2015 Aug 07;128(1419):50-5
pubmed: 26365846
Med J Aust. 2007 Nov 5;187(9):485-9
pubmed: 17979607
Acad Med. 2015 Mar;90(3):277-8
pubmed: 25551859
Lancet. 2008 Nov 1;372(9649):1579-89
pubmed: 18984192
Implement Sci. 2016 Apr 21;11:55
pubmed: 27097827
Int J Health Policy Manag. 2018 Nov 28;8(2):63-75
pubmed: 30980619
Healthc Pap. 2016;15 Spec No:90-5; discussion 97-123
pubmed: 27009644
BMJ Open. 2020 Jun 1;10(6):e036453
pubmed: 32487579
Aust Health Rev. 2016 Apr;40(2):194-204
pubmed: 26210992
J Gen Intern Med. 2007 Nov;22(11):1544-52
pubmed: 17891503
PLoS One. 2013 Nov 15;8(11):e78962
pubmed: 24260139
BMC Res Notes. 2016 Jun 28;9:327
pubmed: 27352864
Stud Health Technol Inform. 2007;129(Pt 2):1179-83
pubmed: 17911901
PLoS One. 2020 Jul 2;15(7):e0235531
pubmed: 32614864
Health Policy. 2016 Jun;120(6):706-17
pubmed: 27178799
BMJ. 2017 Sep 4;358:j3895
pubmed: 28870886
Front Public Health. 2016 Sep 14;4:201
pubmed: 27683658
Cien Saude Colet. 2020 Mar;25(4):1197-1204
pubmed: 32267422
Acad Med. 2009 Oct;84(10):1333-5
pubmed: 19881415
Public Health. 2019 Apr;169:195-200
pubmed: 30876724
Aust Health Rev. 1995;18(3):6-17; discussion 18-29
pubmed: 10152275
Am J Public Health. 2015 Apr;105(4):670-9
pubmed: 24922130
Health Econ. 2020 Oct;29 Suppl 1:3-7
pubmed: 33146937
Health Care Manage Rev. 2018 Apr/Jun;43(2):168-180
pubmed: 27922462
N Engl J Med. 2009 Feb 26;360(9):849-52
pubmed: 19246356
Yearb Med Inform. 2007;:11-8
pubmed: 17700898
Healthc Q. 2020 Jan;22(4):1-2
pubmed: 32073383
J Patient Saf. 2010 Mar;6(1):31-7
pubmed: 22130300
Cancer. 2019 Sep 15;125(18):3100-3103
pubmed: 31154671
Aust J Rural Health. 2011 Jun;19(3):118-24
pubmed: 21605224
BMC Health Serv Res. 2009 Apr 01;9:57
pubmed: 19335920
Prim Health Care Res Dev. 2019 Oct 30;20:e139
pubmed: 31662127
Ann Ist Super Sanita. 2019 Jul-Sep;55(3):276-282
pubmed: 31553323
Med J Aust. 2009 Oct 5;191(7):387-8
pubmed: 19807630
J Palliat Med. 2003 Aug;6(4):671-83
pubmed: 14516514
Nurse Pract. 2003 Mar;28(3):40, 46-8, 51
pubmed: 12800694
CMAJ. 2007 Jul 3;177(1):51-3
pubmed: 17606940
Biometrics. 1977 Mar;33(1):159-74
pubmed: 843571
Acad Med. 2020 Jun;95(6):864-867
pubmed: 31274519
Ann Ist Super Sanita. 2019 Jul-Sep;55(3):249-250
pubmed: 31553318
BMC Med. 2020 May 4;18(1):102
pubmed: 32362273
Maturitas. 2020 Sep;139:6-11
pubmed: 32747042
Policy Polit Nurs Pract. 2011 Feb;12(1):4-17
pubmed: 21555317
Front Public Health. 2018 May 18;6:134
pubmed: 29868542
Global Health. 2016 Aug 24;12(1):49
pubmed: 27558240
Int J Qual Health Care. 2014 Jun;26(3):321-9
pubmed: 24796491
Med J Aust. 2016 May 16;204(9):351-3
pubmed: 27169969
J Pain Symptom Manage. 2017 Apr;53(4):728-737
pubmed: 28062351