Background Public health systems internationally are under pressure to meet increasing demand for healthcare in the context of increasing financial resource constraint. There is therefore a need to maximise health outcomes achieved with public healthcare expenditure. This paper aims to establish and synthesize the contemporary evidence base for approaches taken at a system management level to improve efficiency. Methods Rapid Evidence Assessment (REA) methodology was employed. A search strategy was developed and applied (PUBMED, MEDLINE) returning 5,377 unique titles. 172 full-text articles were screened to determine relevance with 82 publications included in the final review. Data regarding country, study design, key findings and approaches to efficiency improvement were extracted and a narrative synthesis produced. Publications covering health systems from developed countries were included. Results Identified study designs included policy reviews, qualitative reviews, mixed methods reviews, systematic reviews, literature reviews, retrospective analyses, scoping reviews, narrative papers, regression analyses and opinion papers. While findings revealed no comprehensive frameworks for system-wide efficiency improvement, a range of specific centrally led improvement approaches were identified. Elements associated with success in current approaches included dedicated central functions to drive system-wide efficiency improvement, managing efficiency in tandem with quality and value, and inclusive stakeholder engagement. Conclusions The requirement for public health systems to improve efficiency is likely to continue to increase. Reactive cost-cutting measures and short-term initiatives aimed only at reducing expenditure are unlikely to deliver sustainable efficiency improvement. By providing dedicated central system-wide efficiency improvement support, public health system management entities can deliver improved financial, health service and stakeholder outcomes.
Rationale, aims and objectives Public health systems are under pressure to meet increasing demand for health care in environments of increasing financial resource constraint. There is therefore a need to maximise health outcomes given limited public healthcare expenditure. This paper aims to establish the extent of literature and approaches to efficiency improvement in public health systems of developed countries. Methods The Rapid Evidence Assessment model was used to address the review question. Two database searches returned a result of 3,526 unique titles, which were individually screened for potential relevance. 144 titles were selected for full review to determine relevance. 73 papers were included in the final review. Results Data on country, study design, key findings and links to efficiency improvement were extracted and synthesized. Synthesis of findings revealed that the literature on this topic is disparate and non-cohesive. A range of isolated approaches were described, and no evidence or consensus on a single best-practice approach to efficiency improvement was identified. Conclusions Combining the factors identified in this review has the potential to inform a framework for supporting efficiency improvement in public health systems. By considering these factors central health system management bodies can support efficiency improvement to deliver both financial and health services benefits.
Rostering is an important process to enable efficient, effective and safe delivery of health care, and one which receives little attention. The work outlined in this case study demonstrates that the analysis of rostering processes from a range of perspectives including the organisation, staff and the roster manager can identify significant opportunities for improvement. Roster governance is not universally applied, nor understood, which can result in dissonant expectations between managers and staff and a lack of transparency in how and why decisions about rostering are made. Redesigning roster processes can promote more effective governance and improve organisational efficiency.
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