Table 3 Overview and types of challenges and emerging trends for healthcare managers internationally within the included literature

Societal and system-wide (macro)

Demographic and epidemiological transitions

Population growth

[34, 47, 48, 61]

Ageing populations

[21, 47, 49, 53, 57, 61, 69]

Rise in chronic, non-communicable disease and lifestyle-related health issues

[21, 46,47,48,49,50,51,52, 56]

High disease burdens and poor health indicators

[46, 47, 51]

Growing and shifting supply and demand patterns

More patients with complex needs requiring multiple healthcare providers

[21, 46, 54, 55, 83]

Hospital capacity issues

[50, 53]

More knowledgeable and health-literate consumers

[34, 53, 54]

Higher expectations from healthcare organizations (value-for-money)

[16, 34, 43, 53, 57, 60]

Increasing dissatisfaction with healthcare system

[61]

Greater treatment affordability, increased medical tourism, growing health insurance use, rising incomes

[48]

Inequalities in access to healthcare

[51, 72]

Advances in science and technology

New Information and communication Technology (ICT) systems

[47, 48, 53, 54, 57, 69, 83]

Innovations in healthcare services and delivery (electronic medical records, telemedicine, internet-based care, hospital and ward redesign)

[47, 54, 56,57,58]

New categories or specialization of service providers

[54, 83]

Greater integration and interdisciplinary teams and collaborative healthcare practice

[54, 55]

Political and economic change

Adapting to changes in government and health sector reforms

[18, 19, 24, 28, 31, 47, 53, 54, 59, 60]

Decentralisation of healthcare

[24, 27, 35, 59, 72]

Budget constraints, measures to avoid deficits

[16, 19, 53, 60, 61]

Disconnection between population needs and resource allocation

[23, 27, 40, 47, 57, 72]

Lack of or increasing collaboration between governments, health providers, community representatives and other stakeholders to address the needs of healthcare systems

[27, 40, 49]

Shifting to patient-focused care; greater attention to community health and addressing social determinants of health

[16, 21, 28, 32, 34, 38, 53,54,55, 58]

Corporatisation and privatisation

Emergence of new business models for healthcare; Public–Private Partnership (PPP) models

[22, 48, 54, 59, 62, 63]

Move from independent health organisations to large, networked health systems

[22, 59, 62]

High or uneven demand for specialist tertiary care

[22, 49]

Growth of the private sector; competition for health professionals

[22, 34, 35, 57, 61, 62]

Increasing costs

Healthcare costs

[21, 22, 53, 61, 64, 69]

Managerial costs

[34, 64]

Costs associated with developing new programmes

[19, 47, 53]

Crises in human resources for health

Shortage of trained health personnel, out-migration of skilled health workers

[23, 25, 41, 46, 47, 50, 51, 61]

Lack of effective retention strategies and poor working conditions

[46, 80]

Challenge to maintain health services with appropriate skill mixes

[35, 46, 47, 51, 61]

Limited resources and health infrastructure and their maintenance

[46, 47, 50, 72]

Deficiencies in health information systems

[23, 25, 49]

Organisational (meso)

Human resource management challenges

Inefficiency and insufficiencies in provision of health services and use of resources; increased demands for efficiency and cost-cutting

[18, 21, 49, 53, 57, 61, 63,64,65]

Barriers to implementing lean healthcare: outsourcing hospital activities, limited knowledge of lean

[17, 21]

Inadequate planning and performance evaluation systems; poor talent identification; poor deployment and underutilization of staff

[23, 25, 28, 30, 43, 49, 69, 72, 80]

Lack of support and opportunities in management training and leadership development within organisations

[22, 26, 28, 31, 41, 42, 46, 47, 67, 82]

Poor quality of services or concerns of declining quality; poor culture regarding patient safety

[18, 33, 35, 46, 61, 69]

Changes in organisational structures and measures

Dominant hierarchical culture

[21, 22, 36, 43, 54, 63, 64, 72]

Selective recruitment into leadership positions; need for robust succession planning and management

[44, 66, 67]

Excessive bureaucracy or lack of transparency in organisational rules and processes

[21, 24, 30, 64, 67]

Inadequate systems to prevent and control healthcare associated infections (HAIs)

[53, 68]

Target-driven approach to performance measurement

[61]

Fee-for-service payment models encouraging volume not quality of care

[18, 23, 57, 61]

Value-based payment models, other new payment models

[24, 49, 62, 69, 70, 72, 83]

Intensification of front-line and middle management work

Broad responsibility; balancing clinical, teaching, research and management roles

[22, 28, 29, 42, 53, 64, 70, 81]

Long working hours, unpredictable work patterns, tight deadlines, stress and reduced productivity

[22, 29, 37, 42, 51]

Difficulties of middle-level and front-line managers to operationalise executive strategic directions and initiatives (lack of incentives, lack of support, resource constraints, conflict between organisational priorities and employees’ own goals and values)

[16, 21, 24, 26, 30, 31, 37, 42, 53, 65, 72, 81]

Informal and shared leadership in the front-line in the absence of formal management

[20]

Individual (micro)

Shifting health manager role

No universal standard definition for a health manager nor defined competency standards

[28, 59]

Lack of transparency and accountability

[24, 28, 30, 31, 67]

Increasing dual clinician and manager and leadership roles

[18, 28, 53, 63, 70, 71, 74, 75]

More physicians becoming senior healthcare managers

[39, 63, 64]

More non-physician health managers, new types of professional healthcare managers

[73, 74]