Table 3 Overview and types of challenges and emerging trends for healthcare managers internationally within the included literature
From: Priorities and challenges for health leadership and workforce management globally: a rapid review
| Level | Challenge or emerging trend | Aspects of the challenge or emerging trend | References |
|---|---|---|---|
| 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] |