Table 1 Summary of system-wide efficiency improvement approaches
From: Supporting efficiency improvement in public health systems: a rapid evidence synthesis
Strategic aim | Specific strategies identified | Source |
|---|---|---|
Centralised efficiency improvement management | Utilise peer performance benchmarking to identify and share high-performing services, models, initiatives and approaches | Allin, Grignon & Wang 2016 [1] Grimes et al. 2011 [25] Nuti et al. 2016 [25] Rumbhold et al. 2015 [23] White, 2015 [26] Alatawi, Niessen & Khan 2020 [27] |
Establish service level agreements and performance targets to set expectations and delivery accountabilities | Anderson & Catchlove 2012 [28] Christiansen & Vrangbaek 2018 [29] Zhang, Tone & Lu 2018 [30] | |
Sponsor efficiency practice networks for system-wide collaboration and knowledge-sharing | Auerbach et al. 2014 [31] | |
Provide financial incentives for adoption of efficient practices | Bradford et al. 2016 [32] Elshaug et al. 2017 [33] | |
Establish system-wide policy guidance on which practices are most efficient and which lower-value practices should be replaced | Elshaug et al. 2017 [33] Garcia-Armesto, Campillo-Artero & Bernal-Delgado 2013 | |
Establish best practice guidance for financial and management decision-makers on resource allocation and reallocation | Elshaug et al. 2017 [33] Harris et al. 2017 [34] | |
Establish a centralised efficiency improvement unit to support system-wide improvement processes | Hassanian, 2017 [2] Lavoie-Tremblay et al. 2012 [35] | |
Address reducing duplication and maximising asset utilisation at a whole-of-system level | Pencheon, 2015 [36] Tsai et al. 2017 [37] | |
Ensure timely, transparent performance reporting for improvement initiatives | Tataw, 2014 [38] Alatawi, Niessen & Khan 2020 [27] | |
Concurrently improving efficiency, quality and value | Establish system-wide policy for balancing expenditure, quality and value | Akinleye et al. 2019 [39] |
Integrate financial, workforce and clinical service data to model improvement impact | Birch et al. 2015 [40] | |
Systematically identify and address health service overuse/underuse | Ellen et al. 2018 [6] Elshaug et al. 2017 [33] Kumar 2011 [41] | |
Partner with primary care services to enable early intervention | Fiorentini et al. 2011 [42] Gaertner, Maier & Radbruch 2015 [43] | |
Determine a sufficient time period within which efficiency improvement initiatives can be delivered and realised | Hebert et al. 2014 [44] Schakel, Wu & Jeurissen 2018 [45] | |
Weigh costs of innovation with potential efficiency and value generated | Mussap, 2014 [46] | |
Engaging stakeholders in efficiency improvement | Include frontline staff and managers in designing efficiency improvement initiatives | Ashton, Bramley & Armstrong 2012 [47] De Rosis & Nuti 2018 [48] Elshaug et al. 2017 [33] |
Leverage evidence of combined cost and patient outcome improvements to promote stakeholder acceptance of efficiency approaches | Gans et al. 2012 [49] Murphy et al. 2016 [50] | |
Link frontline staff performance goals with organisational improvement goals | Kämäräinen et al. 2016 [51] | |
Continue to engage with improvement initiative stakeholders following implementation to promote improvement longevity | Lennox, Maher & Reed 2018 [52] | |
Establish clear and transparent improvement targets at the health service level | Nuti et al. 2016 [53] Moberg & Fredrikkson 2020 [54] Christiansen & Vrangbaek 2018 | |
Tailor resource allocation and service optimisation messaging to promote frontline clinician and management engagement | Moberg & Fredriksson 2020 [54] Harris et al. 2017 [34] Wolfenden et al. 2019 [55] |