Implications and application
The current public health system climate is one of increasing demand and
tightening resourcing, yet the vast majority of project-level
sustainability approaches in healthcare do not include a cost-related
definition of sustainability(44). System-level
responses to the challenge presented by the increasing need for
efficiency are often reactive, involving short-term actions such as
reducing funding rates, setting short-term targets, reducing services
and delaying non-essential activities(74). Such
approaches are unlikely to result in sustainable improvements and are
also likely to impact capacity for investment, capability development
and innovation aimed at improving both quality and
efficiency(79). Continuing with such approaches is
unlikely to meet current and future sustainability
pressures(7).
This study presents a synthesized view of current evidence relevant to
efficiency improvement in public health systems. While studies aimed at
improving efficiency were widespread, no single comprehensive frameworks
were identified in this review. This paper addresses the gap in the
literature in this space by outlining the range of current
evidence-based factors and strategies associated with supporting
efficiency improvement in public health systems. Evidence is also
presented which supports tandem improvements in financial efficiency and
health service outcomes. Public health systems in developed countries
may find guidance in this study on which efficiency improvement
approaches are linked with success. The findings of this study may also
be used to guide reflection on current practice in order to identify
approaches in place as well as potentially-successful approaches not
currently in place for the purpose of validating and augmenting
efficiency improvement practices.